In Home and Co Communit ity- Base sed Long Term rm Se Serv - - PowerPoint PPT Presentation

In Home and Co Communit ity- Base sed Long Term rm Se Serv rvic ices es and Su Support rts s Pro rogra rams ms



An allegatio egation n or

• r an actual

al oc

• ccurrenc

rrence e of

• f

an inciden ident t that adve versel rsely impa pacts cts or has the potentia ential to adve verse rsely impact pact the health, alth, welfare fare or safet ety y of a p parti ticip cipant ant. Eve very ryone

• ne that works

ks with h long g term services vices and supp pports

• rts progr

grams ms must st report. port.

 Compla

• mplain

ints ts are e also so to to be be reported

• rted th

throu

• ugh

gh th the Re Repor

• rtable

table Eve vent nt mo modul ule. .

 Ma

Main in ty types of

• f com
• mplaints

laints to to report

• rt:

a) qual

ality ity of f car are – worker sleeps on duty

b) se

serv rvic ice e is issu sue – wheelchair repair not done

 No

Not all ll co compla laints ints need to b be re report rted. d. Lis isten n careful ully ly & & use dis iscretion ion. .

E.G. Pers

rson n co compla lain ins s that ch chic icken is is serv rved d 7 days a w week, every week. Turns out that chic icken n is is se served d twic ice a w week & & cli lient has

• ptio

ions. ns. A

A compla

laint int that nothin ing g but hotdogs gs are served ed should ld be reported. d.

 Reviews

views REs s fr from m Suppo ports rts Pla lanners, ers, Pro rovide viders, rs, Par articipa cipants, nts, Fam amily, y, or

• ther

er inter erested ested par arties es. . ~ Purp rpose

• se of

f re revi view ew is help p ensure re problems roblems ar are re reso solved, lved, to id identify ntify tre rends nds with h typ ypes of f incidences, idences, to pro ropose pose qual ality ty imp mprove rovemen ment, t, an and to me meet fe federal ral re requirements. irements.

 Is

s di dire rectly tly re resp sponsibl nsible e to the he fed eder eral l Cent nters rs for r Medi dicare re and nd Medi dicaid aid Services rvices (CMS) S) for r the he ope pera ratio tion n of the he Community mmunity Op Optio ions ns Waiv iver, er, Commu mmunit nity Fir irst st Cho hoic ice e and nd the he Medi dicaid id Pers rsona nal l Care re Pro rogra ram. m.

 Al

All l of the hese se pr progra rams ms us use or w r wil ill l us use the he Me Medi dicaid id Rep eport rtabl able e Ev Even ents s sy syst stem em.

 CMS

S provi vides des Maryl ylan and d wi with a cer ertain ain % % of matching hing funds ds for operatin rating g appro roved ved program grams s

 CMS requires that State’s ensure that certain

federal eral Assuran urances es wi will be met

 A

A system tem of rep eporting rting ev even ents ts hel elps ps us to meet the CMS Assuran urance e of ensuring uring the health, lth, we welfare re and safety ty of parti ticipants ipants serv erved ed in our programs. grams.

 We mu

must t provid

• vide CMS

MS wi with th evi vide dence nce th that t we we ha have ve a sy syste tem m to to com

• mmunica

municate te issue ues s inv nvol

• lving

ving partici rticipants pants in n a ti time mely ly ma mann nner and nd th the me e means ns to to res espond

• nd to

to the the issues. ues.

 We

We use data from RE progr gram am to show w CMS that t we we have ve evi vidence nce that people e are res esponding ponding time mely to issues, ues, priorit itizi izing ng issues sues and looking ng for wa ways to prevent vent problems blems from re-occurr curring.

• ng. Quality

ty imp mprov rovem ement ent is ex expec ected ted wh when en we we see ee problem blematic atic data trend nds. s.

 Imm

mmediate ediate Jeopardy ardy (IJ) ) is is defined fined as as an an al alleged ged or r ac actual al incident ident that at pre resents sents an an imm mmediate diate & se seri rious

• us

thre reat at of f in inju jury, ry, har arm m or r deat ath h of f an an individual. dividual.

 A t

A tele leph phone

• ne cal

all l mu must st be ma made to the ap appropriate ropriate off ffices ices or au r author horities ities within thin 24 hours rs. .

 This

is includes: ludes:

 Law enforceme

ement nt

 Chil

ild or a adult lt protectiv ive e servic ices es

 Th

The e Divi vision

• n of Qualit

ity y and Comp mpliance ance Revi view

 Other

er protocol

• l your

r employer yer may require uire

If f the informati

rmation

• n you rece

ceive ive is insuffi ficient cient for you to know whether er the situatio tion n is under r co control, rol, you will need to make an onsite te visit t within n 24 24 hours rs to mak ake e sure e the e saf afet ety y of the e par artici cipan pant t is being g ensured.

If f the situatio

tion n is under co control rol and the cl client t is known wn to be safe, you will need to go onsite e within in (2) 2) business ness days.

 The SP’s report must be made thru the

tracking cking syst stem em wi within (5) calend ndar ar days s of the eve vent. t.

 This

s report rt made wi within (7) calend ndar ar days s of the origi ginal nal eve vent must contain in the interven ervention,

• n, and follow

w up action plan.

 The incident

ent must be resolve ved d by the SP P wi within n (45 45) calen endar dar days s of the e ev even ent. t.

 Min

inor r in inci cidents nts do no not have to be be re report rted. d.

 The standa

dard d is is to re report any in injury y that re requires ires tre reatment ent beyond nd Fir irst Aid id.

 You should

ld stil ill l report min inor in incid idents nts if if they y happen en re repeatedly. edly.

 e.g.

• g. Partic

icip ipant ant fall lls but does not in injure herself; elf; however er, , 3 fa fall lls occur in in (2 (2) weeks

 Wh

When the same type of in inci cident ent happens ens repeatedly edly wit ith a n narrow range ge of tim ime, such h as ~ ~ Fall lls ~ D Dis isorie ient ntat ation ion ~ R Refusing sing to ke keep medic ical al appoin intmen tments Revie iew the cir ircumstanc tances es around d these in inci cidents ents to de determ rmine ine if if somethi hing ng ca can be done to re reduce the frequen uency. y.

e.g.

• g. A pa

part rtic icip ipant ant has fall llen n (3) 3) tim imes in in two weeks. s. You revie iew where fall lls are happeni ening ng and look at the participant’s environment. Is it wet flo loors in in th the bathroom?

• m? throw rug in

g in the bedroom? m? objects ts la layin ing g all ll ov

• ver the

house? se? Can the envir ironment nment be modif ifie ied d to he help lp prevent ent the fall lls? s?

 Comp

mplete lete all sec ections

• ns of the

e rep eport rt wi with useful eful detail il

 The Medicaid

aid revi viewer wer should ld read d the report

• rt

and have ve a clea ear unders erstan anding ding of wh what happ ppen ened, ed, wh what wa was done & wh what remains ns to be done

 Dates

es are e ve very imp mportant! tant!

 Attachm

chmen ents ts can be uploaded aded but the report rt must st still be complete te in all areas! as!

 Th

The e SP SP wi will rev eview ew all information mation and docum umen ent findings ings

 Action

n steps ps must be identi tifi fied ed ~ lo ~ locate e a new ew assist isted ed livi ving g home me ~ reques uest increase ease in hours rs of personal sonal assist istan ance ~ ob ~ obtain n a PE PERS RS ~ continue nue wi with curren ent plan of servic vice, e, no change ges s needed ded at this time

 Th

The Re Report rtabl ble e Ev Events s sect ctio ion of th the trackin ing g system em has a p pla lace for progr gress s notes

 Once

ce you have co comple leted ed a se sect ctio ion of th the report, you cannot go go b back and amend nd it it

 The purpose

se of the progr gress ss note is is to all llow you to up update te in informati ation n or m modif ify y it it as needed.

• ed. For ex

examp mple le, , you may need to note that the date of the event t was in inco corr rrect ct or r pro rovid ide e more re in inform rmation tion about the event.

 Progr

gress ss notes are als lso used d to d document ent foll llow-up. up. The Medic icaid id revie iewer ers s need to kn know that there e was appropria iate te foll llow-up up so the case can be clo losed at the St State le level. l. e.g.

• g. A participant’s physician refers him to

a ca cardio iolo logi gist st for foll llow-up up post hospi pita taliza lization tion for r ch chest pain

• in. DHM

HMH H revie iewer wers s wil ill l lo look fo for a p progr gress s note stating ing that a ca cardio iolo logy gy appt was sch chedul eduled ed or r even better, r, attended ded.

 RE

RE de descr crip iptions ions of cir circu cumstanc stances es aro round d a death h should ld in inclu lude e whethe her death was: ~ p predic icted ted to o

• ccur due to t

termin inal l or very y unstab able le condit itio ion n (antic icipat ipated) ed) ~ n not antic icip ipat ated ed because use despi pite e healt lth status tus person n was very stable le but die ied unexp expec ecte tedly dly

~ t the result lt of abuse e or ne negl glect ~ r rela lated d to m medic icati ation n error ~ c consequ quenc ence e of sudden den event – chokin ing, g, vehicl icle e accid ident nt, , fall ll ~ r rela lated d to e exis istin ting g healt lth h condit ition ions s or

• nset

et of an acute proble lem m li like pneumoni monia

 If

If a provider

er reports a d death to you, you wi will need to confi firm the dates & e events with fa family

• r a representa

tativ tive e - if a f at all possibl ble. e. Info forma mation ion about a death is needed to determine ine if fo f follow-up p or remediation ion is needed. If

If a fa

family is reticent t about sharing info formation, ion, let them know you are expected d to gather some info formation tion – off ffer to call back later. If fa family is still unwilling ng to discuss, s, document! nt!

 There is

is a sp specia ial l email il address ss to a ale lert the the St State revie iewer ers s that you are enterin ing g an Immedi ediat ate e Je Jeopard rdy y (IJ) J) re report rt. This is is is necessar sary y because use the trackin ing g syst stem em does not pla lace ce an ale lert rt on IJ RE IJ REs. Therefo efore, e, revie iewer ers s need to kn know that a prio iorit ity y case is is bein ing g reported. d.

 No

No det etail l about t the e incident ent is nee eeded.

• ded. You

may simply y indicate ate that an IJ on client # (tracking acking system em ID) has been n submi mitt tted ed.

Email

il address ss for notif ifyi ying ng St State revie iewer ers s

• f Immedi

diat ate e Je Jeopardy dy (IJ) J) report:

dh dhmh. h.reunit@maryla reunit@maryland. nd.gov gov

 The two primary reviewers at this time are:  Oluwaseyi

waseyi Aja jayi - He Health h Po Policy Analys yst t As Asso sociate iate – oluwa waseyi.ajay seyi.ajayi@mar maryland.gov yland.gov

 Chri

risty sty Abumer ere, e, RN, CRNP christy.ab isty.abumer umere@mary e@maryland and.gov .gov

410-767-5220