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“Decisioneering”

Performance Standardization Guidance for Licensure Steve Lambert, Associate Director Adult Services and Enforcement Division of Licensing Programs Virginia Department of Social Services. “Decisioneering”. PERFORMANCE-BASED LICENSING AND MONITORING Division of Licensing Programs, VDSS

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“Decisioneering”

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  1. Performance Standardization Guidance for Licensure Steve Lambert, Associate DirectorAdult Services and EnforcementDivision of Licensing ProgramsVirginia Department of Social Services

  2. “Decisioneering”

  3. PERFORMANCE-BASED LICENSING AND MONITORING Division of Licensing Programs, VDSS July 10, 1999

  4. Types of Licenses • Initial (Conditional)- issued for up to 6 months • Provisional – issued for up to 6 months • 1-yr • 2-yr • 3-yr

  5. Previous Performance Measures • In substantial compliance = 1-yr • Complying substantially with most standards, but exceeding with others = 2-yr • Substantially exceeding with most standards = 3-yr

  6. OLPHIN Division Of Licensing Programs Help and Information Network

  7. CHAPTER 603. An Act to amend and reenact §63.2-1706 and §63.2-1728 of the Code of Virginia, relating to licensure of a facility; interview with residents or participants. [S 339] Approved April 11, 2010 2. That by November 1, 2010, the Department of Social Services shall, in consultation with key stakeholder groups, develop specific criteria by which the Department issues one-, two-, and three-year assisted living facility licenses. Such criteria shall be separately stated for each licensure period and shall be unambiguously communicated to all entities seeking initial and renewal licenses.

  8. Performance Standardization Guidance for Licensure Measurable data reflecting performance with regulatory requirements -2 -1 Average 1 2 3-yr Lic 2-yr Lic 1-yr Lic Prov Lic Sanction Below Average Above

  9. Performance Standardization Guidance for Licensure Performance Indicator 1: Degree of non-compliances or Avg Violations/Inspection Performance Indicator 2: Degree of risk or Avg Risk Score/Inspection Performance Indicator 3:Negative Events: Being sanctioned anytime during the licensure period; Being required by the licensing office to submit an IPOC for serious and/or systemic violations 12 months or less of the license’s expiration date • Having an avg. risk rating score of 6 or higher at renewal (relevant only to issuing an extended license, i.e., a 2- or 3-yr license)

  10. Risk Assessment Matrix C) High C-1 C-2 C-3 B) Medium B-1 B-2 B-3 A) Low A-1 A-2 A-3 1) Moderate 2) Serious 3) Extreme Probable Event of Harm Probable Severity of Harm

  11. Performance Indicator 1 Performance Indicator 2

  12. Family Day Home Performance Indicator 2 Performance Indicator 1

  13. Licensure Condition 1 • When values for performance indicators 1 and 2 fall under the same license type • 3-yr 2-yr 1-yr Provisional • PI-1 • PI-2

  14. Licensure Condition 2 • When values for performance indicators 1 and 2 fall side by side, aligning with two different license types • 3-yr 2-yr 1-yr Provisional • PI-1 PI-2

  15. Licensure Condition 3 • When values for performance indicators 1 and 2 are separated by one or more license types • 3-yr 2-yr 1-yr Provisional • PI-1 PI-2

  16. General Rule: Performance Indicator 3 • When performance indicators 1 and 2 do not align with the same license type or when both align with an extended license… • Select the performance indicator that aligns with the more favorable license type provided that: • a sanction was not issued during the licensure period; • 2) an IPOC was not requested by the • licensing office 12 months or less of the • license’s expiration date; and/or • 3) the avg. risk rating score at renewal is • not 6 or higher (relevant only when considering the issuance of an extended license)

  17. Family Day Home 1) When values for performance indicators 1 and 2 fall under the same license type 1 Year My Joy Is Yours

  18. 2) When values for performance indicators 1 and 2 fall side by side, aligning with two different license types 2 Year 1 Year Home Away From Home

  19. 3) When values for performance indicators 1 and 2 are separated by one or more license types 1 Year 3 Year Tender Hearts

  20. Caution!

  21. “Decisioneering”

  22. Comments from Providers on Project: Pre-Implementation of Pilot Study: My recommendation is to re-implement the “exceeds” category which would be a measurable tool.  Consistency in determining license types will still be driven by the bias of the licensing inspector. The number of violations is based on the bias of the licensing inspector which directly affects the scores for non-compliance and risk rating. If our analysis is correct, we would predict that the use of this tool as currently designed will virtually eliminate three year licenses and reduce the number of licenses given for two years.  The modal result will most certainly be a one year license.  Seems like instead of hoping all ALFs are providing best practices and compliance with the standards, we would be pushed in the direction of hoping others do poorly so we could boost our rating. This thing is so complicated that I cannot discern if I have any objections or not.  The tool and process should be abandoned. Realizing the complexity of the system, perhaps the answer lies in having one year licenses across the board. To ensure that assisted living facilities are always striving for excellence, we need to confirm the licensure tool includes incentives to strive for and obtain a two-year or three-year license. The new tool does not fully include the areas in which the facilities “exceed the minimum standards” when determining the 1, 2, or 3 year licenses as before. If we are interpreting risk averages correctly, there is a serious arithmetical problem with them, unless the Tool was purposely designed to produce the results it does, it is arithmetically impossible to earn more than a one year license if you have any risk violations at all.   This assessment discriminates regionally because it takes an area like Northern Virginia, which has mostly ALFs with private-pay residents and compares them to ALFs in areas like Southwest Virginia and the Richmond area where the ALFs have mostly poor residents and residents receiving public assistance.

  23. Pilot Study: January-June 2011 • 49% (53 of 108) of adult and children’s inspectors participated • 169 license renewals were submitted • 80% of the time inspectors agreed with the license type indicated by the licensure tool • When inspectors did not agree with the tool, the average difference was 1 license type, e.g. a 1-yr vs. a 2-yr or a 2-yr vs. a 3-yr.

  24. Pilot Study: January-June 2011 17% 24%

  25. Thank You For Coming! It’s about us

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