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Office of Developmental Programs
Quality Assessment & Improvement for
HCBS Services
July 19, 2017
Farm Show Complex, Harrisburg PA
7/17/2017 1
WELCOME!
7/17/2017 2
StrategyGoals
Policies
Procedures/Practices
Financing
Training & TA
Service Innovation
Outcome Data
Outcomes
Leadership
13
EDL Recommendations
Listening toself- advocates and
families
Catalysts
Adapted from Hall et al (2007)
Framework for Change
t
Interagency and Stakeholder
Collaboration
t
StrategyServices
Provider
Qualifications
Policies
Procedures/Practices
Financing
Training & TA
QA & I
Leadership
13
EDL Recommendations
Listening toself- advocates and
families
Catalysts
Interagency and Stakeholder
Collaboration
The Waiver is the Strategy
P/FDS & Consolidated Waivers Outcome
Desired Outcomes in Brief
✓ Families with infants and toddlers
and people with Autism get the
support they need
✓ People will be connected to their community
✓ People will live with people they like and who
care about them
✓ People will be physically and mentally healthy
7/17/2017 5
Families with Infants Toddlers Will Get Support
✓Families with infants and toddlers get
the support they need
Because there are infants and toddlers with very
complex needs whose families need help to take
care of them through …..
Supports in the home
Life Sharing
And because we need an
alternative to pediatric nursing homes for them.
7/17/2017 6
People with Autism Will Get Support
People with Autism who don’t have ID
will get the support they need
because….
7/17/2017 7
People Will Connect with Their Community
✓People learn new things, meet new
people, make friends and feel connected
to their community…because it’s the
path to a good life.
Work is one way to do that. People who have a job meet new people,
learn new skills and they feel like they belong, like they are
contributing…..and we want to make sure everyone has that opportunity.
• Expand employment supports
– $15,000 beyond P/FDS cap
– Advanced Supported Employment
– Benefits Counseling
– Transportation benefit for people living in
group homes who have a job
7/17/2017 8
t
People Will Connect with Their Community
• Volunteering is a way to meet people & make a
contribution to the community. It can lead to paid work.
– Meals on Wheels, working in an animal shelter, a food
pantry or helping out in a nursing home or day care center
– these are opportunities to make a difference in the
community, to develop work skills and habits and to meet
people.
• Learning to navigate the community more
independently whether it’s crossing a street at the light or
taking public transportation develops independence skills.
• Going to adult education classes in schools
or libraries creates opportunities.
7/17/2017 9
10
Developing interests and skills in the arts –
painting, singing, dancing, drama – or pursuing
hobbies that other people are interested in – things
like racing model cars, cooking clubs, adult softball or
bowling leagues – all expand opportunities.
Like many of us, people we serve have weight
problems and health risks….so healthy activities like
walking clubs, cycling, water aerobics, diet groups
and yoga can be fun, and they can provide a peer
support group to improve health.
People Will Connect with Their Community
People Will Live with People They Like
• People will live with people they like
and who care about them because it
is the most important thing in life.
– Enhance Support to Families
• Family/Unpaid Caregiver Training and Consultation
• Participant-Directed Goods and Services (P/FDS only)
• Expand Life Sharing to immediate and extended family
members
11
People Will Live with People They Like
– Life Sharing for people in their own homes
– Supported Living Model
– Housing Tenancy and Tenancy Sustaining
Services
12
Waiver Services
– Consultative Nutritional
Services
– Art, Music and Equine-
Assisted Therapy
– Community Participation
– In-home and Community
Support
7/17/2017 13
OK34%
Overweight33%
Obese33%
66 % of 53,000 are Overweight or Obese
They are at risk of diabetes, heart disease and cancer
People Will be Healthy Physically
35%
50%
35% of People with ID have Mental Illness
Mental Health Diagnosis NO MI
7/17/2017 14
Waiver Services
– Art, Music and Equine-
Assisted Therapy
– Communication Specialist
– Behavior Supports
– Community Participation
– In-home and Community
Support
People Will be Healthy Mentally
How will we maximize all of
these new opportunities in the
waiver and achieve the
outcomes?
How to Begin
7/17/2017 15
With a Conversation
• Help people/families create a vision
• Help people/families see all the possibilities
• Show the alternatives
16
How will we know if we are
achieving the outcomes?
QA & I
7/17/2017 17
StrategyP/FDS &
Consolidated
WaiverTypes of Service
Service Specifications
Training Requirements
Rate Structure
Training & TA
Outcome Data
QA & QI
Leadership
Values
Listening to
self- advocates and families
Catalysts
Making Change
t
Interagency and Stakeholder
Collaboration
QA and QI
1. Focus on the Person
2. Based on EDL
recommendations
and outcomes
3. Focus is on quality
improvement
4. Simplify the process
Leadership
Values
Listening to
self- advocates and families
Catalysts
Designing QA and QI to Achieve the Outcomes
tInteragency and Stakeholder
Collaboration
Focus on the Person
• The sample cases are
applied across the AE,
SC and provider.
• Conducting interviews
with individuals
Based on Everyday
Lives Values
• Based on the EDL
recommendations
• Measures aspirational
objectives not just
compliance
Designing QA & QI to Achieve the Outcomes
Simplified
• Less file reviews – 8,800
over three yrs. instead of
15,800.
• Limit provider reviews to
one AE
• Every 3 years
• Questions focus on the
entity being reviewed
• Less Questions
Focus on
Improvement not only
Compliance
• Provider self-assessment
encourages improvement
• 3 yr. cycle allows time to
make improvements
Designing QA & QI to Achieve the Outcomes
7/17/2017 21
Designing QA & QI to Achieve the Outcomes
• Compliance with regulations and rules is still
important but they aren’t enough. We are going
beyond to measure whether we are achieving
valued outcomes for people.
• The QA & QI system is simplified but it’s not simple.
This is a large system with many requirements that
must be met to preserve the program in the most
meaningful and time efficient way possible.
7/17/2017 22
Everyday Lives: Values in Action
7/17/2017 23
Purpose of Revised QA&I Process
7/17/2017 24
• Eliminate multi-layered
process and unnecessary
duplication
• Create more time to focus on
the experience of individuals
• Create more time to focus on
quality improvement
• Desire to move away from
hierarchical compliance and
remediation toward
collaborative partnerships that
foster technical assistance and
shared learning
• Improve methods for collecting
and using data in a timely way
Quality of
the
Individual’s
Experience
Compliance
Purpose of Revised QA&I Process
The mission of the
Office of
Developmental
Programs
is to support
Pennsylvanians with
intellectual and
developmental
disabilities to achieve
greater independence,
choice, and opportunity
in their lives.
7/17/2017 25
Individual
ODP Goals for QA&I
7/17/2017 26
• Measure progress toward systems
improvement based on Everyday
Lives: Values in Action ISAC
recommendations
• Gather timely & useable data to
manage the ODP system performance
• Use data to manage the service
delivery system with a continuous
quality approach
• Demonstrate AE outcomes with
operating agreement
• Collect data for Waiver performance
measures
• Prepare SCOs and Providers to
comply with 6100 regulations
QA&I Partnership
7/17/2017 27
ODP
SCOs
AEs
Providers
ODP QA&I Implementation Team
7/17/2017 28
• Comprised of staff from the Bureau of
Community Supports
QA&I Record
Reviewers
QA&I Leads
QA&I Coordinators
QA&I Review Cycle
7/17/2017 29
QA&I Full Review Period
7/17/2017 30
Self Assessment
Desk Review
Onsite Review
Comprehensive Report
Corrective Action & Quality
Improvement
Technical Assistance
QA&I Interim Review Period
7/17/2017 31
Self Assessment
Corrective Action & Quality
Improvement
Technical Assistance
QA&I Annual Timeline
7/17/2017 32
Onsite
Selections
Announced
June 15
June 30
ODP Issues
Statewide
QA&I Report
• Self
Assessments
Begin
• AE& SCO
Desk Reviews
Begin
July 1
July 15• ODP Notifies
AEs of
Provider Pool;
• Provider Desk
Reviews
Begin
Self
Assessments
Deadline
August 1*(8/31 for 2017)
August 31*(9/30 for 2017)
ODP Issues Self
Assessment
Statewide
Aggregate
Report
All Onsite
Reviews Begin
September 1
November 30Finalize All
Desk Reviews
All Onsite
Reviews
Completed
December 31
January 31All
Comprehensive
Reports Issued
Comp Report
Responses
Complete
including
Corrective Action
& Quality
Improvement
February 28
April 30All
Updated
QM Plans are
Submitted
QA&I Sampling
7/17/2017 33
• Core Sample
– Random, representative STATEWIDE sample
– Sample taken from total Consolidated and P/FDS Waivers
– Opportunity to follow individuals throughout their
experience in the service system
• Self Assessment Sample
– Entities will choose their own individuals to review for the
self assessment
• Provider Sample for Onsite Reviews
– Providers selected by ODP based on last digit of MPI #
– AEs conduct desk & onsite reviews
7/17/2017 34
LUNCH
and
NETWORKING