1. Quality Improvement Strategy

2. Context for the Focus on Quality
Began with the growth & expansion of HCBS waiver programs
Growth in expenditures
Growth in people served
Growth in consumer direction
Self Direction presents challenges for assuring quality

3. CMS approach to Quality
A quality management data driven model with continuous over-sight
Quality elements are designed into the program
Each state has a quality strategy to continually evaluate it’s own performance, to correct deficiencies and make system improvements….which will tell us if
assurances are met
outcomes are achieved
people are satisfied
CMS reviews the effectiveness of the state’s Quality Management Strategy

4. CMS Quality Framework

5. Quality Framework Focus Areas
Participant Access
Information and referral; intake and eligibility determination;
referral; choice
Participant Service Planning
Assessment; service plan, implementation & monitoring; respond to
changing needs; choice; participant direction
Provider Capacity
Licensure and certification; training; provider monitoring
Participant Safeguards
Incident management; risk assessment; behavior
management; med administration; natural disasters
Rights and Responsibilities
Due process; grievance procedures
Outcomes and Satisfaction
System Performance
Quality Improvement program; financial management

6. Quality Framework Processes
Design… build quality in up front
Discovery… look for problems & opportunities
for improvement
Remediation… fix problems
Improvement… make improvements

7. Community First Choice
Establish & maintain a quality assurance system
Incorporate feedback
Monitor the health and well-being of each individual
Provide information about the provisions of quality assurance
Requirements of CFCO regulations

8. Community First Choice
CMS Quality Framework
Build upon existing structure
Develop Quality Outcomes
Consumer Satisfaction