Iowa Department of Human Services Iowa Medicaid Enterprise ... · Iowa Medicaid Enterprise HCBS...

Iowa Department of Human Services

Iowa Medicaid Enterprise HCBS Provider Training and Technical Assistance

FY17 Annual Project Report

Completed By: Shelly Chandler Executive Director Iowa Association of Community Providers 7025 Hickman Road, Suite 5 Urbandale, Iowa 50322 515-270-9495 x203 [email protected] Identification Information: Project Name: HCBS Waiver and Habilitation Services Training and Technical Assistance Contract #: MED-15-013 Organization: Iowa Association of Community Providers (IACP) Project Director: Shelly Chandler Address: 7025 Hickman Road, Suite 5, Urbandale, Iowa 50322 Telephone Number: 515-270-9495 E-mail Address: [email protected] Fax Number: 515-270-1035

Other Staff Working on Project:

Gayla Harken, Outreach Director Phone #: 515-270-9495 Lisa Schwanke, Medicaid Compliance Specialist Phone #: 515-270-9495 Teri Freeman, Communications Director Phone #: 515-270-9495

IACP SFY17 Annual Project Report Shelly Chandler

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7025 Hickman Road Suite 5 • Urbandale Iowa 50322 • P (515) 270-9495 • www.iowaproviders.org

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Ben Woodworth, Training Director Phone #: 515-270-9495 Brita Nelson, DirectCourse/Medicaid TA Specialist Phone #: 563-380-0151 Julie Fuller, Administrative Assistant Phone #: 515-270-9495 April Metzger, Medicaid TA Specialist Phone #: 515-270-9495 Amy Desenberg-Wines, ICIE Phone #: 515-270-9495 Jess Kreho, ICIE Phone #: 515-270-9495


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Scope of Work and Progress: TECHNICAL ASSISTANCE

GENERAL ACTIVITIES During SFY17, members of IACP’s Technical Assistance team engaged in the following activities pursuant to the contract:

1. Monitored Medicaid rules to keep providers informed and to advocate for improved services and relationships between all partners of the Medicaid system. Members of the Technical Assistance (TA) team monitored the legislative rules process to be able to inform providers of upcoming changes impacting service delivery.

2. Met regularly throughout SFY17 with state managed care entities to continue communication and clarify processes associated with the transition to managed care. Specifics of some of those meetings and events are detailed below.

3. Continued work with QSDA (Quality Services and Data Alliance) Regional and Provider Data Collection Initiative. History: In 2012, Iowa’s disability system underwent a mental health redesign, resulting in counties re-organizing into regional entities. Regions are charged with creating a core set of services statewide and collecting/reporting data for all persons served through the MHDS system.

IACP Technical Assistance, Regions, and ISAC have collaborated to identify several initial desired outcomes for program participants who are receiving ongoing disability services. Meetings to discuss this process have included other community stakeholders including MCOs, and DHS. The foundation of the data collection is based on Community Resource Alliance’s 5 Star Quality Outcomes that emphasize inclusion in community. The Outcomes, which are entered by providers into the ISAC CSN system, include community housing, community employment, somatic care, and


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community integration. While MCOs track physical health, tracking outcomes that indicate program participant quality of life are critical to demonstrate program impact and return on investment (ROI).

Specific information about the types of data points currently being collected:

● Community Housing measures safety, affordability, accessibility, and acceptability to the person.

● Community Employment collects data 4 times a year over 4 predetermined weeks. Information includes if the person is working at or above minimum wage for a minimum of 5 hours per week. This information will be adjusted next year to match the reporting benchmarks determined by IME and the MCOs.

● Community Inclusion is looking for a minimum of 3 activities of the person’s choosing per year that allows them to be integrated into the community of their choice. Inclusion is specifically defined and tenants must be met to count in the measure.

● Somatic care involves seeing a physician on a routine basis for other than emergency care.

This initiative has been voluntary and to date has collected unduplicated data on over 7,000 members who have had over 60,000 outcomes recorded.

QSDA To Date: # of clients with at least 1 outcome entered: 7,335 # of providers with at least 1 user account: 161 # of user accounts: 504 # of outcomes reported overall (a client can have up to 4 outcomes entered per quarter): 60,140

Many regions have built into their budgets dollars for beginning pay for performance with their providers which is a directive included in SF2315.

4. Managed care continued to be a major focus of the TA team during SFY17. Providers had many questions regarding processes utilized in the managed care transition.. The TA team provided education about the Medicaid Modernization initiative for providers. This effort continues to be ongoing as we assist providers with understanding the processes associated with working with the


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Medicaid partners. TA staff have routine contact with the MCOs and IME to assist with issues and to provide clarification for not just providers, but MCO staff as well.

5. HCBS Final Rule information continued to be addressed by the TA team this year. Individual

consultations, inclusion in regional trainings, and reviewing assessment forms via webinars were included in training activities. The TA team offered insight and information as providers assessed their agency’s readiness for compliance and visited about possible strategies for meeting the new regulations.

6. TA staff met with IME Department staff regularly to review a variety of topics, local compliance

trends, legislative rules/updates, national regulation changes, and current training needs.

7. Use of FileMaker database software continued in SFY17. This system has allowed us to keep real time information about categories of questions, agency information, and contact/response times.

8. Senate File 2315 mandates the use of Evidence Based Practices across providers. TA, in

conjunction with Regional partners, sponsored several trainings that focused on Trauma Informed Care (TIC) this year. The initiative to create competency around TIC practice provides a solid foundation for the delivery of care and support. Continued initiatives in this area are planned for the next training year. Additionally, the partnership with the regions and the TA team is focused on bringing best practice and research based practice information to providers for the purpose of improving skills needed to work successfully with members living in their community. C3 de-escalation is one of the initiatives that began implementation and will continue into the following contract year. A more complete description of this effort is included in the training description section of this report.

9. IACP’s TA team supported efforts to increase knowledge of and access to technology for HCBS

participants. This included collaboration on several webinars as well as focused questions and time during regional training sessions. The desire to be most efficient and least intrusive in member’s lives drives the need for continued effort in this area. A stumbling block to more robust implementation


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of technology for providers is a lack of funding through the MCOs. TA will offer continued education to MCO partners on the benefits of using non-traditional supports for members.

10. The TA team hosted two RCF meetings to discuss implementation and impact of HCBS settings

final rule. The outcome has been that a significant number of larger facilities have either downsized or started providing services in the community. We are aware of at least 5 larger RCFs that have closed and those members are now being served via HCBS in the community.

11. TA staff conducted provider surveys of IHH implementation experience. The results were utilized

to inform conversations with MCO and providers staff, including formulation of questions covered during two IHH/Provider group meetings. These meetings were well attended and provided the foundation for future learning collaboratives between all stakeholders.

Employment

12. Beginning in November of 2016, IACP contracted with the Iowa Coalition for Integration & Employment to provide training, TA, information, and resources related to employment. Some highlighted activities include:

● Partnering with Iowa Department of Transportation in planning and facilitation of a meeting of Iowa’s regional transit managers and cross-section of Iowa Community Rehabilitation Service Providers regarding CMS’s rules for HCBS settings and potential impact on transportation needs across the state

● Assisted with development and delivery of employment focused webinars ● Gathered information and made recommendations to IME regarding employment service

provider qualification requirements for consideration for rule modification and clarification support.

● Developed resource guides and tools for providers related to Iowa’s new employment rules. ● Developed employment specific section for IACP’s website on family engagement, training

archive, transformation of services, and other employment resources/links


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● Developed a tool/resource for employment service providers regarding documentation requirements under Workforce Innovation and Opportunity Act, Section 511. This includes identification of relevant referral resources and clarification of state direction for process/procedures between state agencies

● Planned and facilitated an MCO Employment Workgroup meeting on December 16, 2017 and coordinated efforts with IME to have a meeting in January with MCO leadership on employment services.

● Planned and facilitated two statewide Employment Service Providers Network Meetings: Connect, Converse, Conspire

● Planned and facilitated WIOA workgroup meeting around case manager/care coordinator (CM/CC) responsibilities and DHS/IVRS/IDB memorandum of understanding around the role of CM/CC in providing career counseling, information, and referral under WIOA

● Facilitated MCO Employment Workgroup meeting with MCO leadership around WIOA requirements; CM/CC’s role with career counseling, information, and referral; training needs; and discussion of coordination of data collection efforts

● Developed Staff Qualification and Training Requirements Tool to illustrate HCBS and IVRS requirements for providers and distributed to providers across the state

● Conducted outreach around identification of services for self-advocacy, self-determination, and peer mentoring resources and assisted with facilitating a planning meeting to bring Iowa’s Independent Living Center staff, Iowa Developmental Disabilities Council staff, Iowa’s Client Assistance Program Coordinator, and Iowa VR staff together to discuss and address services available and need for further development of these resources

● Planned and facilitated an MCO data workgroup meeting to try and align processes for data collection around employment. Identified questions and clarification needs for MCOs. Follow-up work with this group will continue

● Communicated with IVRS Administrators on provider needs for WIOA Section 511 Career Counseling, Information, and Referral Services. Developed a plan to offer the required counseling for subminimum wage employees and began to develop materials, process, and tools to implement


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● Redrafted language for recommendations for rule changes around provider qualification/training questions and submitted to IME

● Delivered regional training for roadshow at four Iowa locations on Iowa Medicaid HCBS Employment Service Administrative Rules, Tiers, WIOA Section 511, and Employment Resources

● Worked with IACP and IME to plan and facilitate the MCO Employment/Data workgroup meeting. Captured notes and submitted to IME for review

● Helped with the development and implementation of a survey in partnership with Iowa APSE to assess CRP needs related to professional development and employment services applicant pool

● Coordinated two meetings geared at reaching consensus around employment rules between state and private funders.

● Held regular Community of Practice calls for employment staff ● Worked to address member and provider issues with access to transportation through

coordination of a meeting with state DOT and regional transit representatives. MARKETING

1. The IACP TA program and trainings were marketed in many ways. While IACP has access to well over 150 Medicaid providers through member contacts, significant effort was made to market program availability to all enrolled HCBS Waiver & Habilitation providers. Examples of some of the materials are located in the Appendix.

These efforts included:

a) Posting of TA contact information and training dates on public portions of the IACP website. b) Training notices mailed to each provider on the Medicaid provider listing obtained from IME. c) Advertisement and distribution of information for providers on how to access technical

assistance services at each regional training event during SFY16. d) Attempting further dissemination of materials by requesting stakeholder contacts lists from

partner organizations.

IACP TECHNICAL ASSISTANCE TRAININGS


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Throughout the year, IACP’s TA staff provided trainings in a variety of settings. Trainings ranged from group meetings to regional trainings and web-based content delivery. This year, the TA staff trained 3830 individuals.

State Fiscal Year Attendance

SFY12 784

SFY13 1807

SFY14 2080

SFY15 2519

SFY16 3743

SFY17 3830

The IACP Technical Assistance Team attendance at training sessions since the program’s inception in 2012 totals 14,763 individuals. This does not include over 1000 Medicaid members and their staff who attended career counseling webinars consistent with the WIOA standards. Training is provided through a variety of modes to ensure the broadest possible reach to Iowa’s HCBS providers. Regional trainings, centralized trainings and webinars were utilized throughout the year. Details on each type of training follow. Regional Trainings


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1. This reporting year, IACP TA facilitated 8 regional trainings. All regional training curricula are web-ready in accordance to IME requirements. These have been sent to IME personnel for their feedback a minimum of two weeks prior to the training event.. In addition, resources from the regional trainings are publicly available on the IACP website. (Please see sample training notices attached.)

2. Training topics by month of regional training: (See attached marketing flyer example)

October 2016

HCBS Settings Managed Care Question & Answers HCBS Self-Assessment

April 2017 Employment Services (Iowa Medicaid HCBS Employment Service Administrative Rules, Tiers, WIOA Section 511, and Employment Resources) Transition Plan Update Utilization Review Tools Questions and Answers

3. Regional training attendance totaled 777 provider staff.

4. Training feedback surveys were distributed after each regional training session. Examples of some

provider commentary feedback are as follows:

When asked “What Was Particularly Helpful about the Training?” comments included;

● Networking and hearing what is happening across the state the location is reasonable drive (1.5 hours) Overall I believe we are very fortunate to have such well informed and skilled persons to train and support us. You all are awesome.


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● Thinking about the need to do internal reviews for home based hab tier placement. We hadn't thought about doing that in a formal way.

● The worksheets for clarifying and justifying the hab tiers was very helpful. Thank you for giving us some worksheets to use. The supported employment information was very useful also. I liked getting an updated issue of the FAQs from IME.

● The IACP staff are always upbeat and encouraging! Appreciate hearing how they advocate for us!! I like the interaction with other providers - hearing what other agencies are currently experiencing or have recently experienced. It is nice to get examples of forms, checklists, etc. that have been successful for others.

● Updates on the state transition plan and what others' experience has been so far. I also likes how it was organized so I could take off after the morning session since my agency does not provide employment services.

● The settings information and Q&A was helpful. The staff kept the time moving and I really appreciate that.

● Knowing what is new and being updated with new issues with MCO's, policies and other information that we need to know to continue to do our jobs better.

● Great information. All of the agenda items were needed to be discussed and reviewed. ● Everything is always explained and questions are answered so we can understand materials and new

information. ● The training helped to focus on the QA process. The information as well as the questions asked

were helpful. I liked that the changes were pointed out and an explanation given for what is being sought.

● At this point of change, the Q & A session was very valued. I learned from questions I hadn't even thought to ask. Hearing from other providers is helpful. I would also remark that keeping informed of new and changing guidelines and how to prepare for these is critical. There is so much to keep up with right now that it's most extremely helpful to an organization with limited admin staff to have IACP scrutinizing information and updates and keeping us all informed of the most relevant points.

● This was really my first detailed exposure to the CMS settings so it was really informative. ● Very knowledgeable presenters! Well organized. ● It cleared up a lot of information that seems very ambiguous in IME informational letters.

Information about rate settings & transition was particularly helpful for our agency. Centralized Training


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IACP’s TA team held three centralized trainings/meetings reaching a total of 1682 provider staff.

1. July 2016 – Tonier Cain

On July 6th and 8th, IACP partnered with Polk County Health Services to sponsor Tonier Cain, a nationally recognized consumer advocate who has spoken on trauma, incarceration, and recovery. Ms. Cain provided attendees with basic principles of recovery from trauma and how to begin to transform services and systems of care to be trauma informed. The event was held in Des Moines and total attendance, which was comprised of all levels of providers, was 539. Feedback from this event was very positive.

2. December 2016—IHH/Habilitation/MCO Summit

December 6, 2016, a summit was held in Ankeny. Attendance topped 240 persons and included representatives from IHHs, providers, all three MCOs, and the IME. The summit was the culmination of efforts from IACP TA, the MCOs, and IME to clarify the process for persons accessing the Habilitation program. A panel from IME and the MCOs reviewed a summarized a consensus document (attached in appendix) that detailed the rules and processes used by each organization. Resources were provided that were pertinent to the delivery of Habilitation services and a panel discussion was held that addressed questions from all participants.

3. February 2017 – Person-Centered Planning

Derrick Dufresne presented foundation skills of person centered planning in Ankeny to more than 436 persons who represented providers, IHHs, MCO, and the IME. A live demonstration of the process of developing a person-centered plan was provided, using a representative from the Technical Assistance program, and an opportunity for questions and answers followed. Feedback for this event was overwhelmingly positive and Derrick has been invited back to Iowa to build further on the topic.

4. April 2017 – IHH Summit

April 20, 2017, a second summit was held in Ames at the Scheman Center. More than 262 persons


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attended the event that targeted children’s waiver IHH services. A resource packet that included a flow matrix and associated resources was developed, discussed and distributed to attendees and posted on the public website (attached in appendix). Information was developed by MCOs and IME who also staffed a panel that responded to pre-submitted questions as well as questions from the floor. A FAQ document was created and distributed following the event.

5. June 2017 - From Trauma to Addictions with Peter Volkman

The Polk County Critical Incident Stress Management (CISM) Team partnered with IACP, AmeriHealth Caritas, and the International Critical Incident Stress Foundation to offer this training. This training was filled to capacity with 80 people in attendance. The focus of this training was a continuation of efforts to bring education around evidence based practices to HCBS providers across the state. This event was the third in a series that focused on the importance of creating competence in the area of Trauma Informed Care.

6. June 2017 – C3 De-escalation

The IACP Technical Assistance team, in conjunction with Iowa Law Enforcement Academy and the MHDS Regions brought Andra Medea to Iowa for a two day event that focused on collaboration between community emergency responders and HCBS providers to acquire skills necessary to address crisis situations for persons who have disabilities in the community. The first day focused on offering education around resources available to all who interface with persons who may be experiencing crisis and resulted in a plan to regionally work toward a more collaborative approach when addressing these situations. The second day focused on MHDS regions and selected providers in their areas who were interested in having further training around the C3 techniques (described below) as part of a statewide pilot. There were 8 Regions and 14 providers who expressed interest in this effort. Regions have committed to funding this initiative and providers will track results and share support with others as it relates to the implementation of these de-escalation tools.

Web-Based Training


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Continuation of web-based training offered as part of the regularly scheduled TA offerings allowed a wider reach of provider staff with a quicker turnaround time. In addition, relevant trainings were recorded and posted both on the public portion of the IACP website as well as through the DirectCourse system. Over 1,158 provider staff were reached through this mode of training.

Date Training Attendance Jul-16 Substitute Decision Making 24 Oct-16 WIOA: What's It to Us? 70 Nov-16 New HCBS Employment Rules 193 Nov-16 WIOA: Iowa Partners 198 Dec-16 Ombudsman 22 Jan-17 OSHA 171 Feb-17 Community of Practice 81 Mar-17 Community of Practice 32 Apr-17 Member-focused technology 76 Apr-17 Coleman Institute 39 Apr-17 Community of Practice 34

May-17 Iowa Community of Practice - WIOA and Section 511 55

May-17 Community of Practice 53

Jun-17 The Role of Person-Centered Planning in Achieving Integrated Employment Outcomes 55

Jun-17 Community of Practice 55 TOTAL 1,158

Individual Provider Trainings


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The TA team conducted 39 individual consultations to Waiver and Habilitation provider agencies. Topics included engagement, service planning, HCBS rule changes, and documentation.

HCBS WAIVER AND HABILITATION TECHNICAL ASSISTANCE

The IACP Technical Assistance Team responded to 861 TA inquiries during SFY17. Year to year data:

State Fiscal Year # of TA Requests SFY2012 269 SFY2013 657 SFY2014 708 SFY2015 540 SFY2016 981 SFY2017 861

Total 4016

The average response time for HCBS TA inquiries was .815 calendar days. The highest overall area of TA requests came in questions came related to billing managed care. Common question areas are noted in the graph below.


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On-Line Learning Systems DirectCourse: GENERAL INFORMATION/ACTIVITIES

1. The IACP DirectCourse program offers Iowa providers training from: a) The College of Direct Support (CDS) b) The College of Employment Services (CES) c) The College of Recovery and Community Inclusion (CRCI) d) The College of Personal Assistance and Caregiving (CPAC) These curricula are delivered through the Elsevier Performance Manager Learning Management System (LMS).

2. The 104 organizations utilizing the learning management system have enrolled over 30,000 learners serving over 18,800 Medicaid members. Those Medicaid members are receiving services through the following funding streams:


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Since Iowa began utilizing DirectCourse (CDS), learners have completed 842,963 lessons. Of those lessons, 225,222 were completed during SFY17.

3. SFY17 monthly training completion by number of lessons:


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4. Use of FileMaker software began SFY13 with building a database for all DirectCourse technical assistance and informational inquiries. Use of this system continued through SFY17.

5. The DirectCourse newsletter was completed and sent to agency admins. See example attached.

6. IVRS Certifications SFY15 - IVRS Training Certifications issued during SFY15: 23 for Job Coaching, 1 for Employer Development and 30 for the Dual Certificate (Job Coaching and Employer Development). SFY16 - IVRS Training Certifications issued during SFY16: 22 Job Coaching, 6 Employer Development and for the 28 Dual Certificate (Job Coaching and Employer Development). SFY17 - IVRS Training Certifications issued during SFY17: 97 Job Coaching, 33 Employer Development and for the 28 Dual Certificate (Job Coaching and Employer Development).

Relias 7. Relias was utilized, on a trial basis, by a number of mental health centers to access training that

addressed working with members who have mental illness. This contract continued through the end of calendar year 2017.


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DIRECTCOURSE: SYSTEM USE AND TECHNICAL ASSISTANCE

1. IACP DirectCourse staff are available to work individually with providers throughout the state, providing implementation and technical assistance as needed by each agency. This process of training and support is part of what Elsevier staff attributes to Iowa’s system rollout being the most successful of any state contract.

Contacts noted in the graph include on-site implementation/consultation, web-based consulting and technical assistance, and basic Q&A regarding system use.

2. Lesson completion data showed the most frequently used lessons during SFY 2017 came from:

CDS: Cultural Competence: What is Cultural Competence?


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CDS: Universal Precautions CDS: Health Insurance Portability and Accountability Act (HIPAA)

DIRECTCOURSE: MARKETING 3. IACP staff marketed the DirectCourse program at the IACP Annual Convention in May 2017. This event was open to all HCBS and Habilitation providers regardless of membership or affiliation with IACP. In addition, outreach and education regarding the DirectCourse system was provided through advertisement at IACP monthly advisory meetings and at each of the regional TA trainings. Information regarding DirectCourse curricula and Elsevier Performance Manager Learning Management System (LMS) is also posted and available to any visitor on the IACP website. SFY17 SUMMARY The transitioning to Medicaid managed care was still a major focus for the TA team during FY17. Continued use of webinars made training more accessible to a greater range of provider staff than regional trainings alone. Online learning through various learning management systems (DirectCourse, Relias) appears to be an efficient means of training staff across Iowa. PROGRAM VIABILITY AND SUSTAINABILITY The HCBS Provider Training and Technical Assistance program has initiated conversations with Iowa legislators and other stakeholders, such as MCOs, Regional CEOs, and IVRS regarding continued financial support should current funding not be available after SFY18. We are alert to applicable grant opportunities that may also support this effort. There is wide interest in maintaining access to quality and consistent training and information for all HCBS providers across our state. It is hoped that funding for this initiative will continue to be supported, as it has been in the past, as the numbers of persons who benefit from it have far exceeded initial expectations and the program has become a trusted source of support for many.


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PROPOSED TRAINING PLAN for SFY18 This document represents a tentative training plan for SFY 18. Some events are already scheduled and others are proposed. We continue to be open to adding items as we are made aware of specific training needs for providers of HCBS services.

Q1

TITLE Program Type Date

C3 TA Central

DRI - Navigating the Grievance and Appeals Process TA WEbinar Sept 2017

Host Home TA Webinar August 24, 2017

Employment Community of Practice TA Webinar TBD

Q2


C3 TA Central


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Regional Training TA/BI Regional October 2017

Derek Dufresne TA/IACP Central November 2, 2017

Supported Employment Summit TA

Self Assessment TA Webinar TBD

Technology in HCBS Services TA Webinar December

What's New ? (Rules/Manuals/ILs) TA Webinar December

RCF Transition Planning TA Central October

Supported Employment Summit TA In Person October


MHFA TA In Person TBD

Q3


BI Cert BI In Person/Web

MCO Corrective Action Plans TA Webinar February

Iowa Settings Reviews - How is it going/Lessons Learned with One Year to Go TA Webinar March

Batch Eligibility process TA Webinar




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Q4


BI Cert BI In Person/Web

TA Regional Training TA Regional April 2018

Annual Convention Membership In Person May 2018


What's New? (Rules/Manuals/ILs) TA May 2018


Additional Potential Topic Areas:

Documentation

Staff Training Requirements

Transportation

MCO Manual Navigation

Managed Care Service Planning


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Appendices

1. Habilitation Service Matrix 2. IHH Service Matrix 3. TA Regional Training Flier 4. Person-Centered Training Flier 5. Tonier Cain Training Flier 6. C3 Explaination of Content 7. DirectCourse Newsletter


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