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PSA 4 Quality Assurance Summit. Agenda. Welcome & Introductions 2011 Monitoring Schedules Reports Nursing Home Transition Request for Proposal Training Schedules PSA 4 Best Practices Summary of 2010 Monitoring Visits Technical Assistance Forms / ElderSource Website

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Psa 4 quality assurance summit

St. Johns Management Emergency Operations Center February 10, 2011

PSA 4 Quality Assurance Summit


Agenda

Agenda

  • Welcome & Introductions

  • 2011 Monitoring Schedules

  • Reports

  • Nursing Home Transition

  • Request for Proposal

  • Training Schedules

  • PSA 4 Best Practices

  • Summary of 2010 Monitoring Visits

  • Technical Assistance

  • Forms / ElderSource Website

  • Open Discussions/Feedback / Conclusion


Welcome introductions

Welcome & Introductions

1

Bill Hardy, Director of Operations


Eldersource provider agencies

ElderSource & Provider Agencies

Together Everyone Achieves More


Psa 4 quality assurance summit

2011 A New Year

2


2011 a fresh start

2011 Monitoring Schedule

Medicaid Waiver, Programs & Finance

New Monitoring Procedures

Programs

Medicaid Waiver

on site longer – extended technical assistance

New Monitoring Tools

2011 - A Fresh Start


2011 programs fiscal monitoring

Baker County COA - Feb 22,23,24

Clay County COA - March 28, 29,30

City of Jacksonville (Senior Services/Independent Living) - April 25,26,27

Urban Jacksonville - May 23,24,25

Jacksonville Area Legal Aid – June 9

St. Johns County COA - July 5,6,11

Nassau County COA - August 1,2,3

AHEC - Sept 6

Flagler County Social Services - October 10,11,12

COA of Volusia County - November 7,8,9,10

Community Legal Services of Mid-Florida - November 8

2011 Programs Fiscal Monitoring


2011 med waiver monitoring

2011 Med-Waiver Monitoring

  • Clay CCOA - March 28,29,30,31 & April 1

  • Baker CCOA – April 25, 26, 27, 28 , 29

  • Urban Jacksonville – May 23,24,25,26,27

  • Nassau CCOA – July 25,26,27,28,29

  • Flagler County BCC – August 15,16,17,18,19

  • St. Johns CCOA – September 12,13,14,15,16

  • COA Volusia County – November 7,8,9,10,14


Reports

Reports

3


Psa 4 quality assurance summit

CIRTS Data Accuracy

APS

Encumbrance Report

Outcome Measures

Surplus Deficit

Fiscal Reports

NSIP


Cirts data accuracy

CIRTS Data Accuracy


Aps referrals summary

APS Referrals Summary


Aps summary 2010

Did the intake entity acknowledge receipt of the referral in ARTT on the same day the referral packet was received?

3 out 10 did not acknowledged the same day – without explanation to why

Was a 701B assessment completed by the lead agency within 72 hrs. after the referral (Exception: if CARES completed a full assessment prior to referring to lead agency, another assessment is not required for services that do not exceed 30 days).

2 out of 10 did not have a 701B completed referral documented with in 72 hours in CIRTS

Did the CCE Lead Agency initiate the emergency or crisis resolving service(s) recommended or agreed to by APS (not just case mgmt) within 72 hours of referral?

2 out of 10 did not have documentation that services that services were put in place (no documentation- log sheets)

If the lead agency did not order the services that were recommended by the APS Protective Investigator, did APS and Case Manager Supervisor jointly review the case to resolve the issues?

2 out of 10 did not have narratives of communications with the APS Protective Investigator

APS Summary 2010


Aps summary 2010 cont

Did the CCE Lead Agency enter the case status in ARTT fields #30, 31, 36 and 37 within 72 hours of referral?

5 out of 10 referrals did not have the fields populated with in 72 hours

Were service units entered daily (not aggregately) for core services and case mgmt for the first 72 hours after APS referral and entered either daily or aggregated weekly for the next 27 days?

5 out of 10 were not entered in CIRTS correctly

If services were refused by the client or delayed due to circumstances beyond control of the service provider, did the lead agency contact APS within 24 hours?

4 out of 10 had no evidence (documentation) of follow up contact with the APS investigator

APS Summary 2010 cont..


Aps summary 2010 cont1

APS Summary 2010 cont..

Does documentation indicate the Case Manager followed up with client or caregiver within 2 weeks on service arrangements and referrals ensuring services had begun?

2 out of 10 did not have documentation of follow up with client in reference to services

Did the intake entity reassess the client and consult with APS prior to termination to determine if services could be safely terminated (eff.:12/19/07)?

3 out of 10 had no documentation of a visit at 30 days to evaluate the services

Is a complete referral packet in the file (referral form, Adult Safety Assessment of Factors, Adult Safety Assessment of Overall Safety, Capacity to Consent Assessment (or CF-AA 1112 form if client lacks capacity), Court order (if services were court ordered)? (eff.: 12/19/07)

10 out 10 APS files had the completed referral package


Outcome measures overview 2009 2010 results

4 out of 10 Outcome Measures Not Achieved

CARES (Imminent Risk) 69.77% (Goal 90 %)

Imminent Risk Referrals Not Receiving a Service:

Caregiver Likely 86.13% (Goal 89 %)

Percent of caregivers and family assisted caregiver who self report they are very likely to provide care.

Environment 65.22% (goal 79%)

Percent of elders who are assessed with high or moderate risk environments who improved their environmental score on reassessment

CCE/MW 5.0 months (goal 2.8 months)

Average time in Community Care for the Elderly program for Medicaid probable consumers.

Outcome Measures Overview 2009-2010 Results


Outcome measures overview currently achieving 2010 2011

6 out of 10 Outcome Measures Not Achieved

ADL 63.70% (Goal 65 %)

Percent of new service recipients whose ADL assessment score has been maintained or improved.

CARES (Imminent Risk) 61.58% (Goal 90 %)

Imminent Risk Referrals Not Receiving a Service

APS 87.82% (Goal 97 %)

Percent of Adult Protective Services (APS) High Risk referrals that are in need of immediate services to prevent further harm who are served within 72 hours.

As of Jan 31, 2011

Outcome Measures OverviewCurrently Achieving -2010-2011


Outcome measures overview currently achieving 2010 20111

Cont…

Caregiver Likely 86.26% (Goal 89 %)

Percent of caregivers and family assisted caregiver who self report they are very likely to provide care.

Environment 74.74 % (goal 79.3%)

Percent of elders who are assessed with high or moderate risk environments who improved their environmental score on reassessment

Nutrition 54.29 % (goal 66.%)

Percent of new service recipients with high risk nutrition scores whose nutritional status improved

As of Jan 31, 2011

Outcome Measures OverviewCurrently Achieving -2010-2011


Surplus deficit

Surplus Deficit


Fiscal reports

Fiscal Reports

ADI, CCE, EHEAP, HCE, OAA & RELIEF – due 8th

Cirts reports must be submitted at the same time as expenditures report

HCE Exception Report must be turned in each month regardless if there are any changes to be made for that month. Please note that if there is a new provider, name change or change of address – Fiscal needs the old information also. The providers system is based on client and the ElderSource system uses the caregiver.

Surplus Deficit - due on the 10th

CIRTS Data Accuracy – due the 20th of the following month you are reporting on.

Service Cost reports - due February and August each year

Annual Co-Payment Report – due July 30 each year


Psa 4 quality assurance summit

Currently added to C1 &C2

A different way of handling NSIP

NSIP


Nursing home transition

Nursing Home Transition

4

Case Management


Request for proposal

RFP – Municipality will no longer be exempt

Request for Proposal

5


Training schedule

What’s on the schedule for 2011?

Training Schedule

6


Tentative 701a b assessment training schedule

Tentative 701A – B Assessment Training Schedule

  • 1st Quarter March 15 - 16, 2011

  • 2nd Quarter May 17 - 18, 2011

  • 3rd Quarter August 16 – 17

  • 4th Quarter November 15 – 16

  • (2 day training)


Tentative 701c assessment training schedule

1st Quarter March 22, 2011

2nd Quarter June 7, 2011

3rd Quarter August 23, 2011

4th Quarter November 2, 2011

(1/2 day training)

Tentative 701C Assessment Training Schedule


Menu planning food safety training schedule

Menu Planning – Annual Training

This must be done Annually.

Food Safety

All Food service staff and volunteers must receive semi-annual training for prevention of food borne illness. Staff and volunteers must be training prior to assuming food service assignments (DOEA programs & service handbook ch4-105)

Menu Planning / Food Safety Training Schedule


Psa 4 best practices

PSA 4 Best Practices

7

What has worked for other agencies can work for you


Psa 4 quality assurance summit

Home Deliver Meal Coolers

Vista Print Signs

Charly Poniatowski, COA of Volusia County

Home Deliver Meal Coolers - Plug in

Al Rizer, Clay County Council on Aging

MSDS – Material Safety Data Sheets

Chemicals that are available for use at the nutritional site

Joanne Hinkel, Flagler County Social Services


Psa 4 quality assurance summit

2010 a Year in Review

8

Summary of 2010 Monitoring Visits


Help us help you a year in review

TRENDS Table report reviewed the following areas:

M O N I T O R I N G

Follow up from the last monitoring

Positive and Noteworthy Activities

Client Satisfaction

Nutrition/Congregate Meal Site's Compliant

Assessments

Care Plan

Case Narratives

Home visits/Interview clients

Etc.

F I L E R E V I E W

Findings /Recommendations

Technical Assistance

Quality assurance/Grievance Policy

Assessments

Care Plan

Case Narratives

Home visits/Interview clients

Case management Billing

Etc.

F I N A N C I A L C O M P L I A N C E

Financial/Accounting Files

observe transportation route (if available)

Etc.

Help Us Help You – A Year in Review


Trends table legend represents compliance or noncompliance utilizing the following acronyms

TRENDS Table“Legend” represents compliance or noncompliance utilizing the following acronyms:


Psa 4 quality assurance summit

TRENDS TABLEExamples of Monitoring areas per county


Help us help you a year in review1

Help Us Help You – A Year in Review

  • What does it mean to have

  • Quality Assurance……

  • Provider Visits (announced or unannounced)

  • Findings

  • Recommendations

  • Technical Assistance

  • ElderSource helpline/Internet

  • Corrective Action Plan


Medicaid waiver trends

Medicaid Waiver Trends

A review of 65 randomly selected ADA waiver client files revealed compliance deficiencies in the following areas:

4 files did not document ElderSource approval to begin services;

9 files contained errors with the provider choice form;

6 files contained errors with the Fair Hearing form;

3 files did not document POA;

10 files did not contain proof of current financial eligibility;

2 files did not document a current 2515 form;


Medicaid waiver trends1

Medicaid Waiver Trends

1 file did not contain a 3008 form;

3 files contained a LOC gap;

22 files contained errors with the 701B;

5 files contained a missed or late 701B;

3 files did not contain a CM signature on the 701B;

4 files contained late or missed care plans;

1 file contained a care plan that was not signed by the CM;

2 files care plans did not meet assessed need;


Medicaid waiver trends2

30 files care plans were not legible and maintained in detail;

14 files did not document quarterly reviews on the care plan;

21files contained errors and/or missing service authorizations;

23 files contained errors with CIRTS;

9 care plans were over the threshold and did not document CPR approval;

19 files contained problems with the narratives;

15 files did not document client condition;

2 files did not document service provision;

Medicaid Waiver Trends


Medicaid waiver trends3

10 files did not document service receipt;

13 files did not document client satisfaction;

17 files did not document monthly contact;

1 file did not document a quarterly face visit;

11 files did not contain comprehensive narratives;

33 files contained errors with paid claims.

Medicaid Waiver Trends


Technical assistance

Technical Assistance

9

How can we help you?


Technical assistance ideas

Technical Assistance Ideas

REFER

Assistive Eating Devices

EHEAP

Application and sample forms – on web

Webinar – What would you like to see

Job Shadowing


Eldersource website forms

Have you looked at the ElderSource website lately?

ElderSource Website / Forms

10


Eldersource website

ElderSource Website

Have you looked at the ElderSource website lately?

Did you know you can access forms from the main page? - Provider Resources

Did you know that you can access additional client resources from the website?

What else would you like to see available on the website?


Provider resources

Provider Resources

Assessment Forms:

DOEA 701A - Sept 08

DOEA 701B - Sept 08

DOEA 701C - Sept 08

Care Plan

Checklist:

ElderSource APS file review checklist (jan2011)

ALE case file review tool & ALE case file review tool - instructions

ADA case file review tool & ADA case file review tool - instructions

Fiscal:

Surplus Deficit Form – Jan 2011

Annual Co-Payment Report

Forms:

Consumer Satisfaction Survey Results Summary

Volunteer Activity Report

CIRTS Data Accuracy – Jan 2011

Adaptive Eating Device – with list of items

Schedule of Events

Programs / Fiscal monitoring schedule

Nutrition:

How to Calibration a Thermometer

Calibrating Probe Thermometer

NPCR Nutrition Program Compliance Review (Feb. 2010)

HDM Evaluation for frozen meals (DOEA 217)

Information:

Link up Florida – Providers that provider low cost telephone service.

Assurance Discounted Cell Phone Service (English & Spanish)

Notice of Instructions:


Summary open discussion q a

ElderSource Contact Information

Summary / Open Discussion Q&A

11


Eldersource contact information

ElderSource Contact Information

  • Main Number 904-391-6600

  • Elder Helpline 904-391-6699

  • Fax Number 904-391-6601

  • Hearing Impaired – 904-391-6697

  • Toll Free 888-242-4464

  • www.myeldersource.org

  • 4160 Woodcock Drive, Jacksonville, FL 32207


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