Quality Improvement Quality Improvement

StrategyStrategy

Context for the Focus on QualityContext for the Focus on Quality

Began with the growth & expansion of HCBS waiver programs

Growth in expenditures Growth in people served Growth in consumer direction

Self Direction presents challenges for assuring quality

CMS approach to Quality

A quality management data driven model with continuous over-sight

Quality elements are designed into the program

Each state has a quality strategy to continually evaluate it’s own performance, to correct deficiencies and make system improvements….which will tell us if

• assurances are met• outcomes are achieved• people are satisfied

CMS reviews the effectiveness of the state’s Quality Management Strategy

CMS Quality FrameworkCMS Quality Framework

Quality Framework Focus AreasQuality Framework Focus Areas Participant Access

Information and referral; intake and eligibility determination; referral; choice

Participant Service PlanningAssessment; service plan, implementation & monitoring; respond to

changing needs; choice; participant direction Provider Capacity

Licensure and certification; training; provider monitoring Participant Safeguards

Incident management; risk assessment; behavior management; med administration; natural disasters Rights and Responsibilities

Due process; grievance procedures Outcomes and Satisfaction System Performance

Quality Improvement program; financial management

Quality Framework ProcessesQuality Framework Processes

Design… Design… build quality in up front

Discovery… Discovery… look for problems & opportunities

for improvement

Remediation… Remediation… fix problems

Improvement… Improvement… make improvements

Community First Choice Establish & maintain a quality assurance system Incorporate feedback Monitor the health and well-being of each individual Provide information about the provisions of quality

assurance

Community First Choice

CMS Quality Framework Build upon existing structure Develop Quality Outcomes Consumer Satisfaction