1. STATE OF NORTH DAKOTA Assessment / Standard Fee Schedule Design Project for People with Developmental Disabilities Quality Indicator Selection Steering Committee Meeting April 5 th, 2012

2. Why focus on Quality? You get what you measure.

3. Why Quality in a Rate-Related Project? RATE PROJECT-SPECIFIC GOALS Ensure the objective monitoring of impact of changes on quality of services (avoid unintended consequences) Build rate model to adequately incentivize and reward high quality services Ensure objective monitoring of quality of new processes emerging from the rate methodology

4. Why Quality Indicators in General? CMS is increasingly requiring it for all Medicaid services including HCBS programs (Quality Framework) Newer Medicaid program models incorporate pay-for- quality clauses Provide support to providers in fulfilling their mission and allow differentiation based on quality Seek to ensure quality of services purchased Enhance quality of life and health for individuals served

5. Proposed JVGA-Potentia Quality Tasks Task 1: Initial Information Gathering Task 2: Sharing of Best Practices (indicators, data collection methods and data tracking systems) Task 3: Compilation of a Final List of Select Outcomes/Performance Indicators. Task 4: Identification of Optimal Data Collection and Measurement Methods. Task 5: Testing of Indicator Measurement Process and Output.

6. Core Quality Management Principles Collaborative Consensus-Based Process Meaningful and Measurable Indicators Clear Indicator Definitions Comprehensive Data Collection Method Sound Data Analytics Process Thorough Testing through Baseline Analysis

7. Potential Domains of Quality DomainPriority LevelPriority Score Health and WellbeingHigh4 DignityModerate Structure (Infrastructure, staffing, etc)High1 Interpersonal RelationshipsModerate RightsModerate Integration and InclusionHigh2 Respect for Cultural and Linguistic Differences Moderate Safety (linked to Health & Wellbeing)High3 Self DeterminationHigh5 ProcessHigh6 * Priority Levels - High, Moderate, Low ** Priority Score - Score Each Domain from 1 upwards, with one being the highest priority

8. Criteria for Quality Indicator Selection CriteriaFocus Area Deals with an area of critical importance with regard to the services to persons with disabilities impacted by the new assessment process Relevance Reflects the use (or not) of credible “best practices” in the relevant domain or area being evaluated Impactable Can be captured in a timely manner through available data sources or through existing data collection processes in place Easy Data Capture Can be clearly defined based on a standard definition that is well accepted nationally or regionally Measurable Will have results that can be evaluated as either better or worse than other results, in contrast to descriptive information that shows how results may be different from each other. Objectivity Reveals significant actual or potential differences in results across different environments or scenarios Impactable Addresses specific and relevant quality concerns of the Committee and the provider community and consumers at large Relevance

9. QI Informational Sources Agency for Healthcare Research and Quality (AHRQ): Developing Quality of Care Measures for People with Disabilities: Summary of Expert Meeting, September 2010 http://www.ahrq.gov/populations/devqmdis/devqmdis.pdf http://www.ahrq.gov/populations/devqmdis/devqmdis.pdf Agency for Healthcare Research and Quality (AHRQ) https://www.talkingquality.ahrq.gov/default.aspx https://www.talkingquality.ahrq.gov/default.aspx Council on Quality and Leadership: http://www.c-q- l.org/personaloutcomemeasuresindex.aspxhttp://www.c-q- l.org/personaloutcomemeasuresindex.aspx National Core Indicators Project: http://www2.hsri.org/nci/http://www2.hsri.org/nci/ Center for Health Systems Research and CMS Developmental Disability Quality Indicator Project ; http://www.chsra.wisc.edu/chsra/projects/completed/quality/icfmr.htmhttp://www.chsra.wisc.edu/chsra/projects/completed/quality/icfmr.htm AHRQ Appendix III: Compendium of Measures and Tools Identified Through the Medicaid Home and Community-Based Services Measure Scan as of July 5, 2007 http://www.ahrq.gov/research/ltc/hcbsreport/hcbsapiii.htm#Contents http://www.ahrq.gov/research/ltc/hcbsreport/hcbsapiii.htm#Contents CMS Update on HCBS Quality Focus: http://www.reinventingquality.org/docs/AYuskauskas10.pdf http://www.reinventingquality.org/docs/AYuskauskas10.pdf

10. Review of Sample Quality Indicators Review Sample Indicator Document

11. Quality Indicator Evaluation REVIEWER’S INDICATOR CHECKLIST: For each statement, please circle ONLY 1 level of agreement. Based on information available for this area of evaluation, this indicator … Fully Disagree Fully Agree 1 Deals with an area of critical importance with regard to the services to persons with disabilities impacted by the new assessment process 1234 2 Reflects the use (or not) of credible “best practices” in the relevant domain or area being evaluated 1234 3 Can be captured in a timely manner through available data sources or through existing data collection processes in place 1234 4 Can be clearly defined based on a standard definition that is well accepted nationally or regionally 1234 5 Will have results that can be evaluated as either better or worse than other results, in contrast to descriptive information that shows how results may be different from each other. 1234 6 Reveals significant actual or potential differences in results across different environments or scenarios 1234 7 Addresses specific and relevant quality concerns of the Committee and the provider community and consumers at large 1234 TOTAL SCORE:

12. Next Steps Complete Review and Scoring of Quality Indicators – May 2012 Finalize Indicators with Definitions – June 2012 Finalize Data Capture Methodology – September 2012 Baseline Quality Assessment – December 2012