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INFORMATION SOLUTIONS The National Quality Contractor Technical Assistance to State HCBS Waivers Beth Jackson, Ph.D. 617-492-9326.

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Presentation on theme: "INFORMATION SOLUTIONS The National Quality Contractor Technical Assistance to State HCBS Waivers Beth Jackson, Ph.D. 617-492-9326."— Presentation transcript:

1 INFORMATION SOLUTIONS The National Quality Contractor Technical Assistance to State HCBS Waivers Beth Jackson, Ph.D

2 Copyright 2005 Thomson Medstat 2 INFORMATION SOLUTIONS NQC Technical Assistance Funded by CMS since 2001 Free to States Access Directly through NQC or CMS (Regional or Central Office Staff) Medstat: TA to Waivers for Aged/Disabled and Medicaid Agencies HSRI: TA to MR/DD Waivers Operating and/or Medicaid Agencies May Request TA

3 Copyright 2005 Thomson Medstat 3 INFORMATION SOLUTIONS Types of TA Available Developing Appendix H for a 1915c Application or Renewal –Including Waivers That Integrate the Self-Direction Option Guidance in Responding to a CMS Request for Evidence –Issued by CMS Approximately18 Months Prior to Expiration Assessing Strengths and Gaps of a Waiver’s Quality Management System Developing Medicaid Agency Administrative Oversight Strategies Crafting Specific Quality Management Strategies, e.g., –Incident Management Reporting and Tracking –Risk Management –Provider Performance –Participant Feedback Surveys Develop Products and Resources for States (see CMS website) –Risk Management –Sampling –Independent Providers –Participant Experience Survey

4 Copyright 2005 Thomson Medstat 4 INFORMATION SOLUTIONS States Receiving Technical Assistance National Quality Contract

5 Copyright 2005 Thomson Medstat 5 INFORMATION SOLUTIONS NQC’s Experience Since States 100 Waiver Programs 64 Aged/Disabled Waivers 36 MR/DD Waivers All regions of the country represented

6 Copyright 2005 Thomson Medstat 6 INFORMATION SOLUTIONS Trends in Waiver Quality Most waivers have some processes in place for quality assurance Many do not have processes to address all of the assurance components Many do not have ability to capture evidence regarding whether their system is working –as designed –as described in their waiver application –in accordance with the waiver assurance components Without this evidence, States do not have the ability to generate system outcome indicators And thus, States have difficulty –evaluating the quality in their programs –demonstrating to CMS that they are meeting the assurances

7 Copyright 2005 Thomson Medstat 7 INFORMATION SOLUTIONS Example: Service Plan Assurance Component Assurance: Service Plan 6 Components of Service Plan Assurance that must be addressed One of these is: “Services are delivered in accordance with the service plan, including type, scope, duration and frequency specified in the service plan.” The Quality Management Strategy must describe how the state will monitor this component … –that is, how will the state know that program participants receive the services/supports included in their service plan?

8 Copyright 2005 Thomson Medstat 8 INFORMATION SOLUTIONS Service Plan Assurance Component, con’t WHO monitors whether program participants receive what they should? –What entities within state government, and/or non-state entities are responsible for this monitoring? FMS agency? State Regional Office? Waiver QM Unit? Medicaid QM unit? HOW is this done? What is the DISCOVERY process(es)? What is the methodology? –Comparison of Service Plan with paid claims? Consumer survey Participant record reviews? 100% review? Less than 100% review? What is the sample? Is it representative of the entire waiver population? What are your sampling parameters? –Complaint Tracking System? –Incident Management Reporting and Tracking System?

9 Copyright 2005 Thomson Medstat 9 INFORMATION SOLUTIONS Service Plan Assurance Component, con’t What do you measure? What are your indicators? What kinds of reports are generated (aggregating information across participants)? How frequently do you measure this? WHO is responsible for reviewing the results? HOW is information used to make improvement?

10 Copyright 2005 Thomson Medstat 10 INFORMATION SOLUTIONS Example: Health & Welfare Component Assurance: Health & Welfare 2 Components of the Health & Welfare Assurance that must be addressed One of these is: “There is continuous monitoring of the health and welfare of waiver participants and remediation actions are initiated when appropriate” The Quality Management Strategy must describe how the state will examine whether participant monitoring for health and welfare is occurring as specified in the waiver application? –that is, how will the state know that program participants’ health and welfare is being monitored?

11 Copyright 2005 Thomson Medstat 11 INFORMATION SOLUTIONS Health & Welfare Component, con’t WHO examines whether program participants are monitored for their health/welfare? What entities within state government, and/or non-state entities are responsible for this monitoring? FMS agency? Case Management Supervisors? State Regional Office? Waiver QM Unit? Medicaid QM unit? HOW is this done? What is the DISCOVERY process(es)? What is the methodology? –Chart audit? 100% review? Less than 100% review? What is the sample? Is it representative of the entire waiver population? What are your sampling parameters? –Complaint Tracking System? –Incident Management Reporting and Tracking System?

12 Copyright 2005 Thomson Medstat 12 INFORMATION SOLUTIONS Health & Welfare Component, con’t What do you measure? What are your indicators? What kinds of reports are generated (aggregating information across participants)? How frequently do you measure this? WHO is responsible for reviewing the results? HOW is information used to make improvement?


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