part i: the pepsi project pamela sulmer, ms -- dhs disability services division leah zoladkiewicz --...
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PART I: THE PEPSI PROJECTPART I: THE PEPSI PROJECT
Pamela Sulmer, MS -- DHS Disability Services DivisionPamela Sulmer, MS -- DHS Disability Services DivisionLeah Zoladkiewicz -- DHS Disability Services DivisionLeah Zoladkiewicz -- DHS Disability Services Division
ScopeScope
Home and Community Based Waiver Providers:Home and Community Based Waiver Providers:Community Alternative Care Waiver (CAC)Community Alternative Care Waiver (CAC)Community Alternative for Disabled Individuals Community Alternative for Disabled Individuals
Waiver (CADI)Waiver (CADI)Developmental Disability Waiver (DD)Developmental Disability Waiver (DD)Traumatic Brain Injury Waiver (TBI)Traumatic Brain Injury Waiver (TBI)Elderly Waiver (EW)Elderly Waiver (EW)
What Defines HCBS Quality?What Defines HCBS Quality?
Participant-Centered Access & Service Participant-Centered Access & Service PlanningPlanning
Provider Capability & Service CapacityProvider Capability & Service Capacity
Participant Safeguards & Rights ProtectionsParticipant Safeguards & Rights Protections
Positive Service Outcome & Participant Positive Service Outcome & Participant SatisfactionSatisfaction
Core Components of a Quality Core Components of a Quality Assurance System Assurance System
Service Providers meet Compliance StandardsService Providers meet Compliance Standards
Timely Response to Client ComplaintsTimely Response to Client Complaints
Tools to Prompt Informed Client ChoiceTools to Prompt Informed Client Choice
Service Delivery Monitoring & Systems Service Delivery Monitoring & Systems ImprovementImprovement
Minnesota: A Statewide SystemMinnesota: A Statewide System
Locally-Directed / Locally-ExecutedLocally-Directed / Locally-ExecutedLocally-Directed / Locally-ExecutedLocally-Directed / Locally-Executed
State-Directed / State & Locally-State-Directed / State & Locally-AdministeredAdministered
State-Directed / State & Locally-State-Directed / State & Locally-AdministeredAdministered
Fee For Service ContractsFee For Service Contracts
Establish Provider Standards Establish Provider Standards
Set forth Service Delivery RequirementsSet forth Service Delivery Requirements
Lay the Foundation for Oversight & Lay the Foundation for Oversight & MonitoringMonitoring
Define the Provider FieldDefine the Provider Field
Elimination of Local ContractsElimination of Local Contracts
Centralized HCBS System per CMS MandateCentralized HCBS System per CMS Mandate
Uniform Provider & Service Delivery Uniform Provider & Service Delivery StandardsStandards
Consistent Monitoring & OversightConsistent Monitoring & Oversight
Well-Coordinated Administrative PartnershipWell-Coordinated Administrative Partnership
Waiver Provider Quality Waiver Provider Quality Management: The VisionManagement: The Vision
• State Provider Qualifications & Service State Provider Qualifications & Service StandardsStandards
• Consistent Oversight & Compliance AssuranceConsistent Oversight & Compliance Assurance
QUALIFIED PROVIDER OPTIONSQUALIFIED PROVIDER OPTIONS
• State Provider Qualifications & Service State Provider Qualifications & Service StandardsStandards
• Consistent Oversight & Compliance AssuranceConsistent Oversight & Compliance Assurance
QUALIFIED PROVIDER OPTIONSQUALIFIED PROVIDER OPTIONS
• Provider Performance Beyond ComplianceProvider Performance Beyond Compliance
• Client Experience Evaluation & ReportingClient Experience Evaluation & Reporting
OPTIMAL SERVICE EXPERIENCE OPTIMAL SERVICE EXPERIENCE
• Provider Performance Beyond ComplianceProvider Performance Beyond Compliance
• Client Experience Evaluation & ReportingClient Experience Evaluation & Reporting
OPTIMAL SERVICE EXPERIENCE OPTIMAL SERVICE EXPERIENCE
Provider Meets Qualifications & EnrollsProvider Meets Qualifications & EnrollsProvider Meets Qualifications & EnrollsProvider Meets Qualifications & Enrolls
Provider Complies with Service Provider Complies with Service StandardsStandards
Provider Complies with Service Provider Complies with Service StandardsStandards
Provider Performance & Public Provider Performance & Public Reporting Reporting
Provider Performance & Public Provider Performance & Public Reporting Reporting
The PEPSI Initiative The PEPSI Initiative Phase 1: Review Local Contract ElementsPhase 1: Review Local Contract Elements
Phase 2: Streamline & Strengthen StandardsPhase 2: Streamline & Strengthen Standards
Phase 3: Design an Integrated Compliance Phase 3: Design an Integrated Compliance Assurance SystemAssurance System
Phase 4: System Development towards Phase 4: System Development towards System Transition System Transition
StakeholderStakeholder InvolvementInvolvement
Solicitation of Workgroup MembersSolicitation of Workgroup Members
Work Group StructureWork Group Structure
Work Group ProcessWork Group Process
Phase IPhase I Provider RequirementsProvider Requirements
• Reviewed Components of Model Contract Reviewed Components of Model Contract /Current MHCP Provider Agreement/Current MHCP Provider Agreement
• Recommended Elements to Move Forward Recommended Elements to Move Forward into Uniform Provider Requirementsinto Uniform Provider Requirements
• Established Universal Provider RequirementsEstablished Universal Provider Requirements
Universal RequirementsUniversal Requirements
Training Direct Care StaffTraining Direct Care Staff
Training Owners/ManagersTraining Owners/Managers
Policies and ProceduresPolicies and Procedures
InsuranceInsurance
Phase II Provider RequirementsPhase II Provider Requirements
Evaluated Current standards/Qualifications Evaluated Current standards/Qualifications for Unlicensed Waiver Servicesfor Unlicensed Waiver Services
Recommended Enhancements for Recommended Enhancements for Standards/QualificationsStandards/Qualifications
Service Specific RequirementsService Specific RequirementsTraining Training
Professional licensure/certification/degreeProfessional licensure/certification/degree
Policies and proceduresPolicies and procedures
Background ChecksBackground Checks
InsuranceInsurance
Compliance Assurance SystemCompliance Assurance System
Universal & Customized Standards at the Universal & Customized Standards at the CenterCenter
Ultimately 4 Distinct Functional Ultimately 4 Distinct Functional ComponentsComponents
State-Directed / Jointly AdministeredState-Directed / Jointly Administered
DHSEnrollment
NEED
ID
Client
HCBSAdministrator
Coordination & Faciliation of Service Delivery Per DHS-
Protocol
Proivder Monitoring & Oversight: State-HCBS Administrator Function Per DHS Protocol
Provider
Provider
ProviderProvider
Provider
Provider
Provider
Provider
Provider
ProviderProvider Provider
Provider
Provider
ProviderProvider
Provider Provider
Provider
Enhanced Standards
Certified Assessor
Per DHS-
Protocol
Assessment
Delegated Function Delegated Function Delegated Function
State-Level Provider Oversight Functions & Coordinated Efforts w/
Delegated Local Authorities
CMS
Statewide Consistency Centralized Accountability
Pro
vid
er
Client
Provider
Provider Qualifications
Routine Operational Review
Complaint Response
State HCBS Rate Framework
Se
rvic
e C
ap
ac
ity
As
se
ss
me
nt
& R
es
po
ns
e M
od
ule
PEPSI DEFINES A STATE-DIRECTED INTERGOVERNMENTAL COMPLIANCE ASSURANCE SYSTEM
Provider
ProviderProvider
- Deemed Review Status - Relies on State Certified Provider Data Base- Unfettered Access to Compliance Assurance Data Base
MCO:
Provider Qualification ReviewProvider Qualification ReviewWho are You? How are You Qualified to Who are You? How are You Qualified to
Deliver Service(s)?Deliver Service(s)?
Do You Agree to Comply with Required Policy Do You Agree to Comply with Required Policy and Procedures?and Procedures?
Conducted by the State Prior to Enrollment Conducted by the State Prior to Enrollment
Qualified HCBS Provider DirectoryQualified HCBS Provider Directory
Routine Provider ReviewRoutine Provider ReviewReview 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
Complaint-Driven ReviewComplaint-Driven ReviewThreshold Health & Safety, Participant Rights, Threshold Health & Safety, Participant Rights,
Service Delivery & Operational Management Service Delivery & Operational Management Complaints Rise to Complaints Rise to Uniform Management LevelUniform Management Level
Locally-Administered “State-Directed” Complaint Locally-Administered “State-Directed” Complaint Discovery, Remediation, Improvement Discovery, Remediation, Improvement
Augments Existing Centralized Complaint Augments Existing Centralized Complaint SystemsSystems
HCBS Compliance Assurance HCBS Compliance Assurance System GoalsSystem GoalsCompliance Assurance via Reasoned ReviewCompliance Assurance via Reasoned Review
Uniform Management & OversightUniform Management & Oversight
Leveraging of Expertise & Capability towards Leveraging of Expertise & Capability towards Productive Administrative PartnershipProductive Administrative Partnership
Efficiencies Maximized at Every LevelEfficiencies Maximized at Every Level
Achieving Consistent Oversight Achieving Consistent Oversight ActivityActivity
Centralized System with Well-Directed Centralized System with Well-Directed Division of LaborDivision of Labor
Policy-Embedded IT Drives Review & Policy-Embedded IT Drives Review & ResponseResponse
System Supports Administrative FunctionsSystem Supports Administrative Functions
Value Added for State and Local PartnersValue Added for State and Local Partners
Essential FunctionsEssential Functions
Provider Screening, Service Monitoring, Provider Screening, Service Monitoring, Transparent ReportingTransparent Reporting
Systems-Level Review of Local ActivitySystems-Level Review of Local Activity
ID & Target Improvement OpportunitiesID & Target Improvement Opportunities
Efficient Data Management & Program Efficient Data Management & Program ReportingReporting
Develop Provider Qualification
ReviewCertify/
Enroll Providers
MN HELP Directory
Contract Eliminatio
n
2012
2013
Develop Complaint
Management
Development and Rollout Vision Development and Rollout Vision
Develop Routine Field Review
2014
Q-1
Work AheadWork AheadPolicy Development to Support Monitoring Policy Development to Support Monitoring
Functions & State/Local CoordinationFunctions & State/Local Coordination
Business Process Analysis & Rework Business Process Analysis & Rework Supporting Transition to Centralized SystemSupporting Transition to Centralized System
Development of Core IT InfrastructureDevelopment of Core IT Infrastructure
Development of Training to Support Development of Training to Support ImplementationImplementation
UpshotUpshot
Participants: Access to Qualified ProvidersParticipants: Access to Qualified Providers
Providers: Uniform Statewide Requirements Providers: Uniform Statewide Requirements Eligible if Qualified & Eligible if Qualified &
CompliantCompliant
Local Partners: Efficient, Consistent Oversight Local Partners: Efficient, Consistent Oversight
Access to Statewide Provider DataAccess to Statewide Provider Data
Additional Opportunities Additional Opportunities Lead Agency/Provider Training Opportunities & Lead Agency/Provider Training Opportunities &
Delivery Methods- Tues. 8:30 AM Delivery Methods- Tues. 8:30 AM Commons Commons DoubletreeDoubletree
New Licensing Standards – Tues. 8:30 AM New Licensing Standards – Tues. 8:30 AM RiverviewRiverview
Rate Setting Methodologies Overview – Tues. 1:30 Rate Setting Methodologies Overview – Tues. 1:30 PMPM Ballroom A Ballroom A
Provider Enrollment for HCBS Waiver Providers – Provider Enrollment for HCBS Waiver Providers – Wednesday 9:45-12:00 & 12:45-3:00 Wednesday 9:45-12:00 & 12:45-3:00 McDonnell McDonnell BB
ResourcesResourcesPEPSI Website:PEPSI Website: http://www.dhs.state.mn.us/dhs 144650
PEPSI Email:PEPSI Email: DHS.DSD.pepsi@state.mn.us
DSD Resources : DSD Resources : http://www.dhs.state.mn.us/id_003540
MNHelp:MNHelp: http://www.mnhelp.info
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