Settlement Agreement Provision
V.I.1
The Commonwealth shall use Quality Service Reviews (“QSRs”) to evaluate the quality of services at an individual, provider, and system-wide level and the extent to which services are provided in the most integrated setting appropriate to individuals’ needs and choice. QSRs shall collect information through:
a. Face-to-face interviews of the individual, relevant professional staff, and other people involved in the individual’s life; and
b. Assessment, informed by face-to-face interviews, of treatment records, incident/injury data, key-indicator performance data, compliance with the service requirements of this Agreement, and the contractual compliance of community services boards and/or community providers.
V.I.2
QSRs shall evaluate whether individuals’ needs are being identified and met through person-centered planning and thinking (including building on individuals’ strengths, preferences, and goals), whether services are being provided in the most integrated setting appropriate to the individuals’ needs and consistent with their informed choice, and whether individuals are having opportunities for integration in all aspects of their lives (e.g., living arrangements, work and other day activities, access to community services and activities, and opportunities for relationships with non-paid individuals). Information from the QSRs shall be used to improve practice and the quality of services on the provider, CSB, and system wide levels.
V.I.3
The Commonwealth shall ensure those conducting QSRs are adequately trained and a reasonable sample of look-behind QSRs are completed to validate the reliability of the QSR process.
V.I.4
The Commonwealth shall conduct QSRs annually of a statistically significant sample of individuals receiving services under this Agreement.
About Quality Service Reviews (QSRs)
QSRs are an external review conducted by a vendor procured through competitive bid per the Commonwealth’s established procurement process. Reviews are conducted annually on a sample of providers, with the goal that each provider is sampled at least once every two to three years, comprised of Person-Centered Reviews (“PCRs”) and Provider Quality Reviews (“PQRs”), to evaluate the quality of services at an individual, provider, and system wide level and the extent to which services are provided in the most integrated setting appropriate to individuals’ needs and preferences. The QSRs assess on an individual service-recipient level and individual provider level whether:
a. Individuals’ needs are identified and met, including health and safety consistent with the individual’s desires, informed choice and dignity of risk.
b. Person-centered thinking and planning is applied and people are supported in self-direction consistent with their person-centered plans, and in accordance with CMS Home and Community Based Service planning requirements.
Information from the QSRs is used to improve practice and quality of services through the collection of valid and reliable data that informs the provider and person-centered quality outcome and performance results. DBHDS reviews data from the QSRs, identifies trends, and addresses deficiencies at the provider, CSB, and system wide levels through quality improvement processes. All QSR reviewers are trained and pass written tests and/or demonstrate knowledge and skills prior to conducting a QSR, and reviewer qualifications are commensurate to what they are expected to review.
Authorizing Authority
Processes, Protocols and Standards
Instruments and Tools