Develop opm ent al Disabilit ies Medicaid Waiver er S Ser - - PowerPoint PPT Presentation

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Develop opm ent al Disabilit ies Medicaid Waiver er S Ser - - PowerPoint PPT Presentation

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Develop opm ent al Disabilit ies Medicaid Waiver er S Ser ervices es Qualit y Assu ssurance ce 14 th Annual Family Caf Conference June 14-16, 2012 1 Welcom e and I nt r t roduct i t ions Charmaine Pillay Delmarva Medical

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Develop

  • pm ent al Disabilit ies Medicaid

Waiver er S Ser ervices es Qualit y Assu ssurance ce

14th Annual Family Café Conference June 14-16, 2012

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Welcom e and I nt r t roduct i t ions

 Charmaine Pillay Delmarva Medical Foundation, Inc.  Leigh Meadows Agency for Health Care Administration (AHCA)

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What is s Qualit y Assu ssurance ce?

 Florida’s funding for quality assurance is a 75% government match funded separately from funding for developmental disabilities Medicaid Waiver programs. Funding for the Delmarva contract does not take away from waiver services funds.  Florida’s goal for contracted quality assurance review is to improve the quality of Medicaid-related supports for Florida citizens with developmental disabilities.

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What at is is Delm lm arv arva? a?

The State of Florida’s Agency for Health Care Administration (AHCA) contracts with Delmarva Foundation to provide quality assurance for the state’s Developmental Disabilities Services system. Delmarva’s number one goal in Florida has always been to improve the quality of support for Florida's citizens with developmental disabilities. We work in partnership with the Agency for Persons with Disabilities (APD) at the central office and each local area office. We actively promote individuals' rights, choice, full inclusion, health and safety, respect and dignity, and satisfaction with services and supports.

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Purpose o e of t he e Qualit alit y Assuran rance Cont rac act

 To evaluate the effectiveness of every provider involved in the life of individuals participating in the DD Waivers and Consumer Directed Care Plus (CDC+).  To measure the efficiency and effectiveness of the entire service delivery system.  To help ensure participants are involved in the development of the Support Plan and that providers follow the Support Plan as written.

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What at Does Delm lm arv arva D a Do?

 Interviews participants and representatives of the Developmental Disabilities (DD) Medicaid Waiver and Consumer Directed Care (CDC+) programs to determine their satisfaction with waiver services. Delmarva reports what they discover to AHCA and APD.  Monitors the services delivered to DD Waiver and CDC+ participants by reviewing Medicaid providers. Delmarva also reports information they discover to AHCA and APD. This information tells AHCA and APD what needs to be improved in the waiver services delivery process.  Provides training and education to providers, APD area offices, and DD Waiver and CDC+ participants and families.

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Waiv aiver r Qualit alit y Man anag agem ent

Delmarva’s Role:

  • Discovery of how the system is working for participants and how

providers are delivering services. APD’s Role:

  • Remediation (correcting problems) of

providers and improvement of the system as a whole. AHCA’s Role:  Manage the contract.  Monitor Delmarva and APD.  Ensure the entire system is in compliance with federal and state regulations.  Report to the federal government.

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Who D

  • Decides H

How

  • w Discov
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is is Carrie arried O Out ?

 Performance Measures for the Developmental Disabilities Waivers are defined under core assurances required by the federal government in the actual Medicaid Waiver applications.  State rule for the DD Waiver handbooks are created based on Waiver core assurances and performance measures.  Delmarva, AHCA, and APD work together to create review tools to help us measure whether or not core assurance performance measures are being met.  Performance Review tools, policies and procedures for reviews are posted to Delmarva’s website for the public to access. www.dfmc-florida.org  Delmarva’s review process includes feedback from participants, providers, documentation, provider input, and observation.

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Waiver er S Ser ervices es D Des esignat ed ed f for Rev eview ew in t t he Qualit y Assurance C Cont ract

  • Adult Day Training
  • Behavior Analysis
  • Behavior Assistant
  • Companion Services
  • In-Home Support
  • Personal Care

Assistance

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  • Residential Habilitation
  • Respite
  • Special Medical Home

Care

  • Support Coordination
  • Supported Employment
  • Supported Living

Coaching

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Qualit y Assu ssurance ce Disco scovery P Proce cess ss

Person Centered Reviews (PCRs) Assess Waiver participant’s support delivery systems from the perspective of individuals.

Provider Discovery Reviews (PDRs)

Evaluate provider performance, based on service delivery measures and program standards.

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Qualit y Assu ssurance ce Per erson Cent er ered ed R Rev eview s

 Begins with a face-to-face interview with the individual.  Reviews supports and services specific to that individual.  Review of the Cost Plan, Support Plan, Implementation Plan and service records from each provider rendering services to the individual.

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Qualit y Assu ssurance ce Prov

  • vider Discov
  • very Review s

 Are based on the provider’s particular service.  Evaluate performance in delivering appropriate services and supports to assist the person in achieving personal goals/outcomes and meeting identified needs.  Assess provider’s compliance with Medicaid Handbooks, state rules, and APD provider agreement terms.

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Qualit alit y Assuran rance Report rt s

 Provider scoring is “Met” or “Not Met”.  PCR Reports include findings from interviews with individuals and record review for each provider.  PDR Reports include findings from administrative record reviews, observations, alerts, and potential recoupment.  Public Reporting Website coming soon – www.flddresources.org

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Waiv aiver H r Han andbook

State Rule: Developmental Disabilities Waiver Services Coverage and Limitations Handbook: 59G-13.083

  • Defines DD Waiver provider qualifications
  • Lists requirements and limitations for all services:
  • Go to: http://mymedicaid-florida.com
  • Select “Public Information for Providers”
  • Select “Provider Support” on the left
  • Select “Handbooks”
  • Select “Developmental Services”

**Providers are responsible for adherence to this rule for compliance with reviews**

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St at e e Agen ency and Del elm arva Web ebsit es es

 http://ahca.myflorida.com Agency for Health Care Administration  http://apd.myflorida.com Agency for Persons with Disabilities  www.dfmc-florida.org Delmarva Foundation  http://www.myflorida.com/accessflorida Department of Children and Families, Access Florida (to apply for Medicaid)  http://www.leg.state.fl.us/Statutes/ The Florida Statutes website (AHCA Statutes: Chapter 409. APD Statutes: Chapter 393.)

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Cont a t act s t s

 Leigh Meadows, Delmarva Contract Manager, AHCA (850) 412-4258 E-mail: leigh.meadows@ahca.myflorida.com

  • Charmaine Pillay, Director, Florida Quality Assurance Program,

Delmarva Foundation (866) 254-2075 Email: pillayc@dfmc.org  Beth Stratigeas, Customer Service Representative, Delmarva Email: Stratigease@dfmc.org Phone: (866) 254-2075 x12005 Fax: (813) 977-0027

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Quest ions a and Answ ers

Now it is your turn.

You have questions! We will answer them the best we can…

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