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HCBS Waiver Quality Improvement

Reporting

Settlement Agreement Provision

The Commonwealth’s HCBS waivers shall operate in accordance with the Commonwealth’s CMS-approved waiver quality improvement plan to ensure the needs of individuals enrolled in a waiver are met, that individuals have choice in all aspects of their selection of goals and supports, and that there are effective processes in place to monitor participant health and safety. The plan shall include evaluation of level of care; development and monitoring of individual service plans; assurance of qualified providers; identification, response and prevention of occurrences of abuse, neglect and exploitation; administrative oversight of all waiver functions including contracting; and financial accountability. Review of data shall occur at the local and state levels by the CSBs and DBHDS/DMAS, respectively

Reports

Compliance Indicators

V.D.1

  1. The Commonwealth implements the Quality Improvement Plan approved by CMS in the operation of its HCBS Waivers.
  2. The CMS-approved Quality Improvement Plan in the DD HCBS waivers outlines:
    1. Inclusion of the evidence based discovery activities that will be conducted for each of the six major waiver assurances.
    2. The remediation activities followed to correct individual problems identified in the implementation of each of the assurances.
    3. Identification of the Department and Division responsible for overall management of the respective QM function(s). DMAS, as the Single State Medicaid Agency, retains overall authority for the operation of the DD HCBS waivers in their entirety.
    4. Processes to oversee and monitor all components related to the QM Strategy.
    5. Identification of performance measures that will be assessed.
    6. Processes to review performance trends, patterns, and outcomes to establish quality improvement priorities.
    7. Processes to recommend changes to policies, procedures and practices, waivers, and regulation as informed through ongoing review of data.
    8. Processes to ensure remediation activities are completed and to evaluate their effectiveness.
    9. Processes to report progress and recommendations to the QIC.
  3. The Commonwealth has established performance measures, reviewed quarterly by DMAS and DBHDS, as required and approved by CMS in the areas of:
    1. health and safety and participant safeguards,
    2. assessment of level of care,
    3. development and monitoring of individual service plans, including choice of services and of providers,
    4. assurance of qualified providers,
    5. whether waiver enrolled individuals’ identified needs are met as determined by DMAS QMR,
    6. identification, response to incidents, and verification of required corrective action in response to substantiated cases of abuse/neglect/exploitation        (prevention is contained in corrective action plans).
  4. The performance measures are found in the published DD HCBS waivers and found at cms.gov and are posted on the DBHDS website.
  5. Quarterly data is collected on each of the above measures and reviewed by the DMAS-DBHDS Quality Review Team. Remediation plans are written and remediation actions are implemented as necessary for those measures that fall below the CMS-established 86% standard. DBHDS will provide a written justification for each instance where it does not develop a remediation plan for a measure falling below 86% compliance. Quality Improvement remediation plans will focus on systemic factors where present and will include the specific strategy to be employed and defined measures that will be used to monitor performance. Remediation plans are monitored at least every 6 months. If such remediation actions do not have the intended effect, a revised strategy is implemented and monitored.
  6. DMAS provides administrative oversight for the DD Waivers in compliance with its CMS-approved waiver plans, coordinates reporting to CMS, and conducts financial auditing consistent with the methods, scope and frequency of audits approved by CMS.
  7. The DMAS-DBHDS Quality Review Team will provide an annual report on the status of the performance measures included in the DD HCBS Waivers Quality Improvement Strategy with recommendations to the DBHDS Quality Improvement Committee. The report will be available on the DBHDS website for CSBs. Quality Improvement committees to review. Documentation of these reviews and resultant CSB-specific quality improvement activities will be reported to DBHDS. The above measures are reviewed at local level including by Community Service Boards (CSB) at least annually.
  8. The Commonwealth ensures that at least 86% of individuals who are assigned a waiver slot are enrolled in a service within 5 months, per regulations.

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