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A STATE WIDE PROVIDER QUALITY SYSTEM IN MN

A STATE WIDE PROVIDER QUALITY SYSTEM IN MN. PART I: THE PEPSI PROJECT Pamela Sulmer, MS -- DHS Disability Services Division Leah Zoladkiewicz -- DHS Disability Services Division. Scope. Home and Community Based Waiver Providers: Community Alternative Care Waiver (CAC)

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A STATE WIDE PROVIDER QUALITY SYSTEM IN MN

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  1. A STATE WIDE PROVIDER QUALITY SYSTEM IN MN PART I: THE PEPSI PROJECT Pamela Sulmer, MS -- DHS Disability Services Division Leah Zoladkiewicz -- DHS Disability Services Division

  2. Scope Home and Community Based Waiver Providers: • Community Alternative Care Waiver (CAC) • Community Alternative for Disabled Individuals Waiver (CADI) • Developmental Disability Waiver (DD) • Traumatic Brain Injury Waiver (TBI) • Elderly Waiver (EW)

  3. What Defines HCBS Quality? • Participant-Centered Access & Service Planning • Provider Capability & Service Capacity • Participant Safeguards & Rights Protections • Positive Service Outcome & Participant Satisfaction

  4. Core Components of a Quality Assurance System • Service Providers meet Compliance Standards • Timely Response to Client Complaints • Tools to Prompt Informed Client Choice • Service Delivery Monitoring & Systems Improvement

  5. Minnesota: A Statewide System Locally-Directed / Locally-Executed State-Directed / State & Locally-Administered

  6. Fee For Service Contracts • Establish Provider Standards • Set forth Service Delivery Requirements • Lay the Foundation for Oversight & Monitoring • Define the Provider Field

  7. Elimination of Local Contracts • Centralized HCBS System per CMS Mandate • Uniform Provider & Service Delivery Standards • Consistent Monitoring & Oversight • Well-Coordinated Administrative Partnership

  8. Waiver Provider Quality Management: The Vision • State Provider Qualifications & Service Standards • Consistent Oversight & Compliance Assurance • QUALIFIED PROVIDER OPTIONS • Provider Performance Beyond Compliance • Client Experience Evaluation & Reporting • OPTIMAL SERVICE EXPERIENCE

  9. The Whole Provider Picture Provider Meets Qualifications & Enrolls Provider Complies with Service Standards Provider Performance & Public Reporting

  10. The PEPSI Initiative • Phase 1: Review Local Contract Elements • Phase 2: Streamline & Strengthen Standards • Phase 3: Design an Integrated Compliance Assurance System • Phase 4: System Development towards System Transition

  11. StakeholderInvolvement • Solicitation of Workgroup Members • Work Group Structure • Work Group Process

  12. Phase IProvider Requirements • Reviewed Components of Model Contract /Current MHCP Provider Agreement • Recommended Elements to Move Forward into Uniform Provider Requirements • Established Universal Provider Requirements

  13. Universal Requirements • Training Direct Care Staff • Training Owners/Managers • Policies and Procedures • Insurance

  14. Phase II Provider Requirements • Evaluated Current standards/Qualifications for Unlicensed Waiver Services • Recommended Enhancements for Standards/Qualifications

  15. Service Specific Requirements • Training • Professional licensure/certification/degree • Policies and procedures • Background Checks • Insurance

  16. Compliance Assurance System • Universal & Customized Standards at the Center • Ultimately 4 Distinct Functional Components • State-Directed / Jointly Administered

  17. Provider Qualification Review • Who are You? How are You Qualified to Deliver Service(s)? • Do You Agree to Comply with Required Policy and Procedures? • Conducted by the State Prior to Enrollment • Qualified HCBS Provider Directory

  18. Routine Provider Review • Review of Service Operations in the Field • Verification of Assurances Provided at Enrollment • Are you Complying with Required Standards of Practice & Adhering to the Policies You’ve Adopted? • State-Directed / Largely Locally Conducted

  19. Complaint-Driven Review • Threshold Health & Safety, Participant Rights, Service Delivery & Operational Management Complaints Rise to Uniform Management Level • Locally-Administered “State-Directed” Complaint Discovery, Remediation, Improvement • Augments Existing Centralized Complaint Systems

  20. HCBS Compliance Assurance System Goals • Compliance Assurance via Reasoned Review • Uniform Management & Oversight • Leveraging of Expertise & Capability towards Productive Administrative Partnership • Efficiencies Maximized at Every Level

  21. Achieving Consistent Oversight Activity • Centralized System with Well-Directed Division of Labor • Policy-Embedded IT Drives Review & Response • System Supports Administrative Functions • Value Added for State and Local Partners

  22. Essential Functions • Provider Screening, Service Monitoring, Transparent Reporting • Systems-Level Review of Local Activity • ID & Target Improvement Opportunities • Efficient Data Management & Program Reporting

  23. Development and Rollout Vision Develop Provider Qualification Review Certify/Enroll Providers MN HELP Directory Contract Elimination Develop Complaint Management Develop Routine Field Review Q-1 2012 2014 2013

  24. Work Ahead • Policy Development to Support Monitoring Functions & State/Local Coordination • Business Process Analysis & Rework Supporting Transition to Centralized System • Development of Core IT Infrastructure • Development of Training to Support Implementation

  25. Upshot Participants: Access to Qualified Providers Providers: Uniform Statewide Requirements Eligible if Qualified & Compliant Local Partners: Efficient, Consistent Oversight Access to Statewide Provider Data

  26. Additional Opportunities Lead Agency/Provider Training Opportunities & Delivery Methods- Tues. 8:30 AM Commons Doubletree New Licensing Standards – Tues. 8:30 AM Riverview Rate Setting Methodologies Overview – Tues. 1:30 PM Ballroom A Provider Enrollment for HCBS Waiver Providers – Wednesday 9:45-12:00 & 12:45-3:00 McDonnell B

  27. Resources PEPSI Website: http://www.dhs.state.mn.us/dhs 144650 PEPSI Email:DHS.DSD.pepsi@state.mn.us DSD Resources : http://www.dhs.state.mn.us/id_003540 MNHelp:http://www.mnhelp.info

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