3 Metrics and Analytics Division Mission and Functions
4 Division MissionProvide timely and accurate reporting and analyses for decision makers in support of the overall goals and objectives of the PA Department of Aging and Office of Long Term Living. Administer the Social Assistance Management System (SAMS) and Omnia in support of the Aging Network to assure data integrity for Aging and NHT Programs and Operations.
5 Division FunctionsProvide cost and effectiveness analyses of current programs, proposed modifications to current programs and new programsProvide census and demographic data support for PDA/OLTLPrepare or assist program offices in preparation of mandatory state and federal reports e.g. CMS 372 Reports, NAPIS ReportSupport QM with samples, surveys and reports for annual assurancesSupport QM in the design, implementation, administration and use of QMMU Monitoring Database
6 Division Functions (cont’d) Prepare Benchmarking reports and Dashboards to support ongoing evaluations of AAA’s, Providers and Waiver Program operations and Aging ProgramsProvide Administration, Technical and User Support for SAMS and OmniaDevelop, prepare and publish procedures for implementation of new programs and policies in SAMSPrepare and conduct training for SAMS and Omnia users – On-site, Webinars, etc.Design and implement new Assessment Forms, modify existing forms as required
7 Division Functions (cont’d) Represent PDA/OLTL needs and interests regarding Information Technology issuesTest and evaluate new versions of SAMS, Omnia and HCSISTest and evaluate SAMS, Omnia, and DPW Enterprise Data Warehouses for data integritySurvey design and analysis supportProvide technical database and report creation support for PDA/OLTL BureausDevelop an integrated Incident, Complaint, Hearings and Appeals Database and Reporting System
8 Management ReportsPerformance Reports - Consumers served, units delivered, dollars expended, etcDemographic Reports – Consumer and provider characteristicsScorecard – Measures compared to established targetsOutcomes Analyses – What you got for what you spentPDA/OLTL Custom Reports System – Library of reports for service models utilizing SAMS and OmniaEDW Reports - Library of reports for service models utilizing HCSIS
9 Quality Management, Metrics and Analytics Data Collectionand Reporting Section
10 ObjectiveProvide the OLTL Network with Training, Technical Assistance and Resource Material to enhance the skills of 2,000 plus SAMS/OMNIA Users in order to promote quality and accurate data entry
11 SAMS/OMNIATwo separate Databases. OMNIA serve as the repository for assessments and SAMS serves as the repository for demographics, service programs and service delivery information.Each case record within the databases are automated clinical records.
12 The OLTL Network Assessors Care Managers/Service Coordinators Protective Service WorkersSAMS AdministratorsNetwork SupervisorsNetwork AdministratorsOver and Under 60 NHT Transition Coordinators
13 Resources Provided to the Network WebinarsTraining ManualsVideosDashboardsAd Hoc Requests
14 Where the Resource Material is Located Unsecured FTP Site for access by the AAA NetworkAllshare Drive (S:) Drive for access by PDA and OLTL staffOLTL Website
16 Current Monitoring Status The QMET has completed all monitoring visits of HCBS providers to date (328). In addition to waiver provider visits QMET has completed:Abbreviated On-Site Monitoring Visits36 F/EA On-Site Reviews100 follow up visits150 StIPSRemaining Standards Implementation Plans are being completed and approved with follow up of plans being scheduled
17 What is QMET looking at?The current services agencies are providing to consumers against the standards outlined in the Waiver Reference Guide.The F/EA standards as currently approvedQMET is only reviewing Waiver programs for standards that are listed in the waiver for the services the provider actually provide to consumersThe FEA standards finalized on 12/17/08. Available on QMET website.
18 Where are the QMETs finding? Overall compliance with the waiver program standards is excellent.Most commonly missed standards areDistributing hotline number to consumersIncident reporting was inconsistent with waiver requirementsBilling/ Bookkeeping ErrorsDocumentation
19 What’s Next for the QMETs? Review of the waiver monitoring tool and provider letterContinue scheduling of on-site monitoringsFollow up of Corrective Action Plans (StIPS)Clarify how providers are expected to monitoring their subcontractorsNow that the QMET has had the opportunity to work with the tool in the field, we want to rephrase some of the questions so they are more logical and more precise. We also recognize the information requested in the initial letter was not as precise as it could be. We are working to make ourselves clearer. (The lists we request of providers were not worded in a way that we were getting the information that we wanted, so we are trying to get the language right. Currently, when the information is not what we need, we call providers and work out the details so we get what we need). Any changes willProviders will continue to receive a 30 day notice prior to our visit. A thanks to all providers for working so closely with us as we ask for information prior to our arrival. By providing timely and accurate information, our visits have been smooth and efficient.QMET recognizes that AAAs and under 60 providers need more clarification on what is expected of them in regards to agencies they subcontract with. We are working on information and training materials for AAAs and under 60 providers that clearly explain the waiver requirements as to what subcontractors need to meet and who is monitoring those subcontractors to ensure they meet CMS expectations as waiver providers.
20 QMET ResourcesThe Waiver Reference Guide and FEA standards can be found atOrType “QMET Resources” into your favorite search engineQMET protocols also found on website.
22 Level of CareBased on the review of the data from the past 24 months on the Level of Care performance measures the following changes are being submitted to CMS in the required 372 documents regarding remediation:The level of care performance measure reports have been run and the data aggregated over the first 6 months of the calendar year. We have also begun to obtain our first round of non-compliance details information for review.
23 Level of Care Next Steps The performance measure for sub-assurance a.i.c is being clarified to more accurately reflect the information being tracked and trended.The frequency of the reports being run for sub-assurance a.i.a is being changed to every 8 weeks.Remediation is being clarified to more accurately reflect current OLTL process.
24 What Does this Mean to You? As a participant, advocate or stakeholderAs a Provider of enrollment, level of care assessment or supports coordination/care managementOLTLThe changes in the performance measures and timing should not have any impact on consumers.The changes mean that providers will no longer be sent or required to complete a Standards Implementation Plan for each month that you receive a non-compliance notice per reportMonitoring activities by the QMET’s will include information provided on the individual providers performance with the level of care sub-assurances.Bureau of Individual Supports will be provided information on non-compliance
26 Service Plan Assurance QMMA and BIS implemented the standardized Individual Service Plan in October 2010Training on the new forms and processes were completed prior to implementation and remain on going as neededMailing/analysis of consumer satisfaction surveys has started.Through the recent Aging and Attendant Care Waiver renewals and work plans, the Service Assurance has many enhancements planned to standardize the way service plans are developed and reviewed. When the work plan steps are completed, the data needed for the service plan performance measures regarding service plan development and review can be obtained.
27 What does this mean to you?…. Service PlansProviders and OLTL staff can expect training on new forms and processes for service plans to be on going as neededParticipants can expect consistent forms and processes will be used across the stateOLtL staff
28 Satisfaction Surveys One Survey for all Waivers Reduce Mailings and Participant IntrusionGather Similar Facts on each Waiver
29 On Going Survey ReviewReview of survey questions wording for understandingAdd questions based on need for more informationResults are one component for determining that all participant needs are met and services are received
30 Mailings will be every 4 months Mailing Cycles for Satisfaction Surveys (New Participants / Ongoing Participants)Mailings will be every 4 monthsEvery 4 months waiver participants who enrolled in that time period will receive a surveyEvery 6 months participants who have received HCBS waiver services for over one year will receive an Annual survey
31 Participant Satisfaction Surveys New questions will be added to surveys for Health and Welfare Assurance as needed to gather appropriate information. Such as:“I know how to report abuse, neglect, or exploitation including the use of restraints and other restrictions.”Possible answers are Yes, No, I don’t understand, & N/A
32 What does this mean for you?…. SurveysQMU staff will answer questions about the survey and analyze responsesProviders may receive questions about the surveysRefer questions to Helpline ( )Participants may receive a survey in the mailComplete survey & return in postage paid envelopeContact Helpline if have questions ( )OLtL staff
34 Health & Welfare Assurance Update Operational FunctionsIncident Data for All Waivers available for OLTL useQuality Assurance HelplineQuality Assurance Helpline DatabaseClarification and revision of Performance MeasuresCan Track and trend aggregated data for Incidents (Aging only) & ComplaintsHelpline – Intake for complaintsRewording of PMs and elimination of one PM
35 HW ~ OLTL Helpline Numbers General Information – 1 (866)Information on OLTL programsEnrolled Participants – 1(800)Concerns/complaints with Home and Community Based servicesProvider Assistance – 1 (800)Billing inquiries, issues, claims processingParticipants are encouraged to work with their provider and or service coordinator - First level of complaints should be addressed with provider and Service Coordinator. If not able to resolve then call the helpline.
36 What does this mean to you?.... Providers document incidents and may be contacted for additional information during the investigation of complaints and incidents. Remediation actions may be required of providers.OLTL staff document and research complaints and incidents, including documentation of the resolution.Participants or their representative's use the 800 line to report complaints and issues they are unable to resolve at the local level. Participants may be contacted to discuss complaints or incidents.Final OLTL Incident policy under developmentComplaints & Incidents
38 Financial Accountability Assurance Paid Claims Review reportNo claims paying with incorrect procedure codesBureau of Provider Support developing internal protocols for remediation which can include recoupmentThe Bureau of Provider Support is processing a paid claim review report, which compares paid claim against allowable procedure codes. The report is analyzed and sent to QMU for our PM tracking and trending.
39 Financial Accountability Assurance Quality Management and Efficiency Teams (QMET) Provider Claims ReviewProbe sampling of claimsAll Provider reviews completed, those out of compliance are correcting issues via a Standards Implementation Plan, (StIP).
40 What does this mean for you?…. Provider, OLTL BPS staff and BFO staff notified if billing errors discovered through financial report or QMET reviewCorrection(s) initiated for identified issues and to prevent reoccurenceParticipants responsible for correct authorization of time sheets
42 Administrative Authority Assurance As reported by the QMEU30 Policies or Directives have been initiated since 01/01/2009, including:Interim Incident Management Procedures for the Aging Waiver (APD )Nursing Facility Clinically Eligible (NFCE) Clarification (APD )PDA Contract Procurement Requirements for Area Agencies on Aging (APD )Provider Rates for Services funded through the OBRA, Independence, and COMMCARE Waivers (various #s)First bullet refers to - One of the PMs for AA refers to the QMET monitoring which you heard about previouslyProvider rates policy is one policy with various #s
43 What does this mean for you?….. Providers and all OLTL staff need to obtain, review and implement policies as applicable.Participants need to be aware that new policies may be issued at any time impacting the waiver and their services.
45 Quality Improvement QMU monitors waiver basics EnrollmentLength of time for enrollmentLength of time for start of servicesWill continue to add new focus areasQMU will continue to monitor some performance measures after they are replacedQMU beginning to go beyond the CMS mandated assurances to monitor other quality focus areas such as access, participant rights and responsibilities, etc.When some PMs appear to lose relevance – i.e. no problems or issues are ever found – they may be replaced but will still be monitored
46 QIS Enhancements QIS expected to change Changes to quality sections of approved 1915(c) waiver applicationsListed on annual CMS 372 reportsDeletion of 2 performance measuresAA – % new policy monitored and remediated by non state entitiesHW – # providers who fail to report incidentsCMS expects quality improvement strategies to change – it is part of the nature of the strategy that you continually review and assess the efficiency and quality (are you getting the results you want?) and make changes for improvement.OLTL has changed many of the performance measures that were approved in the recent Aging and ACW renewals.
47 OLTL Quality CouncilFirst meeting was an orientation meeting held in June 2009First official meeting was held in August 2009Comprised of Participants, Participants Family Members, Provider Agencies, AAA’s, Aging Community Representatives, OLTL Staff
48 Quality CouncilMeetings since have been held quarterly in the months of February, May, August, and November.Minutes and information are posted on the website.
49 What does this mean for you?….. Providers and OLTL staff may notice new reports, remediation and system improvement efforts that are not strictly related to the CMS AssurancesParticipants may experience increased quality of services and service delivery due to remediation and system improvementsEveryone can follow the Quality Council activities on the website.