Cathy Cope Melissa Hulbert Centers for Medicare & Medicaid Services

Major Accomplishments and Outcomes

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  The Department’s Quality Review Program was developed in collaboration with its contracted QIO, First Health Services of South Carolina (hereafter, First Health). Assessment domains include providers’ licensing, quality assurance reviews, risk management, personal outcome measures, and consumer satisfaction. First Health is contracted to perform the scope of work using quality indicators that relate to clients’ health, safety, dignity, personal choice, community participation, and goal attainment.
  

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  The grant’s Quality Evaluation Team assessed the Quality Review Program’s effectiveness in addressing two Quality Framework domains: participant safeguards and participant-centered service planning and delivery. As part of the assessment, NASDDDS drafted a preliminary findings report on QA/QI data collected through both the internal licensing process and the external quality assurance reviews conducted by First Health. In addition, the Team conducted interviews with Department staff, statewide Disabilities Board Executive Directors, and other key stakeholders to identify the strengths and weaknesses of the Quality Review Program and to identify key issues and trends.
  

Based on the findings of the two NASDDDS reports, the Department revised current policies, procedures, standards, and the quality assurance review process to incorporate measures of compliance needed to achieve the intent of the seven domains in the CMS Quality Framework. NASDDDS evaluated the revised system and repeated the review, revision, and evaluation activities to assess the Quality Review Program’s effectiveness in addressing the remaining five domains of the Quality Framework.

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  The University of South Carolina arranged, conducted, and reported on eight focus groups that included state Medicaid staff, Disabilities Board Executive Directors, service coordinators, consumer groups, family member groups, and direct support staff. The purpose of the focus groups was to gather information on the Department’s quality assurance review and licensing processes. Questions for the focus groups were designed based on the CMS Quality Framework, and the information gathered was a key component of the overall evaluation of the Quality Review Program.
  
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  The Department and the University of South Carolina arranged for the Human Services Research Institute to train survey team members and policy staff about how to conduct consumer interviews, using a train-the-trainer process; and to assist the Department in developing a Quality Management process for ongoing continuous quality improvement, which the State implemented.
  
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  The Department and the University of South Carolina used grant funds to plan and implement a Quality Conference to disseminate the results of the Quality Review Program’s evaluation, and to provide information on issues relating to the State’s quality assessment and improvement efforts. The Conference provided a forum for service providers, members of the Stakeholders’ Advisory Group, and family members to discuss local, state, and national perspectives on quality.
  
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  NASDDDS conducted an end-stage assessment to determine the use and applicability of the Quality Review Program’s revised model in addressing the original goals set forth by the Quality Framework. It also developed recommendations for possible use in fulfilling CMS oversight reviews of HCBS waivers.
  

Enduring Systems Change

The State revised policies, procedures, and standards in its Quality Review Program.

Key Challenges

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  As a result of lack of response, the original request for proposals for an external research entity was recalled in March 2004, revised, and released in September 2004. The contract was finally awarded in January 2005, delaying grant implementation by 15 months.
  
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  The Department and the contractors were unable to complete grant activities because CMS would not extend the grant longer than 18 months. The State authorized and appropriated funds to continue paying the contractors until their work was completed.
  

Continuing Challenges

Combining monitoring for regulatory compliance with outcome measurement is a continuing challenge.

Lessons Learned and Recommendations

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  Reporting quality data can create problems if the public does not know how to interpret the data. When data are misinterpreted and used against providers they could be reluctant to provide data in the future.
  
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  CMS should shift its primary quality management focus from emphasizing regulatory compliance to measuring outcomes—or at least achieve a better balance between the two.
  
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  To help states ensure that the data they collect are in accord with the CMS Quality Framework and the waiver assurances, CMS should clarify that the assurances differ from the domains in the Quality Framework, even though some appear to be the same (e.g., service planning).
  
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  Contracting with Quality Improvement Organizations to conduct quality management activities assures the public that the reviews will be objective. Another advantage is that CMS provides a 75 percent federal match for approved QIOs.
  

Key Products

Reports

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  NASDDDS developed two reports: Preliminary Themes from Interviews on Quality Assurance Information Flow at SCDDSN and Themes from Interviews on Quality Assurance Information Flow at SCDDSN: Key Findings and Recommendations on Processing QA/QI Reports and Information.
  
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  The University of South Carolina completed the Report on Interviews with SCDDSN Board Staff: Views on First Health and SCDDSN Licensing Review Processes.
  
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  The University of Minnesota completed Quantitative Data from First Health Services (FHS) on the Relationship between South Carolina Quality Assurance Measures and the National Core Indicators Survey.
  

Directory: sites -> nasuad -> files -> hcbs -> files
sites -> 587 Return function, r i(X) r i(0) r i(1) r i(2) r i(3) 1 0 2 4 6 Thermal Station, I 2 0 1 5 6 3 0 3 5 6 10
sites -> Glossary for Chapter 1 Algorithm
sites -> North Carolina Inclusion Initiative Mapping Where Children with ieps are Being Served Purpose
sites -> Northern England’s set-jetting locations
sites -> Physical custody of 1033 program property accountibility form statement of Physical Custody: By signing for the below 1033 property I am a Law Enforcement Officer of the aforementioned Law Enforcement Agency
sites -> Nstructions for Acquiring Excess Equipment online, through the 1033 Program
sites -> Memorandum of agreement
files -> Acronyms introduction: The most important fact about acronyms and professional jargon is that it is not necessary for any of this work. In fact

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