1. 7/16/20151 Quality Assurance Overview

2. 7/16/20152 Quality Assurance System Overview FY 04/05- new Quality Assurance tools implemented  included CMS Quality Framework and expectations FY 05/06- revisions to Quality Assurance tools  deletion / addition of some QA Indicators and reorganization of some Outcomes,  scoring revision,  modification of performance levels 06/07 - 2015- minimal changes to the Quality Assurance tools  Continuing to compare data / performance across extended periods of time

3. 7/16/20153 Impact of Quality Assurance Data Provides an overview of system performance Viewed and utilized by a wide audience  Data utilized by DIDD Central Office,  Regional Offices,  Quality Management Committees,  court monitors Facilitates change throughout the service delivery system and decision making  Data is used in assessing progress and to identify areas needing corrective intervention Special Reporting  Focused review of Domains, Outcomes and Indicators  Review of provider performance by provider- type and regionally  Comparison of performance across years

4. 7/16/20154 Quality Assurance System Overview Quality Assurance Survey Process:  Consultative Reviews  Annual Review except for some clinical providers and those providers achieving 3 or 4 Star status  Sample Selection  Notification / document request  On-site review  Conciliation process  Report of findings  Reporting through Regional and Statewide Quality Management Committees  Quality Improvement Planning

5. 7/16/20155 Quality Assurance System Overview Quality Assurance Tools:  Organizational: Day-Residential / Personal Assistance / Clinical Independent Support Coordination (organizational practices & utilizing data from waiver Individual Record Reviews)  Individual: Day-Residential Personal Assistance Behavioral Nursing Therapy  Performance Levels: Exceptional Performance Proficient Fair Significant Concerns Serious Deficiencies

6. 7/16/20156 Quality Assurance System Overview Quality Assurance Tool Structure:  Domains- scored as either Substantial Compliance, Partial Compliance, Minimal Compliance or Non-compliance 1. Access and Eligibility 2. Individual Planning and Implementation 3. Safety and Security 4. Rights, Respect and Dignity 5. Health 6. Choice and Decision Making 7. Relationships and Community Membership 8. Opportunities for Work 9. Provider Capabilities and Qualifications 10. Administrative Authority and Financial Accountability  Outcomes- scored as either Substantial Compliance, Partial Compliance, Minimal Compliance or Non-compliance  Indicators- scored as either Yes, No or NA Guidance and Provider Manual References

7. 7/16/20157

8. 8 Quality Assurance System Overview Quality Assurance Scoring & Domain Applicability:  Domains Applicable by Provider Type: Day-Residential: 2, 3, 4, 5, 6, 7, 8, 9, 10 Personal Assistance: 2, 3, 4, 5, 6, 9, 10 Support Coordination: 1, 2, 3, 9, 10 Behavioral: 2, 3, 4, 6, 9, 10 Nursing: 2, 3, 4, 5, 6, 9, 10 Therapy: 2, 3, 4, 6, 9, 10  On the web: QA and Waiver Review Tools Report Card Listing Star Listing & Criteria Resource / Reference Documents

9. 7/16/20159 Star Providers- 2, 3 & 4 Star Awards 4-Star Status:  96% (Exceptional) or above compliance on QA surveys for 2 years; All Domains scoring at least Partial Compliance Must achieve Substantial Compliance in Domain 3 Substantial Compliance in selected Domains, Outcomes and Indicators from QA tools.  No preventable egregious events resulting in death of individual for one year;  Providers of Day Services must provide employment;  No sanction or systemic recoupment for one year;  Annualized substantiated investigation rate of 10 substantiations per 100 persons supported (10:100) or less for one year;  Approval for four-star status is by the Regional Quality Management Committee, followed by submission to State-wide Quality Management Committee for final approval.  4-Star Award recipients skip a survey year.

10. 7/16/201510 Star Providers- 2, 3 & 4 Star Awards 3-Star Status:  85% (Proficient) or above compliance on QA surveys for 2 years; All Domains scoring at least Partial Compliance Must achieve Substantial Compliance in Domain 3 Substantial Compliance in selected Domains, Outcomes and Indicators from QA tools.  No preventable egregious events resulting in death of individual for one year;  Providers of Day Services must provide employment;  No sanction or systemic recoupment for one year;  Annualized substantiated investigation rate of 10 substantiations per 100 persons supported (10:100) or less for one year;  Approval for three-star status is by the Regional Quality Management Committee, followed by submission to State-wide Quality Management Committee for final approval.  3-Star Award recipients skip a survey year.

11. 7/16/201511 Star Providers- 2, 3 & 4 Star Awards 2-Star Status:  Proficient performance for two years; All Domains scoring at least Partial Compliance Must achieve Substantial Compliance in Domain 3  No preventable egregious events resulting in death of individual for one year;  Providers of Day Services must provide employment;  Annualized substantiated investigation rate of 10 substantiations per 100 persons supported (10:100) or less for one year;  Approval for two-star status is by the Regional Quality Management Committee, followed by submission to State-wide Quality Management Committee for final approval.  2-Star Award recipients do not skip a survey year.

12. 7/16/201512 Waiver Monitoring Overview DIDD implements three HCBS Waivers under the administrative oversight of TennCare:  Self-Determination Waiver  State-wide Waiver  Comprehensive Aggregate Cap Waiver Each waiver entails annual monitoring as performed by Quality Assurance, with follow-up remediation and validation activities as coordinated by regional Operations / Provider Support Teams. Monitoring for each waiver consists of administration of two review tools  Qualified Provider  Individual Review (involves identification of a state-wide sample which is selected at the beginning of each waiver-year) All findings / issues are expected to be remediated with provider and systemic trends identified and addressed. Findings / issues are reviewed and discussed by both the Regional Quality Management Committees and the State-wide Quality Management Committee.