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Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Page 1: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

Federal Quality Assurance and Improvement Initiatives

Mary Jean Duckett

Centers for Medicare and Medicaid Services

May 8, 2002

Page 2: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

Duckett 2

Shifting Federal focus - Current

Prospective assurances of quality in waiver applications followed by retrospective review, 3-5 years later

Quality assurance expectations to meet regulatory compliance and/or problem identification, most often with respect to health and welfare

Page 3: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Shifting Federal focus - future CMS recognizes that it has a role that

goes beyond simply giving permission to states to develop institutional alternatives and to monitor compliance with regulatory requirements

It requires that it assess more closely the systems of quality assurance and improvement in place and that it provide direct assistance to its state partners concurrently

Page 4: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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CMSO Quality InitiativesEstablishing a Framework for Quality

Improvement within HCBSDeveloping Quality Improvement Tools for

StatesDeveloping Quality Improvement Tools for

CMSEngaging in Quality Assessment and

Performance ImprovementProviding Technical Assistance and

Resources

Page 5: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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CMSO

F in an c ia l S ys tem s &Q u a lity G rou pR ach e l B lock

S u zan n e B oss tic k

D isab led & E ld eryH ea lth P rog ram sTh om as H am ilton

G len n S tan ton

S u rvey &C ertifica tion

C en te r fo r M ed ica id & S ta te O p era tion sD en n is S m ith

Page 6: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Framework for Quality National Inventory of Quality

Improvement Strategies (DEHPG)Establish a framework/description of relevant

quality domains that will facilitate a common dialog

Identify relevant strategies which states might use to monitor and improve quality within those domains

Conduct research to establish the current “state of the art” for state QA/QI systems for information sharing and planning purposes

Page 7: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

Duckett 7

Tools for States

Consumer Experience Survey/Users Guide (FSQG)

Voluntary Tool for States2 Modules: Elderly/Non-elderly disabled and

MR/DD

Page 8: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Tools for States

Reliability and Validity of Consumer Experience Survey (FSQG)

Current status: Conducting field tests in 3 States

Expected Completion Date: October 2002

Page 9: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Tools for States Self Directed Measures (DEHPG)

Development of performance indicators aimed at family and self-directed service systems, i.e., system performance indicators

Serve as a guide to states as they develop their family and self-directed waivers

States could use it to assess the quality and comprehensiveness of their family and self-directed programs

Page 10: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Tools for CMS Collection and Analysis of State Data

for Long-Term Care/ State Planning Data for Systems Change (DEHPG)

Develop a HCBS waiver databaseIdentify LTC data available and needed for

planningDesign Data Reports and analytical toolsDevelop data collection and transfer processes

and procedures

Page 11: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Quality Assessment and Improvement HCBS Waiver Quality Review Protocol Guide for Conducting Quality Reviews

(FSQG)

Guide for States/Regional Offices (RO) to use as they conduct Quality Reviews

Focus on adequacy and appropriatenessEstimated Completion Date: October 2002

Page 12: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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National Contractor for HCBS Quality (DEHPG)

Resource to CMS Regional Offices (RO) and States

Follow up to RO visits utilizing the protocol where significant opportunities for improvement are identified

Urgent or Emergent follow-up in special circumstances

State requests for consultation, triaged through RO/CO

Page 13: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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National Contractor for HCBS Quality (DEHPG)

Contractors to assist in Root Cause Analysis and identification of quality improvement strategies

NOT look-behind reviewNOT additional monitoring or reviewRepository of CMS Quality related tools,

Technical Assistance and Training2002 focus for MR/DD

Page 14: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Technical Assistance and Resources

Promising Practices (DEHPG)3 year ongoing project to identify and describe

promising practices within state programs intended to assist persons with disabilities of all ages to live and fully participate in communities of their choice

Highlighted will be both broad systems reform efforts (e.g., Michigan’s 1915b/c combo for specialty services) as well as specific tools utilized by states (e.g., Wyoming’s method for individual budgets)

Ongoing posting to CMS web site.

Page 15: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Technical Assistance and Resources Promising Practices

http:www.hcfa.gov/medicaid

Look for “promising practices in home and community-based services”

Page 16: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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TA (cont.)

Data Readiness Project (FSQG)Compile info on selected QI activities that are

data drivenPrepare technical assistance briefs to statesEstimated completion date: late springProvide technical assistance to selected statesEstimated completion date: October 2002

Page 17: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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TA (cont.)

Conference on Quality Measurement and Improvement

May 2-3, 2002, Nashville, TNFeature national/state experts and best

practices in quality measurement/improvementWill include practices identified through the

“Data Readiness” project

Page 18: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

Duckett 18

Other Initiatives of Note

Study of the impact of Medicaid home and community based service programs on quality of life, quality of care, utilization and cost (OSP - Lewin)– Elderly/Disabled and Persons with MR/DD– Resource Network - www.hcbs.org

Page 19: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Other Initiatives of Note

Development and Validation of Performance Measure Set for for the Evaluation of Medicaid Services Rendered to People with DD (SCG)– Indicators for ICF/MR settings– Compliance/Feedback/Benchmarking

Page 20: Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Summary

Coordinated, quality effort that utilizes prospective assurances and retrospective reviews, but will include concurrent quality improvements to further enable the full inclusion and participation of persons with disabilities in communities of their choice.


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