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					      Quality Assurance Overview




May 20, 2011                       1
Quality Assurance System Overview
    FY 04/05- new Quality Assurance tools
     implemented, taking into consideration
     CMS Quality Framework and expectations
    FY 05/06- various revisions to Quality
     Assurance tools, including deletion /
     addition of some QA Indicators and
     reorganization of some Outcomes, scoring
     revision, modification of performance
     levels
    FYs 06/07, 07/08, 08/09, 2010 & 2011-
     minimal changes to the Quality Assurance
     tools, contributing to the ability to further
     compare data / performance across
     extended periods of time




May 20, 2011                                         2
Inter-Rater Reliability Overview
    Reliability: measurement between 2 or more raters
     using the same tool, to establish the extent of
     consensus on use of the tool

    The expected outcomes of the Inter-Rater Reliability studies
     are:
      Provide a wide-range of sampling opportunities across
        regions and surveyors
      Measure the extent of agreement in regard to compliance
        with QA Indicators
      Identify Indicators where there are trends in differences of
        scoring across numerous IRR studies
      Provide opportunities to increase consensus through such
        mechanisms as refining surveyor guidance, modification of
        tools, education of those entities being surveyed


May 20, 2011                                                          3
IRR- Summary of the Data
FY 08/09
    The table below shows reliability data for the FY
     08/09 fiscal year, representing degree of agreement
     among Quality Assurance reviewers.




May 20, 2011                                               4
Quality Assurance System Overview
        Quality Assurance Survey Process:

              Consultative Reviews
              Annual Review except for some clinical providers and those
               providers achieving 3 or 4 Star status
              Sample Selection
              Notification / document request
              On-site review
              Conciliation process
              Report of findings
              Quality Improvement Planning
              Reporting through Regional and Statewide Quality
               Management Committees



May 20, 2011                                                                5
Quality Assurance System Overview
    Quality Assurance Tools:
         Organizational:
              Day-Residential / Personal Assistance /
               Clinical
              Independent Support Coordination
               (organizational practices & utilizing data
               from waiver Individual Record Reviews)

         Individual:
              Day-Residential
              Personal Assistance
              Behavioral
              Nursing
              Therapy




May 20, 2011                                                6
Quality Assurance System Overview
        Quality Assurance Tool Structure:
              Domains
          1. Access and Eligibility
          2. Individual Planning and Implementation
          3. Safety and Security
          4. Rights, Respect and Dignity
          5. Health
          6. Choice and Decision Making
          7. Relationships and Community Membership
          8. Opportunities for Work
          9. Provider Capabilities and Qualifications
          10. Administrative Authority and Financial Accountability
              Outcomes
              Indicators
                Guidance and Provider Manual References


May 20, 2011                                                          7
Quality Assurance System Overview
        Quality Assurance Scoring & Domain
         Applicability:
              Domains Applicable by Provider Type:
               Day-Residential: 2, 3, 4, 5, 6, 7, 8, 9, 10
               Personal Assistance: 2, 3, 4, 5, 6, 9, 10
               Support Coordination: 1, 2, 3, 9, 10
               Behavioral: 2, 3, 4, 6, 9, 10
               Nursing: 2, 3, 4, 5, 6, 9, 10
               Therapy: 2, 3, 4, 6, 9, 10



              On the web:
               QA and Waiver Review Tools
               Report Card Listing


May 20, 2011                                                  8
Quality Assurance System Overview
        Quality Assurance Tool Scoring:
              Domains:
                 6- Substantial Compliance
                 4- Partial Compliance
                 2- Minimal Compliance
                 0- Noncompliance

              Outcomes:
                  SC- Substantial Compliance
                  PC- Partial Compliance
                  MC- Minimal Compliance
                  NC- Noncompliance

              Indicators:
                   Yes- Substantial Compliance
                   No- Noncompliance



              Performance Levels:
                  Exceptional Performance
                  Proficient
                  Fair
                  Significant Concerns
                  Serious Deficiencies


              Special Scoring Criteria:
                  Exceptional: A score of Substantial Compliance is required in Domains 2, 3, 5 and 9, if applicable.

                  Proficient: For each applicable Domain, the performance score must be at least Partial Compliance.

                  Fair: For each applicable Domain, the performance score must be at least Minimal Compliance.




May 20, 2011                                                                                                             9
                   Star Providers- 3 & 4 Star Status
    4-Star Status:
         96% or above compliance on QA surveys for 2 years;
           No Domain below Partial Compliance

           Must achieve Substantial Compliance in Domain 3

           ISC agencies must achieve Substantial Compliance in Domain 2

         No preventable egregious events resulting in death of individual for
          one year;
         Annualized substantiated investigation rate of 10 substantiations per
          100 persons supported (10:100) or less for one year;
         Quality Tier designation from Court Monitor, if applicable.

         Approval for four-star status is by the Regional Quality Management
          Committee, followed by submission to State-wide Quality
          Management Committee for final approval.

    May 20, 2011                                                             10
                   Star Providers- 3 & 4 Star Status
    3-Star Status:
         85% or above compliance on QA surveys for 2 years;
           No Domain below Partial Compliance

           Must achieve Substantial Compliance in Domain 3

           ISC agencies must achieve Substantial Compliance in Domain 2

         No preventable egregious events resulting in death of individual for
          one year;
         Annualized substantiated investigation rate of 10 substantiations per
          100 persons supported (10:100) or less for one year;
         Quality Tier designation from Court Monitor, if applicable.

         Approval for four-star status is by the Regional Quality Management
          Committee, followed by submission to State-wide Quality
          Management Committee for final approval.

    May 20, 2011                                                             11
Impact of Quality Assurance Data
    Provides an overview of system performance

    Viewed and utilized by a wide audience
        Data utilized by DIDD Central Office, Agency
         Teams, Regional Offices, Quality Management
         Committees, court monitors

    Facilitates change throughout the service delivery
     system and decision making
         Data is used in assessing progress and to
          identify areas needing corrective intervention



    Special Reporting
        Focused review of Domains, Outcomes and
         Indicators
        Focused analysis with provider detail
        Review of provider performance by provider-
         type and regionally
        Comparison of performance across years




May 20, 2011                                               12
Sample Data:




May 20, 2011   13
Sample Data:




May 20, 2011   14
Sample Data:
Day-Res.        FY 06/07   FY 07/08   FY 08/09   7/1/09 –
                                                 12/31/10



  Domains 2        21%        24%        41%         53%




            3      23%        40%        42%         45%


            4      65%        71%        75%         83%


            5      37%        35%        42%
                                                    55%
            6      74%        87%        93%         96%


            7      94%        96%        96%         99%


            8      73%        84%        82%         93%


            9      18%        33%        41%         35%


           10      48%        45%        59%         59%




May 20, 2011                                                15
Waiver Monitoring Overview
    DIDD implements three HCBS Waivers under the administrative oversight
     of TennCare:
      Self-Determination Waiver

      State-wide Waiver

      Arlington Waiver



    Each waiver entails annual monitoring as performed by Quality Assurance,
     with follow-up remediation and validation activities as coordinated by
     regional Operations and Case Management staff
    Monitoring for each waiver consists of administration of two review tools
         Qualified Provider
         Individual Review (involves identification of a state-wide sample which is selected
          at the beginning of each waiver-year)
    All findings / issues are expected to be remediated with provider and
     systemic trends identified and addressed as data is analyzed.
    Findings / issues are reviewed and discussed by both the Regional Quality
     Management Committees and the State-wide Quality Management
     Committee


May 20, 2011                                                                                16

				
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