1. HCBS Quarterly Training lst Quarter 2006 The Outcome Based Review Processes Exception to Policy Website Waiver Implementation Issues: Incident reporting – MR, BI, CMHW Discharge Policies Reporting Consumer Deaths

2. Outcome Based Review Processes Three types currently in place: –OB reviews of MR and BI waiver services for SCL and SE –OB reviews for MR Residential Based Supported Community Living providers –OB reviews for I&H, E, PD, A/H waivers LC -PM

3. OB Reviews – MR and BI 20 outcomes –1 organizational –19 consumer related 4 levels of certification –270 probational –1 year –3 year with follow-up monitoring –3 year with excellent 270 - 1yr - 3 yr with monitoring require a submitted CAP All levels will have a compliance review – either on-site or via paper submission IAC 77.37(12)c(1-4)

4. OB Reviews – MR RBSCL Annual recertification required IAC 77.37(23)f(2) Governance is reviewed including: –Certification requirements – DIA licensure –Organizational self-evaluation –Staff training –Consumer files –Service plans –development/revision –Home environment 9 consumer outcomes

5. I&H, PD, E, A/H Reviews Surveys SW files and consumer satisfaction SW files: –Application timeframe –Level of care –Service plan –NODs –CDAC agreement (when applicable) –ROIs 7 consumer outcomes Provider certification not involved, but service provision issues may be addressed directly with a provider

6. Review Similarities Consumer satisfaction drives the reviews Paperwork compliance addressed Expectation of improvement on identified areas of needs Written report is generated HCBS QA processes are continually under review for improvement

7. Exception to Policy Website Exceptions to policy can be completed online This website also offers information on completing an exception to policy Once submitted electronically, the sender will be notified of the receipt of the exception and given the exception identification number This can be used to track the exception The website address is: http://www.dhs.state.ia.us/dhs2005/appeals/exceptions%5Fpolicy.html

8. Incident Reporting Effective 11/1/04, MR and BI waiver SCL and SE agencies were mandated to implement a system for reviewing incidents: –IAC 77.37(1)f(3-7) and 77.37(8)a-e – MR –IAC 77.39(1)f(3-7) and 77.39(6)b(1-5) – BI The CMHW also requires all providers to address incident reporting under 77.46(1)d(1-5) Incident reports must not only be completed, but they must be tracked, trended, and agencies must develop and implement plans of improvement based on the trending issues

9. Tracking-Trending-Improving Tracking and trending goes beyond tallying #s of incident reports Tracking and trending includes: –Identifying specific issues of a consumer – falling, hitting, being hit, etc… –Identifying problem areas agency-wide – need for staff training on a specific issue/concern, staffing ratio needs, etc… Once these issues are identified, the the agency should formulate and implement a plan to correct the issue: –Staff training on a specific area of concern – seizures, dual diagnosis, alternatives to physical interventions, etc.. –Changing areas of concerns for specific consumer issues – roommate problems, medication management alternatives, home modifications, etc.

10. Incident Reporting Issues Only major incidents are required to be submitted – some agencies are submitting minor incidents also Several agencies are not completing major incident reports Agency keeps track of basic information - #s of incident reports and types, but does not use the data to track and trend There is no follow-up or review of the data to identify and implement needed changes

11. Discharge Policies MR and BI waiver rules mandate discharge policies and procedures –IAC 77.37(9) a – b – MR –IAC 77.39(7) a – b – MR The provider shall have written policies and procedures according to state and federal laws for…..discharge. HCBS Specialists will look for these policies It is recommended that these policies contain time frames for discharge and written information regarding the discharge rationale Discharge Policies

12. Reporting Consumer Deaths – MR and BI Waiver For the past several years, HCBS has been tracking information on consumer deaths in the MR and BI waiver programs This information includes: –Name of the consumer –Cause of death - circumstances –Date the death occurred –Agency reporting the death –The HCBS service provider –Any referrals to protective services and follow-up by this entity Please remember to notify your HCBS Specialists of a consumer death.