Reporting

Reporting

Reports

Settlement Agreement Provision

Case Management

a.    The Commonwealth shall ensure that individuals receiving HCBS waiver services under this Agreement receive case management.

b.    For the purposes of this agreement, case management shall mean:

                                     i.        Assembling professionals and nonprofessionals who provide individualized supports, as well as the individual being served and other persons important to the individual being served, who, through their combined expertise and involvement, develop Individual Support Plans (“ISP”) that are individualized, person-centered, and meet the individual’s needs;

                                    ii.        Assisting the individual to gain access to needed medical, social, education, transportation, housing, nutritional, therapeutic, behavioral, psychiatric, nursing, personal care, respite, and other services identified in the ISP; and

                                   iii.        Monitoring the ISP to make timely additional referrals, service changes, and amendments to the plans as needed.

c.    Case management shall be provided to all individuals receiving HCBS waiver services under this Agreement by case managers who are not directly providing such services to the individual or supervising the provision of such services. The Commonwealth shall include a provision in the Community Services Board (“CSB”) Performance Contract that requires CSB case managers to give individuals a choice of service providers from which the individual may receive approved waiver services and to present practicable options of service providers based on the preferences of the individual, including both CSB and non-CSB providers


Compliance

Compliance Indicators

Compliance Indicators for Case Management System Reporting page

III.C.5.b.i

The following indicators to achieve compliance listed in this provision will also achieve compliance with other provisions associated with case management (III.C.5.b.ii, III.C.5.b.iii, III.C.5.c, and V.F.2).  Relevant elements of person-centered planning, as set out in CMS waiver regulations (42 C.F.R. § 441.301(c)), are captured in these indicators. 

In consultation with the Independent Reviewer, DBHDS shall define and implement in its policies, requirements, and guidelines, “change of status or needs” and the elements of “appropriately implemented services.”

DBHDS will perform a quality review of case management services through CSB case management supervisors/QI specialists, who will conduct a Case Management Quality Review that reviews the bulleted elements listed below.  DBHDS will pull an annual statistically significant stratified statewide sample of individuals receiving HCBS waiver services that ensures record reviews of individuals at each CSB. Each quarter, the CSB case management supervisor and/or QI specialist will complete the number of Case Management Quality Review as determined by DBHDS by reviewing the records of individuals in the sample. The data captured by the Case Management Quality Review will be provided to DBHDS quarterly through a secure software portal that enables analysis of the data in the aggregate.  DBHDS analysis of the data submitted will allow for review on a statewide and individual CSB level. The Case Management Quality Review will include review of whether the following ten elements are met:

•         The CSB has offered each person the choice of case manager. (III.C.5.c)

•         The case manager assesses risk, and risk mediation plans are in place as determined by the ISP team. (III.C.5.b.ii; V.F.2)

•         The case manager assesses whether the person’s status or needs for services and supports have changed and the plan has been modified as needed. (III.C.5.b.iii; V.F.2)

•         The case manager assists in developing the person’s ISP that addresses all of the individual’s risks, identified needs and preferences. (III.C.5.b.ii; V.F.2)

•         The ISP includes specific and measurable outcomes, including evidence that employment goals have been discussed and developed, when applicable. (III.C.5.b.i; III.C.7.b)

•         The ISP was developed with professionals and nonprofessionals who provide individualized supports, as well as the individual being served and other persons important to the individual being served. (III.C.5.b.i; III.C.5.b.ii)

•         The ISP includes the necessary services and supports to achieve the outcomes such as medical, social, education, transportation, housing, nutritional, therapeutic, behavioral, psychiatric, nursing, personal care, respite, and other services necessary. (III.C.5.b.i; III.C.5.b.ii; III.C.5.b.iii; V.F.2)

•         Individuals have been offered choice of providers for each service. (III.C.5.c)

•         The case manager completes face-to-face assessments that the individual’s ISP is being implemented appropriately and remains appropriate to the individual by meeting their health and safety needs and integration preferences. (III.C.5.b.iii; V.F.2)

•         The CSB has in place and the case manager has utilized where necessary, established strategies for solving conflict or disagreement within the process of developing or revising ISPs, and addressing changes in the individual’s needs, including, but not limited to, reconvening the planning team as necessary to meet the individuals’ needs. (III.C.5.b.iii; V.F.2)

The Case Management Steering Committee will analyze the Case Management Quality Review data submitted to DBHDS that reports on CSB case management performance each quarter. 86% of the records reviewed across the state will be in compliance with a minimum of 9 of the elements assessed in the review. Any individual CSB that has 2 or more records that do not meet 86% compliance with Case Management Quality Review for two consecutive quarters will receive additional technical assistance provided by DBHDS.

If, after receiving technical assistance, a CSB does not demonstrate improvement, the Case Management Steering Committee will make recommendations to the Commissioner for enforcement actions pursuant to the CSB Performance Contract and licensing regulations.

DBHDS, through the Case Management Steering Committee, will ensure that the CSBs receive their case management performance data semi-annually at a minimum.

All elements assessed via the Case Management Quality Review are incorporated into the DMAS DD Waiver or DBHDS licensing regulations. Corrective actions for cited regulatory non-compliance will be tracked to ensure remediation.

III.C.5.b.ii

The actions to achieve compliance listed in Section III.C.5.b.i will also achieve compliance with this provision of the Settlement Agreement.

III.C.5.b.iii

The actions to achieve compliance listed in Section III.C.5.b.i will also achieve compliance with this provision of the Settlement Agreement.

III.C.5.c

The actions to achieve compliance listed in Section III.C.5.b.i will also achieve compliance with this provision of the Settlement Agreement.

V.F.2

The actions to achieve compliance listed in Section III.C.5.b.i will also achieve compliance with this provision of the Settlement Agreement.