CBAS Quality Strategy 102116

Transcript

1 Community - Based Adult Services (CBAS) Quality Assurance and Improvement Strategy October 201 6 (A Five Year Strategy) -

2 Community Based Adult Services ( - CBAS ) Strategy Assurance and Improvement Quality October 2016 Overview I. The mprovement Community - Based Adult Service s (CBAS) Quality Assurance and I CBAS ( Strategy long effort on the part of multiple - is the result of a year Quality Strategy) stakeholders, including Medi Cal managed care plans, CBAS providers, advocates, and - representatives from the Department of Health Care Services (DHCS) and the California Department of Aging (CDA). The CBAS Quality Workgroup first convened in July 2015 and concluded formal Workgroup activities on June 22, 2016. The Workgroup Charter Appendix 1) ( reference specified that the Wo rkgroup ’s task was to: Develop a quality assurance and improvement strategy for CBAS that includes metrics for tracking and improving participant outcomes and the quality of care delivered by CBAS providers. - – Cal 2020 - Special Demonstration Waiver Medi R equirements in California’s 1115 ) specify that 49 Terms and Conditions (STC assurance and monitoring quality CBAS must be consistent with the managed care Quality Strategy required by federal 49 with managed care plans. STC regulations and incorporated into DHCS’ contracts specifically states that quality assurance and improvement for CBAS must assure participant health and safety and address: The quality and implementation of the CBAS beneficiary’s person - centered  individual plan of care ( I PC ) ; and  The provider’s adherence to s tate licensure and certification requirements. orkgroup to In addition to these requirements, s takeholders indicated they w anted the W the following : address care Quality metrics for person - centered care/continuity of   Clinical and program outcome measures/indicators staff training on best practices and quality improvement  CBAS center  Improved use of existing enforcement provisions for CBAS centers that do not meet licensing or certification standards Numerous quality initiatives are underway at the state and national levels – most notably, the DHCS Managed Care Quality Strategy, the California Association for Adult Day Based Services - (CAADS) Quality Workgroup, and the Home and Community Services ’ Appendix reference ( ] by the National Quality Forum (NQF) coordinated [ t Quality Projec 2 of 10 | Page October 201 6

3 Community CBAS Based Adult Services ( - ) Strategy Quality Assurance and Improvement October 2016 2 ) . Because development of uniform measures for home and community - based services early stages of and long term services and supports are still in the - development, the CBAS Qu ality Strategy focuses primarily on CBAS providers and service delivery rather This focus on provider characteristics participant outcomes. select and performance than assumes that improved lead to better participant outcomes and structures and processes satisfa ction . Still, t he CBAS Quality Strategy is flexible and allow s for later adoption of . participant outcome measures that align with state and national initiatives evolving CBAS Quality Strategy : The  R einforces the program’s purpose – to restore or maintain CBAS participants’ optimal capacity for self - care; delay or prevent inappropriate or undesirable institutionalization; and maintain individuals in their homes and communities for as long as possible ; ffirms the commitment among CDA, DHCS, managed care plans, and providers  A ’s to achieve the program ; through improved provider performance purpose  I dentifies activities to assure federal partners, beneficiaries, an d the public that CBAS providers meet standards for participation in the program ; and  I dentifies new approaches to improving quality and sharing measures of quality with the public. CDA e CBAS Quality Strategy , To accomplish the activities, goals, and objectives of th and DHCS will establish an a dvisory c ommittee comprising CBAS providers, managed outlines This document care plans and interested advocates to guide its implementation . broad terms the in the next five years. B ased on anticipated for efforts implementation input from the CBAS Quality Advisory Committee, CDA and DHCS will develop work plans with the detail necessary for achieving the goals and objectives and completing the activ ities described below . Strategy , Quality To continue to make progress on the goals and objectives of this CBAS ay the need to review and revise it annually. Revisions m DHCS and CDA anticipate incorporate additional focus areas and activities needed to address new policy , quality initiatives, and other changes in the health care/long - term services and supports The CBAS Quality Advisory Committee will play an instrumental role in ironment. env CBAS Strategy evaluation process. In this respect, th Quality is a ongoing guiding this e living document that represents a starting point for quality efforts over the coming five - years one that will remain flexible and responsive to the changing environment and . lessons learned during its implementation 3 of 10 | Page October 201 6

4 Community Based Adult Services ( - CBAS ) Strategy Assurance and Improvement Quality October 2016 Priorities and Strategy II. Activiti es the The CBAS Quality Workgroup and various stakeholders who provided input set requirements based on CBAS Quality Strategy that comprise the priorities and activities Cal 2020 Waiver specified unde of the Medi - r STC 49 , which state that quality assurance and improvement for CBAS must assure participant health and safety and address: -  The quality and implementation of the CBAS beneficiary’s person centered IPC; and  The provider’s adherence to s tate licensure and certification requirements. Additionally, the Workgroup and stakeholders broadly agreed that activities in the CBAS Quality Strategy should focus on identifying and promoting best practices, including - evidence centered and - person based care. CBAS Quality meet the requirements of STC 49 and promote best practices, the both To : on activities that es focus Strategy Giv e providers tools and training to improve the quality of service delivery   Provid e greater transparency through public reporting of provider profile and compliance data  E nhanc e collaboration and partnerships among CDA, managed care plans, and providers accountability provider  Increase remediate Identify and  poor ance perform provider innovative p best practices their e romot and providers  Recognize high perform ing , Objectives for Assuring and Improving Quality III. Goals and T : h has two overarching goals e CBAS Quality Strategy Goal I Assure CBAS through improved provider compliance with program requirements State oversight, monitoring, and . transparency activities Goal II 4 of 10 | Page October 201 6

5 - Community ) Based Adult Services ( CBAS Strategy Quality Assurance and Improvement 2016 October Improve service delivery by promoting CBAS best practices, including person - centered and evidence - based care . Followin g is a summary of the goals and the objectives associated with assuring and The e . five years next over the improving CBAS quality achieving imelines for stimated t the objectives are identified as follows : Term (ST): under two years - Short 10/2018) – (10/2016  - Medium Term (MT): two to four years  (10/2018 – 10/2020) – (10/2020 - 10/2021 or later)  Long Term (LT): over four years GOAL I: Assure mproved provider compliance with program requirements through i CBAS State oversight, monitoring, and transparency activities Target Objective Additional Information Completion Date I .A. MT Data may include: Track and publish provider 10/2020 profile and compliance data on website for public CDA ’s  data Additional descriptive reference . center services (e.g., about of service, hours /days served, special populations etc.) S urvey reports  -  HCB Setting/person centered planning compliance rofessional therapy hour  P s ratio  Staff completion of r equired training  to CDA time reporting n - O -  Best practices for person centered and evidence - based care I.B ST Formalize communications and Conference calls to discuss : 10/2018 collaboration with managed care plans to address identified  Significant provider and/or problems provider participant problems or issues identified by CDA during center monitoring and/or certification survey s of | 5 Page 10 October 201 6

6 Community Based Adult Services ( - CBAS ) Strategy Assurance and Improvement Quality October 2016 CBAS mproved GOAL I: Assure provider compliance with program requirements through i State oversight, monitoring, and transparency activities Target Additional Information Completion Objective Date  Significant provider and/or participant problems or issues identified by managed care plans during credentialing or Physical ) Accessibility Review ( PARs visits  Provider reporting issues  eed for provider The n technical assistance and training Joint onsite visits by managed care may be conducted plans and CDA as needed I.C ST To promote broad understanding of Partner with CBAS providers to 10/2018 offer on the from CBAS program the provider site orientation at CBAS - centers for new CDA CBAS prior to and participant perspective s Branch staff new CDA staff beginning oversight and monitoring duties I.D LT This is a long Reform ADHC statutes and term objective, to be - 10/2021 regulations to conform with the achieved by DHCS, CDA, and California Department of Public current CBAS requirements over several years. Health ( CDPH ) ory focus on Phase I would statut reform. Phase II would focus on regulatory reform. I.E ST Formal activities of the IPC Revision he t Revise and implement 1/201 8 CBAS I P lan of C are in June 2016. ndividual d Workgroup conclude IPC ( Projected implementation of the ) revised IPC is Spring 2017. Post - Workgroup activities include drafting and instructions , revising definitions the Medi - Cal InPatient/OutPatient Manual , and providing training via webinar and at provider conferences . and meetings Page 6 of 10 | October 201 6

7 Community Based Adult Services ( - ) CBAS Strategy Quality Assurance and Improvement 2016 October mproved provider compliance with program requirements through i CBAS GOAL I: Assure State oversight, monitoring, and transparency activities Target Objective Completion Additional Information Date I.F ST may Develop standardized forms . Forms include: 10/2018  Uniform history and physical and update forms per Welfare and Institutions Code ( 14526.1 ) WIC  Participation Beneficiary The Agreement Form that meets regulatory and 1115 Waiver requirements for person - centered planning I.G ST Participant Modify Since most PCR data fields are the 10/2018 drawn from the IPC, both Characteristics Report documents need to align. The newly (PCR)(CDA CBAS 293) to incorporate revised IPC scheduled to be new IPC fields implemented in January 2017 will provide numerous new data fields that will improve program monitoring and reporting. I.H ST CDA currently maintains data on Publish data on CDA’s website 10/2018 about the timeliness of CBAS provider reporting of the Monthly Statistical Summary Report (MSSR) , providers’ submission of Participant Characteristics Report required reports , Discharge Summary and (PCR) Incident Reports . Timely and accurate reporting to CDA and the managed care plans is an important and critical to administrative function as well participant care coordination or that the center has as an indicat established eff ective administrative systems . Information posted to CDA’s website may include data on the percentage of reports submitted on - time or a threshold score , annually of 10 7 Page | October 201 6

8 - Community CBAS ) Based Adult Services ( Assurance and Improvement Quality Strategy October 2016 GOAL I: Assure CBAS mproved provider compliance with program requirements through i State oversight, monitoring, and transparency activities Target Additional Information Completion Objective Date time - indicating a provider is an “on reporter.” I.I MT Information posted to CDA’s website will compliance with Validate imely completion of minimum t include 10/2020 training of requirements for er program training for all center staff p . Publish data on center staff requirements CDA’s website about providers’ compliance with training CBAS c will enters staff training report requirements. CDA will develop information to CDA . a process ing and implement for validat training reports prior to posting provider . results training CDA will develop assist for posting on website to modules providers with understanding minimum training requirements for staff upon hire and on an ongoing basis. I.J MT Laws, regulations, and Waiver Develop user friendly program - t easily accessible. requirements are no 10/2020 checklists/job aids requirement Checklists and job aids could be used for center staff . for staff training CBAS best practices, including service delivery by promoting GOAL II: Improve - centered and evidence - based care person Target Objective Additional Information Completion Date II .A. MT that raining Specialized t Identify and set standards s exceed 10/2020 specialized training of for ay minimum training requirements m n the following: include . center staff Publish data o training on CDA’s website centers that i dentify ing  Person - centered care specialized complete Cultural and specialty  training. population competency Administrator/program  director leadership training I.B I MT Establish core person - Core practices may include: 10/2020 centered care practices . Use of specific PCC tools  Publish data on CDA’s  PCC training of center staff Page 8 | 10 of October 201 6

9 - Community CBAS ) Based Adult Services ( Quality Assurance and Improvement Strategy October 2016 GOAL II: service delivery by promoting best practices, including CBAS Improve centered and evidence based care person - - Target Completion Objective Additional Information Date dentify website i centers ing  Establishing of PCC practices that implement II.C MT Possible measures may include: Develop and adopt 10/2020 CBAS standard ized Surveys conducted annually  participant/caregiver  of surveys Percentage satisfaction survey . Publish returned data on CDA’s website Process for center quality  centers that i dentify ing improvement based on . implement feedback II.D MT Examples of status/ conditions for and adopt validated Identify 10/2020 assessment/ screening may include: screening tools conditions for status/ specific of the CBAS population  Cognitive impairment Publish data on the served.  Depression ing dentify CDA website i Fall risk  centers that adopt (publish)  Suicide Anxiety  Alcohol/Substance Abuse   Medication Management II.E LT Identify centers that inform Centers to report to CDA. CDA will 10/2021 validate. and assist participants with Care completing Advanced CBAS centers will report information to - . life Planning for of end - CDA regarding Advanced Care Post data on CDA’s website Planning practices. CDA will develop identifying centers that offer and implement a process for validating Advanced Care Planning. provider practices prior to posting results. F II. MT Centers are required to provide a rack monthly therapy T 10/2020 minimum consultant hours for each therapy number of hours of center as a percentage of services each month based on hours . Publish data required average daily attendance from the on CDA’s website required previous quarter. The showing hours therapy ratios for each a combination of met through can be | Page of 9 10 October 201 6

10 Community CBAS Based Adult Services ( - ) Strategy Quality Assurance and Improvement October 2016 best practices, including GOAL II: Improve service delivery by promoting CBAS person centered and evidence - based care - Target Objective Additional Information Completion Date services provided (publish) by the physical, center. occupational, or speech therapist, the mental health specialist, and maintena nce program services provided by program aides. These services must be responsive to participants’ assessed needs. II.G. MT , California Section 54211, Title 22 Identify and set standards 10/2020 for an requires Code of Regulations best practices for eam o process t determine the MDT m ultidisciplinary t medical, psychosocial, and (MDT) process . Publish data on CDA’s website functional status of each participant identify ing each participant's and develop centers that care implement (publish) individual plan of Regulations . do not specify how are to centers conduct the MDT assessment and care planning process . easure One m of MDT best practice could be r egular team meetings . IV. Summary The establishes clear goals and objectives and sets a broad CBAS Quality Strategy agenda of activities to be completed between October 2016 and 2021 . The CBAS Quality Strategy is designed to assure federal partners, beneficiaries, and the public that CBAS meet program sta new approaches to providers ndards while they continu e to develop improv . CDA and DHCS will implement t he CBAS Quality Strategy ing service delivery with the ongoing partnership and assistance of managed care plans , CBAS providers , . and advocates who participated in the CDA and DHCS thank all develop ment of the that will help CBAS Quality Strategy and look forward to the continued collaboration , to realize the goals and objectives included here . CBAS Quality Strategy Workgroup Charter Appendix 1 : 2 Appendix I uality Q tate S ational and N nitiatives : 10 of 10 | Page October 201 6

11 Appendix 1 C ommunity - Based Adult Services (C BAS ) Quality Workgroup Charter Workgroup Quality (CBAS) ervices S dult A Workgroup ased B Charter C ommunity - Name that for CBAS assurance and improvement strategy quality a evelop D Purpose participant outcomes and the and improving includes metrics for tracking qualit y of care delivered by providers. CBAS Members Organization Member Celine Regalia Adult Day Services of Napa Valley Ruth Gay Alzheimer’s Association Among Friends Irene Kovalik Mark Kovalik Among Friends Cristine Flandez Anthem Blue Cross Anthem Blue Cross Beth Sharma Deb Toews Anthem Blue Cross Allison Lam Anthem Blue Cross Lydia Missaelides Adult Day Services California Association for (CAADS) DayOut ADHC Elizabeth Machado Lois Sones Elderday Santa Cruz Daisy Absalon Eskaton ADHC Golden Castle ADHC Irina Kolomey Health Net Selina Escobar Health Net Gladys Lazaro Health Net Candace Ryan LA Care Gretchen Brickson LMS Health Partners ADHC Luba Droz Min Cole Mikkon Adult Day Health Care Center Mills Peninsula Health Services Maureen Dunn Antoinette Reddick Mt. Diablo Center t Peg Taylor Center for Adult Day Health Care Diane Pucket ADHC Victory Berdj Karapetian DHCS and CDA DHCS/CDA Staff CBAS provisions of During the CBAS Stakeholder Process to amend the Background Bridge to Reform the 1115 Waiver that began in December 2013, CBAS ir desire to form a providers and managed care plans expressed the workgroup to requirements in , Further . develop a quality strategy for CBAS June 2 of 1 Page 2016

12 Appendix 1 Special Terms and Conditions (STC Waiver Bridge to Reform 1115 the Background, 100 ) specify that quality assurance and monitoring of CBAS must be Continued care Quality Strategy required by federal consistent with the managed contracts with managed care regulations and incorporated into DHCS ’ plans. STC 100 specifically states that quality assurance and improvement for CBAS must assure participant health and safety and address: - The q 1. uality and implementation of the CBAS beneficiary’s person centered IPC; and 2. The provider’s adherence to State licensure and certification requirements. Stakeholders indicated they would like the workgroup to address additional areas including: centered care/continuity of care. etrics for person Quality m - 1. 2. Clinical and program outcome measures/indicators. 3. CBAS staff training on best practices and quality improvement. 4. Improved use of existing enforcement provisions for CBAS centers or certification standards. that do not meet licensing eetings and/or conference calls will begin July 2015. The kick - off meeting Anticipated M Meeting will be combined with a meeting of the CBAS Individual Plan of Care (IPC) Schedule Revision Workgroup. Duration: month period. - The Workgroup will meet over an estimated 12 June 2016 Page of 2 2

13 Appendix 2 National and State Quality Initiatives Quality Initiatives National 1. Agency for Healthcare Research and Quality http://www.ahrq.gov/ National Quality Strategy a. http://www.ahrq.gov/workingforquality/ National Adult Day Services Association (NADSA) 2. http://www.nadsa.org/ - Outcomes Project SA Research a. NA http://www.nadsa.org/research/ National Association of States United for Aging and Disabilities (NASUAD): Initiatives 3. http://www.nasuad.org/about nasuad - a. National Core Indicators – Aging and Disabilities http://www.nasuad.org/initiatives/national - core - indicators - aging - and - disabilities http://nci - ad.org/ 4. National Committee for Quality Assurance (NCQA) http://www.ncqa.org/ 5. National Core Indicators (NCI) http://www.nationalcoreindicators.org/ 6. National Quality Forum (N QF) http://www.qualityforum.org/Home.aspx 7. NCQA Healthcare Effectiveness Data and Information Set (HEDIS) & Performance Measurement http://www.ncqa.org/hedis - quality - measurement 8. The SCAN Foundation http://www.thescanfoundation.org/sites/default/files/essential_attributes_brief_septe mber_2016.pdf State Quality Initiatives California Department of Health Care Services (DHCS) 1. a. Medi - Cal Managed Care – Quality Improve ment & Performance Measurement Reports http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDQualPerfMsrRpts.aspx b. Strategy for Quality Improvement in Health Care http://www.dhcs.ca.gov/services/Pages/DHCSQualityStrategy.aspx

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