Local Provider Monitoring Tool

1. Local Provider Monitoring Tool QI Forum N.C. Council of Community Programs

2. Introduction • What is the new monitoring tool and why is it important? • Rules mandate that there be a standardized tool to be used by LMEs for monitoring. • The tool and accompanying work sheets was developed to promote standardization of the monitoring process across LMEs. • The tool will be used for routine local monitoring of Medicaid and state funded services, including alternative service definitions.

3. Introduction continued: • Domains/Elements reviewed: • Provider’s quality management process • Documentation of and verification of staff competencies and experience • Response to incidents and complaints • Person-centered services and supports • Efforts to safeguard client rights

4. Differences in the new monitoring tool and existing monitoring protocols: • Currently the majority of monitoring is focused on each provider service, leading to a plan to address areas identified for the service reviewed. • The new Provider Monitoring Report will have a single rating for each key element for the entire provider agency across all sites and services within the LME catchment area. • There are limitations on number of consumers/guardians and staff interviewed and number of records to be reviewed.

5. Differences in the new monitoring tool and existing monitoring protocols: • The ratings will give information on where the provider is doing well, based on the sample of documents reviewed during the review, as well as areas where improvement is needed. • Providers will receive a rating of “High, Moderate or Low” for each key element. • The actions to be taken by each LME will be standardized across all LMEs and automatically determined as the worksheets are completed and the Monitoring Report completed.

6. Scope of the Review: • Provider agencies will be assessed on two levels: • I. Organizational level: • Quality management program • Documentation and verification of staff competencies, experience and training • Provider response to incidents and complaints

7. Scope of the Review: • Provider agencies will be assessed on two levels • II. Person Centered Level • Provision of person-centered planning • Provision of person-centered services and supports • Safeguarding individual rights

8. Preparation for the Review: • Gather documents as outlined below for the provider agency since the last monitoring visit or within the last year: • All Level II and III incidents and complaints • Level I Quarterly Report submitted from provider • Reports available to the LME regarding allegations of maltreatment pertaining to the provider agency • All investigations completed by DMH, DHSR, DSS or the LME

9. Preparation for the Review: • Gather documents as outlined below for the provider agency since the last monitoring visit or within the last year: • All plans of correction that resulted from substantiated complaint allegations • The provider’s most recent Quality Management Plan (if available prior to the review) • DMH/DD/SAS assessment guidelines • DMH/DD/SAS Person-Centered Planning Manual

10. Documentation that will be requested from the provider agency: Quality Management Domain • Provider’s QM Plan • Documentation regarding tracking improvement initiatives • Minutes from QM meetings • Sample data report for tracking complaints, incidents, consumer satisfaction • Provider’s grievance/complaints and rights policies and procedures • Minutes of Client Rights/Intervention Committees as allowable under 10A NCAC 27G.0504

11. Documentation that will be requested from the provider agency: Staff Competency Domain • Personnel files • Supervision plans • Training records and calendars • Staffing scheduled and time sheets (where applicable) • Provider’s policies on hiring qualified staff

12. Documentation that will be requested from the provider agency: Person Centered Planning, Person Centered Services and Individual Rights Domains • Service records of sampled individuals • Restrictive intervention logs • Records of accounting of personal funds for sampled individuals (where applicable) • Minutes from client rights committee meetings related to restrictive interventions as allowable in 10A NCAC 27G.0504

13. Documentation that will be requested from the provider agency: Protection from Harm Domain • Provider complaints and rights policies and procedures • All Provider Level I incident reports

14. Standards for Sampling:Personnel records • One service: review 8-10 personnel records (review all files if fewer than 8 personnel) • 2-3 services: review 5 personnel records from each service (Total: 10-15) • 4-6 services: review 3 personnel records from each service (Total: 12-18) • 7-10 services: review 2 personnel records from each service (Total: 14-20) • More than 10 services: review at least 1 personnel record from each service • Review records of clinical staff or paraprofessional staff and those responsible for their clinical/professionalsupervision

15. Sampling: Personnel Interviews • From the Personnel Documentation Sample: • Interview 8-10 personnel • If provider has fewer than 8 personnel, interview all • Only interview staff who have worked with the provider agency for at least 6 consecutive months and have worked with the sampled consumers for at least 60 days • For questions related to provider’s response to incidents, pick a sample of at least 5 staff from incidents reviewed (worksheet #6)

16. Sampling: Consumer Records • One service: review 8-10 consumer records (review all records if fewer than 8 consumers) • 2-3 services: review 5 open consumer records from each service (total: 10-15) • 4-6 services: review 3 open consumer records from each service (total: 12-18) • 7-10 services: review 2 open consumer records from each service (total: 14-20) • More than 10 services: at least one open record per consumer • Select sample from different age/disability groups if possible

17. Sampling: Consumer/Legally Responsible Person Interviews • From the records sampled: • Interview 8-10 individuals (or the legally responsible person) • If the provider serves fewer than 8 individuals, interview all • If possible interview at least two individuals per disability and age group (if a child, interview the parent and/or legal guardian)

18. Sampling: Incidents and Complaints • Select 9 incidents from LME data base (3 each: Level I, II and III) across all provider services in the LME catchment area- • Level I incidents to be reviewed only to determine appropriate categorization • If no Level III incidents, select more Level II incidents to have total of 9 incidents • Fewer than 12 incidents or complaints: review all • Randomly select 9 documented complaints

19. Sampling: Incidents and Complaints • If during the review of a consumer’s record or restrictive intervention log, the LME finds an incident that is not in the sample, the incident will be reviewed in the record and with the consumer and/or staff. • This incident will then be added to the audit sample (up to a total of 15 incidents-no more than 2 incidents for the same consumer)

20. Categorizing CAP Services: • Services where people live: • Residential Supports • Home Supports • Personal Care • Home and Community Care • Services where people work: • Long Term Vocational Support • Supported Employment

21. Categorizing CAP Services: • Services in the Community: • Day Supports • Home and Community (to be replaced by Community Networking via Technical Amendment next year) • Adult Day Health • Transportation

22. Categorizing CAP Services: • Crisis Services: • Crisis Services • Crisis Respite • Behavior Consultation • Respite: • All respite services • Consultative/Training • Specialized Consultation • Individual Caregiver Training and Education

23. Categorizing CAP Services: • Equipment and Supplies: • Specialized Supplies and Equipment • Augmentative Communication • Individual Goods and Services • Home Modifications • Vehicle Modifications

24. Required Actions Based on the Provider Monitoring: • No Actions (None)- requirements associated with the items sub-elements are being met or exceeded by the provider agency. • Recommendation for Improvement (REC): there is a need for improvement in one or more of the sub-elements. No formal follow up required

25. Required Actions Based on the Provider Monitoring • Plan of Correction (POC): there is a deficiency in one or more of the item’s sub-elements sufficient to require a POC. This will be developed and implemented in accordance with DMH/DD/SAS policy. • Plan of Correction with Focused Monitoring (POC-FM): there is a deficiency in one of more of the item’s sub-elements sufficient to require a POC and further monitoring is necessary to determine the extent of the problem prior to issuing the request for the POC. • No later than 10 business days after the monitoring report is issued, the LME will complete an on-site focused (targeted) monitoring to address all elements where this action is required.

26. After completion of the site visit: • At the end of the on site monitoring visit, the LME team shall engage in a brief verbal review of the findings. This is only a cursory review of the results. • The Team Leader shall share the highlights of the findings with the agency’s designee. • The provider will be advised that the LME will have the final written report to the provider within 15 calendar days of the close of the monitoring visit.

27. After completion of the site visit-continued… • The LME shall report and discuss potentially harmful findings, related to health and safety directly with the Provider while on site (if there are no safety concerns for staff) . • Serious/critical health and safety issues SHALL be reported to the appropriate authority immediately (e.g. DSS, DHSR in the case of licensed facilities.

28. Feedback: • The Monitoring Tool Work Group needs your feedback. • A survey is being established on Survey Monkey for each LME and each provider to complete. • The information from the surveys will be incorporated into the ongoing work of the group so we have the best possible tool possible!