Using CORE NDICATORS in Federal HCBS Reviews Jon Fortune, Ed.D David Heath, MPA

1. Using CORE NDICATORSin Federal HCBS Reviews Jon Fortune, Ed.DDavid Heath, MPA Wyoming Developmental Disabilities Division & the Wyoming INstitute for Disabilities (WIND-UCE)

4. HCBS Quality Framework ProtocolRed -Indicates that information gathered by Core Indicators provides data that can be reviewed by CMS Domain Sub-Domain I. Participant Access A. Information/referral B. Enrollment II. Participant-centered A. Participant-centered service planningService planning and B. Service Delivery Delivery III. Provider Capabilities A. Provider Networks & Availability B. Provider QualificationsC. Ongoing Monitoring

5. HCBS Protocol (cont.)Domain Sub-DomainIV. Participant safeguards A. Abuse, neglect, exploitation B. Major & unusual IncidentsC. Housing & environment D. Behavior interventions E. Medication management F. Personal safety & security G. Natural disastersV. Participant rights & A. GrievancesResponsibilities B. Due processC. Fundamental Rights

6. HCBS Protocol (cont.) • Domain Sub-Domain • VI. Participant outcomes & A. Participant satisfaction Satisfaction B. Participant outcomes • System performanceA. System performance appraisal B. Continuous quality improvement C. Cultural competency D. Participant & stakeholder involvement E. Financial integrity

7. Several other features in addition to 150 core indicators helped: • Use CARF…The Rehabilitation Accreditation Commission’s national standards for 3 waivers • Individual waiver budget technology (DOORS) with good system architecture * Extensive rules/training • RN, CDDN consultation • Published service provider site survey reports http://ddd.state.wy.us

8. ‘02 & ‘03 Results – Wyoming (Consumer Survey) Wyoming’s performance was strong along four principal scales – community inclusion, support-related choices, personal choices, and service coordination

9. Satisfaction with Work/Day Program (Consumer Survey) 2001 2002 89.1% (n=264) -YES - 94.2% (n=260) 5.7% (n=17) -In between- 4.3% (n=12) 5.0% (n=15) -NO- 1.4% (n=4)

10. Satisfaction with Residential(Consumer Survey) 2001 2002 89.4% (n=288) -YES- 89.7% (n=272) 3.4% (n=11) -In Between- 5.6% (n=17) 7.1% (n=23) -NO- 4.6% (n=14)

11. Case Management - 2002 (Individually-Selected Service Coordination)(Consumer Survey) • 94.7% know their case manager • 93% say their case manager helps them get things that they need if they ask • 89.6% say that their case manager asks them what they want

12. Case Management (Family Surveys) 80.9% (combined total) Satisfied With Services Provided by Case Manager 71.3% Adult/Family 89.1% Child/Family 78.2% Family/Guardian (Thanks Washington State and Lisa Weber!!!)

13. General Information • 91.6% (n=372) get the services that they need (66% of those answering were consumers) • 3.1% of agency boards are consumers • 19.8% of boards are family members • Community Inclusion is high (often @ 90%) • Choice and decision making was high (most had input)

14. Range of annual per person expenditure by living arrangement (2002)

15. Mortality, Serious Injury and Abuse/Neglect (2002) CMS reviewers liked: • NCI definitions of abuse/neglect (and that information was broken down in respect to restraints, injuries, and “substantiation”) • NCI breakdown of mortality (by age and total number in each population bracket) • NCI breakdown and definition of crimes (forcible rape, aggravated assault, larceny theft)

16. Turnover rate: 50% HELP WANTED Direct service staff members $5.66 Need $10.23 (Core Indicator: staff pay and turnover) Funded July 1, 2002 Wyoming Legislature

17. Contact Information http://www.hsri.org/cip/core.html National Core Indicators Web Site Jon Fortune, Ed.D jfortu@state.wy.us 307-777-7115 David Heath, MPA daheath@uwyo.edu 307-766-2609 DDD Wyoming Web Site http://ddd.state.wy.us http://wind.uwyo.edu/wycip/ Wyoming Core Indicators Web Site