Quality Assurance and Quality Improvement in Home and Community-Based Services
PENNSYLVANIA
Target Population
Persons with disabilities served under Medicaid home and community-based services (HCBS) waivers.
Geographic Focus
Statewide (after a pilot in nine sites that are agency based).
Primary Focus
- The purpose of the grant is to create a uniform and integrated system of quality assurance and quality improvement (QA/QI) for all Medicaid HCBS waivers, by addressing the Centers for Medicare & Medicaid Services (CMS) HCBS Quality Framework (hereafter, the Quality Framework) focus area of participant-centered service planning and delivery. Consumers will, therefore, receive the high quality services they need in the manner they prefer.
- The grant is intended to integrate that focus area into all of the QA/QI systems for Pennsylvania's long term care services and tie it into the Medicaid Management Information System (MMIS).
- The grant will also provide for a backup system for service breakdowns for all critical services; train consumers and staff to support consumer-directed services; and meet and exceed the statutory and CMS requirements to assure the health and welfare of individuals who participate in Pennsylvania's HCBS programs.
Goals, Objectives, and Activities
Goal: Develop new quality management systems for consumer-centered service planning and service provision.
Objectives/Activities
- Develop an instrument to collect information on consumers' preferences, goals, needs, abilities, and health status that produces a personalized service plan across disability.
- Develop a staff training component on using the intake form to prepare the personalized service plan.
- Develop consumer information materials and staff capacity to help participants make informed selections among HCBS services and providers, and direct and manage their own services to the extent that they wish.
- Provide computerized alerts to service coordinators and establish a Help Line accessible to consumers.
- Develop an independent quality monitoring mechanism (third-party evaluation).
- Develop and administer a consumer satisfaction survey to monitor the consumer's well being, health status, and the effectiveness of HCBS in enabling the individual to achieve his/her personal goals.
- Develop a uniform system for incident management.
- Develop a complaint system, cross disability, and survey consumers about handling of the complaints.
- Develop a backup system for providing services in cases of service breakdowns that is available at any time and is accessible statewide.
Goal: Develop an integrated data system that supports continuous quality improvement and correction of system errors, while supporting planning and policy decisions.
Objectives/Activities
- Integrate the data systems of all agencies administering HCBS waivers and identify additional data fields necessary for quality management and include them in the system.
- Develop the reports and alerts necessary to identify care issues and for remediation.
Goal: Implement the new QA/QI systems statewide.
Objectives/Activities
- Phase-in and test the QA/QI systems developed using nine sites.
- Provide training to staff on the QA/QO system.
- Implement the new QA/QI system statewide.
Key Activities and Products
- Develop an intake form that produces a personalized service plan across disability and train staff on how to use the form to prepare the plan.
- Develop materials and staff capacity to provide information and support to help consumers make informed selections among services and direct and manage their own services.
- Administer a survey to ensure that the personalized plan meets the consumers' needs.
- Establish a Help Line accessible to consumers and establish a regular contact schedule for service coordinators with their clients that includes systematic alerts for incidents.
- Develop an independent quality monitoring mechanism.
- Develop uniform systems for incident management and complaints.
- Develop an integrated quality management data system across Aging and Welfare Departments.
- Develop a backup system for providing services.
- Phase-in and pilot the QA/QI systems and roll the system out statewide.
Consumer Partners and their Involvement in Implementation Activities
- Consumers will participate in a pilot of newly developed forms, procedures, and QA/QI systems in nine sites, typically by responding to consumer surveys. Consumers will assist in development of the intake form and staff training intended to produce a personalized service plan.
- Consumers and their families will serve on the statewide project advisory committee.
Public and Private Partners and their Involvement in Implementation Activities
Public Partners
Representatives from the following entities will likely serve on local and statewide project advisory committees: Intra Governmental Council on Long Term Care, Council on Aging, Developmental Disabilities Council, Stakeholder Planning Team, Home and Community Based Stakeholder Planning Team, Planning Advisory Committee for the Office of Mental Retardation, Community Living Advisory Council, and Medical Assistance Advisory Committee.
Private Partners
- Representatives from the following entities will likely serve on local and statewide project advisory committees: Centers for Independent Living, Mental Health Consumers Association, Brain Injury Association of PA, Speaking for Ourselves, Pennsylvania Protection and Advocacy, and Pennsylvania Health Law Project.
- The grant will link the agencies that help coordinate and deliver HCBS into a quality management infrastructure.
Advisory Body, Committee, or Task Force
- In addition to local project advisory committees, Pennsylvania will establish a statewide project advisory committee that will meet on at least a quarterly basis. The committee, led by the Office of Health Care Reform, will include consumers, advocates, providers, and representatives from Pennsylvania's agencies.
- Pennsylvania will invite representatives of more narrowly focused advisory and advocacy committees in the field of long term care to participate in the statewide advisory committee.
Formative/Process Evaluation Activities
- The project manager will provide monthly reports to the Office of Health Care Reform to ensure that the goals and timeline of the project are being met.
- Grant staff from the Office of Health Care Reform and participating State Departments, will analyze the monthly report of this project in conjunction with any Systems Change Grants awarded to Pennsylvania to ensure cross intelligence for continuous quality improvement and successful implementation among grant projects.
- The project manager will regularly engage consumers and stakeholder groups to obtain feedback on the direction and implementation of the grant project in order to inform formative learning.
- Pennsylvania will pilot the QA/QI system at nine sites (three Area Aging Agencies, three county Mental Retardation offices, and three agencies working with consumers with physical disabilities). The test will occur in urban, rural, and suburban locations and the advisory committee will review the resulting information.
Summative/Outcome Evaluation Activities
Pennsylvania staff will develop an evaluation tool to utilize at the close of the grant period. The instrument will evaluate the degree to which the project was able to meet its stated goals and objectives, and the degree to which the grant resulted in enduring systems change.
Strategies to Ensure Sustainability
- Pennsylvania will revise the QA/QI system, if needed, and then automate it and roll it out statewide by the end of the grant in October 2006. Pennsylvania will also train support coordinators and supervisors in its use provide consumer information materials in all offices.
- The outcome of this grant will result in a uniform system of quality management for person-centered service planning and service delivery.
- This grant will result in timely backup services in cases of service breakdowns and for independent monitoring of consumer satisfaction across all disability groups. It will establish a rapid response uniform complaint system for all HCBS participants.
- Because consumer-centered planning and service provision and quality systems are built into the design, the outcomes will help change the paradigm of HCBS in Pennsylvania from agency-provided services to consumer-directed services by ensuring that consumers have the authority to and are comfortable with directing their own services.
- The outcomes will transform the way HCBS are planned and delivered in Pennsylvania by putting the consumers' needs and their satisfaction with services as a driving force in the operation of the waiver programs.