TEXAS DSHS HIV Care services group Ryan white part b Quality Monitoring review project for the mai program 2019 Germane Solutions 5/22/2019

introductions The Care Services Group will conduct program monitoring for year 2019 with the assistance of Germane Solutions (GS). The Germane review team for MAI programs will consist of: Rhonda Stewart, Director of Quality Improvement Jordan McCown, Senior Consultant Blake Kolb, Consultant For the purpose of MAI programs, at least 2 reviewers will be onsite at each individual provider review. Pamela Nims, DSHS Consultant, will attend each site review as well. Germane Solutions 5/22/2019

What is an Objective Review? An objective review “is a process that involves the thorough and consistent examination of applications based on an unbiased evaluation of scientific or technical merits or other relevant aspects of the review”. Review of administrative policies Review of client charts for adherence to the service categories standards of care outlined by the Texas Department of State Health Services Germane Solutions 5/22/2019

Why are we monitoring? Annual requirement for all Ryan White federal funded programs Determine provider compliance with the standards of care Determine quality improvement opportunities that will enhance compliance and improve the client system of care Germane Solutions 5/22/2019

service STANDARDS Twenty-four (24) DSHS Service Standards were revised and updated in 2017 to include the new service definitions in accordance with HRSA PCN 16-02. Four (4) DSHS Service Standards were revised and updated in 2018. HRSA PCN 16-02 was also updated in October 2018. DSHS has continued to revise the monitoring tools as changes have been made. The updated Monitoring Tools in Excel format will be posted to the DSHS HIV/STD website by January 30, 2019. Germane Solutions 5/22/2019

Quality Assurance monitoring As done in 2018, individual service providers will be monitored as per the 2019 DSHS RW monitoring plan. The DSHS HIV Care Services Group monitoring tools will be used by the review team for each of the service categories. Review of clinical and non-clinical charts will provide the information necessary to monitor for each indicator (measure). Germane Solutions 5/22/2019

PREPARATION FOR SITE VISIT Direct care service providers are required to be familiar with the content of the monitoring tools on the DSHS website for each service category funded under Part B and State Services. Look at the DSHS monitoring tools alongside the respective DSHS Service Standards to understand numerators/denominators that determine the outcome for the indicators listed in “performance measures”. If you have any questions regarding the content of the monitoring tools, please reach out to your local MAI Coordinator for clarification. Copies of the updated Monitoring Tools will be available on the DSHS website https://www.dshs.texas.gov/hivstd/taxonomy Germane Solutions 5/22/2019

PREPARATION FOR SITE VISIT The following service categories will be reviewed by the DSHS contracted review team: Categories To Be Reviewed by the DSHS Contracted Review Team in 2019 Universal Standards (US) Health Education/Risk Reduction (HE/RR) Outreach Services Emergency Financial Assistance (EFA) Medical Transportation (MT) Germane Solutions 5/22/2019

PREPARATION FOR SITE VISIT Reviewers will need several items in order to complete the review. Direct care service providers are required to have the following items prepared to be presented at the start of the entrance conference: Note: For 2019 monitoring, all providers will be asked to submit Policy/Procedure and HR items electronically one (1) week prior to the site review. PREPARATION CHECKLIST List of all service categories funded under Part B and State Services, specifically under MAI Personnel files for all personnel funded under Part B and State Services, to include completed trainings – for MAI services specifically All policies and procedures Computer and EHR access if electronic records are to be reviewed MOUs and contracts; Paper files as appropriate Employee manual ARIES ID to Local Medical Record Number Crosswalk Germane Solutions 5/22/2019

Chart sampling for monitoring Tier Sampling (Same Tier system used for last year’s hopwa monitoring) Confidence interval Sampling DSHS will continue to use the 80% confidence level with a +/-8% confidence interval level methodology for: Universal Standards The HOPWA tier system methodology will be used for: EFA HE/RR Outreach Germane Solutions 5/22/2019

Sample Lists A random sample client list with unique ARIES identifiers will be supplied to the direct care service providers two weeks prior to the scheduled visit. Germane Solutions 5/22/2019

The REVIEW PERIOD The measurement year to be reviewed will be the most recently completed 12-month period for all providers. Example: If a review is scheduled to begin on May 15, 2019, the review period will be May 1, 2018 - April 30, 2019. MAI will also be reviewed as the most recently reviewed twelve month period. Germane Solutions 5/22/2019

The process Site visit letters detailing the required documentation needed onsite for the review will be sent to your agency prior to the scheduled day of your site review. If any service category uses ARIES as the primary record and will require a desktop review, please notify DSHS and the GS team no later than February 8, 2019. Site visits will begin with the 30-minute entrance conference with key staff chosen by the service provider, DSHS Staff (where available), and the GS team. A review of policies and procedures specific to the Universal Standards will be completed for new indicators, any indicators that were below 100% in the 2018 monitoring year, and CAPs will be reviewed for completeness. Quality monitoring will consist of clinical chart reviews based on the indicators (measures) outlined in each monitoring tool for the applicable service categories. Germane Solutions 5/22/2019

The process continued… At the end of the site review, an Exit Conference will be conducted with key staff members, DSHS Staff, and the GS team. The Universal Standards draft reports and the quality monitoring draft reports will be provided to the DSHS HIV Care Services Group within two weeks of an individual provider’s completed site review. These reports will provide the outcomes for each measure within the service categories monitored at your respective site. Upon approval of the Quality Monitoring draft report, the providers will receive their copies with the outcomes and any recommendations for improvement processes as indicated. Germane Solutions 5/22/2019

The process finalized Universal Standards – Program items should already be in place. If there are deficient items, a corrective action plan will be required. Plan-Do-Study-Act (PDSA) and Corrective Action Plans (CAPs) will be discussed during the exit interview and will be included in the provider monitoring reports where applicable. Any PDSAs and CAPs currently in place from the 2018 monitoring project should continue as a work-in-progress until completed and approved by DSHS. Any additional findings from the 2019 monitoring should be added to current PDSAs and CAPs to ensure all deficiencies are being addressed. Germane Solutions 5/22/2019

CAP/PDSA Expectations Service Category CAP/PDSA Expectations Universal Standards CAPs required for all indicators below 100% * For eligibility indicators below 100%, a CAP is required, and 90-day submissions, showing results of 10 chart pulls per every 30 days (This process must continue until eligibility indicator reaches 100%). HE/RR 2-3 PDSAs required for each service category for any indicator(s) at or below 50% (HRSA/HAB measures need to be prioritized). EFA, Outreach, Medical Transportation 1 CAP required per service category for any indicator at or below 50%. Germane Solutions 5/22/2019

Closing remarks The review team will continue to work diligently to ensure a smooth process for all Providers. The monitoring outcomes will be presented as an aggregate report to the DSHS HIV Care Services Group at the end of the project period. Germane Solutions 5/22/2019