PART I: THE PEPSI PROJECTPART I: THE PEPSI PROJECT

Pamela Sulmer, MS -- DHS Disability Services DivisionPamela Sulmer, MS -- DHS Disability Services DivisionLeah Zoladkiewicz -- DHS Disability Services DivisionLeah Zoladkiewicz -- DHS Disability Services Division

ScopeScope

Home and Community Based Waiver Providers:Home and Community Based Waiver Providers:Community Alternative Care Waiver (CAC)Community Alternative Care Waiver (CAC)Community Alternative for Disabled Individuals Community Alternative for Disabled Individuals

Waiver (CADI)Waiver (CADI)Developmental Disability Waiver (DD)Developmental Disability Waiver (DD)Traumatic Brain Injury Waiver (TBI)Traumatic Brain Injury Waiver (TBI)Elderly Waiver (EW)Elderly Waiver (EW)

What Defines HCBS Quality?What Defines HCBS Quality?

Participant-Centered Access & Service Participant-Centered Access & Service PlanningPlanning

Provider Capability & Service CapacityProvider Capability & Service Capacity

Participant Safeguards & Rights ProtectionsParticipant Safeguards & Rights Protections

Positive Service Outcome & Participant Positive Service Outcome & Participant SatisfactionSatisfaction

Core Components of a Quality Core Components of a Quality Assurance System Assurance System

Service Providers meet Compliance StandardsService Providers meet Compliance Standards

Timely Response to Client ComplaintsTimely Response to Client Complaints

Tools to Prompt Informed Client ChoiceTools to Prompt Informed Client Choice

Service Delivery Monitoring & Systems Service Delivery Monitoring & Systems ImprovementImprovement

Minnesota: A Statewide SystemMinnesota: A Statewide System

Locally-Directed / Locally-ExecutedLocally-Directed / Locally-ExecutedLocally-Directed / Locally-ExecutedLocally-Directed / Locally-Executed

State-Directed / State & Locally-State-Directed / State & Locally-AdministeredAdministered

State-Directed / State & Locally-State-Directed / State & Locally-AdministeredAdministered

Fee For Service ContractsFee For Service Contracts

Establish Provider Standards Establish Provider Standards

Set forth Service Delivery RequirementsSet forth Service Delivery Requirements

Lay the Foundation for Oversight & Lay the Foundation for Oversight & MonitoringMonitoring

Define the Provider FieldDefine the Provider Field

Elimination of Local ContractsElimination of Local Contracts

Centralized HCBS System per CMS MandateCentralized HCBS System per CMS Mandate

Uniform Provider & Service Delivery Uniform Provider & Service Delivery StandardsStandards

Consistent Monitoring & OversightConsistent Monitoring & Oversight

Well-Coordinated Administrative PartnershipWell-Coordinated Administrative Partnership

Waiver Provider Quality Waiver Provider Quality Management: The VisionManagement: The Vision

• State Provider Qualifications & Service State Provider Qualifications & Service StandardsStandards

• Consistent Oversight & Compliance AssuranceConsistent Oversight & Compliance Assurance

QUALIFIED PROVIDER OPTIONSQUALIFIED PROVIDER OPTIONS

• State Provider Qualifications & Service State Provider Qualifications & Service StandardsStandards

• Consistent Oversight & Compliance AssuranceConsistent Oversight & Compliance Assurance

QUALIFIED PROVIDER OPTIONSQUALIFIED PROVIDER OPTIONS

• Provider Performance Beyond ComplianceProvider Performance Beyond Compliance

• Client Experience Evaluation & ReportingClient Experience Evaluation & Reporting

OPTIMAL SERVICE EXPERIENCE OPTIMAL SERVICE EXPERIENCE

• Provider Performance Beyond ComplianceProvider Performance Beyond Compliance

• Client Experience Evaluation & ReportingClient Experience Evaluation & Reporting

OPTIMAL SERVICE EXPERIENCE OPTIMAL SERVICE EXPERIENCE

Provider Meets Qualifications & EnrollsProvider Meets Qualifications & EnrollsProvider Meets Qualifications & EnrollsProvider Meets Qualifications & Enrolls

Provider Complies with Service Provider Complies with Service StandardsStandards

Provider Complies with Service Provider Complies with Service StandardsStandards

Provider Performance & Public Provider Performance & Public Reporting Reporting

Provider Performance & Public Provider Performance & Public Reporting Reporting

The PEPSI Initiative The PEPSI Initiative Phase 1: Review Local Contract ElementsPhase 1: Review Local Contract Elements

Phase 2: Streamline & Strengthen StandardsPhase 2: Streamline & Strengthen Standards

Phase 3: Design an Integrated Compliance Phase 3: Design an Integrated Compliance Assurance SystemAssurance System

Phase 4: System Development towards Phase 4: System Development towards System Transition System Transition

StakeholderStakeholder InvolvementInvolvement

Solicitation of Workgroup MembersSolicitation of Workgroup Members

Work Group StructureWork Group Structure

Work Group ProcessWork Group Process

Phase IPhase I Provider RequirementsProvider Requirements

• Reviewed Components of Model Contract Reviewed Components of Model Contract /Current MHCP Provider Agreement/Current MHCP Provider Agreement

• Recommended Elements to Move Forward Recommended Elements to Move Forward into Uniform Provider Requirementsinto Uniform Provider Requirements

• Established Universal Provider RequirementsEstablished Universal Provider Requirements

Universal RequirementsUniversal Requirements

Training Direct Care StaffTraining Direct Care Staff

Training Owners/ManagersTraining Owners/Managers

Policies and ProceduresPolicies and Procedures

InsuranceInsurance

Phase II Provider RequirementsPhase II Provider Requirements

Evaluated Current standards/Qualifications Evaluated Current standards/Qualifications for Unlicensed Waiver Servicesfor Unlicensed Waiver Services

Recommended Enhancements for Recommended Enhancements for Standards/QualificationsStandards/Qualifications

Service Specific RequirementsService Specific RequirementsTraining Training

Professional licensure/certification/degreeProfessional licensure/certification/degree

Policies and proceduresPolicies and procedures

Background ChecksBackground Checks

InsuranceInsurance

Compliance Assurance SystemCompliance Assurance System

Universal & Customized Standards at the Universal & Customized Standards at the CenterCenter

Ultimately 4 Distinct Functional Ultimately 4 Distinct Functional ComponentsComponents

State-Directed / Jointly AdministeredState-Directed / Jointly Administered

DHSEnrollment

NEED

ID

Client

HCBSAdministrator

Coordination & Faciliation of Service Delivery Per DHS-

Protocol

Proivder Monitoring & Oversight: State-HCBS Administrator Function Per DHS Protocol

Provider

Provider

ProviderProvider

Provider

Provider

Provider

Provider

Provider

ProviderProvider Provider

Provider

Provider

ProviderProvider

Provider Provider

Provider

Enhanced Standards

Certified Assessor

Per DHS-

Protocol

Assessment

Delegated Function Delegated Function Delegated Function

State-Level Provider Oversight Functions & Coordinated Efforts w/

Delegated Local Authorities

CMS

Statewide Consistency Centralized Accountability

Pro

vid

er

Client

Provider

Provider Qualifications

Routine Operational Review

Complaint Response

State HCBS Rate Framework

Se

rvic

e C

ap

ac

ity

As

se

ss

me

nt

& R

es

po

ns

e M

od

ule

PEPSI DEFINES A STATE-DIRECTED INTERGOVERNMENTAL COMPLIANCE ASSURANCE SYSTEM

Provider

ProviderProvider

- Deemed Review Status - Relies on State Certified Provider Data Base- Unfettered Access to Compliance Assurance Data Base

MCO:

Provider Qualification ReviewProvider Qualification ReviewWho are You? How are You Qualified to Who are You? How are You Qualified to

Deliver Service(s)?Deliver Service(s)?

Do You Agree to Comply with Required Policy Do You Agree to Comply with Required Policy and Procedures?and Procedures?

Conducted by the State Prior to Enrollment Conducted by the State Prior to Enrollment

Qualified HCBS Provider DirectoryQualified HCBS Provider Directory

Routine Provider ReviewRoutine Provider ReviewReview of Service Operations in the Field

Verification of Assurances Provided at Enrollment

Are you Complying with Required Standards of Practice & Adhering to the Policies You’ve Adopted?

State-Directed / Largely Locally Conducted

Complaint-Driven ReviewComplaint-Driven ReviewThreshold Health & Safety, Participant Rights, Threshold Health & Safety, Participant Rights,

Service Delivery & Operational Management Service Delivery & Operational Management Complaints Rise to Complaints Rise to Uniform Management LevelUniform Management Level

Locally-Administered “State-Directed” Complaint Locally-Administered “State-Directed” Complaint Discovery, Remediation, Improvement Discovery, Remediation, Improvement

Augments Existing Centralized Complaint Augments Existing Centralized Complaint SystemsSystems

HCBS Compliance Assurance HCBS Compliance Assurance System GoalsSystem GoalsCompliance Assurance via Reasoned ReviewCompliance Assurance via Reasoned Review

Uniform Management & OversightUniform Management & Oversight

Leveraging of Expertise & Capability towards Leveraging of Expertise & Capability towards Productive Administrative PartnershipProductive Administrative Partnership

Efficiencies Maximized at Every LevelEfficiencies Maximized at Every Level

Achieving Consistent Oversight Achieving Consistent Oversight ActivityActivity

Centralized System with Well-Directed Centralized System with Well-Directed Division of LaborDivision of Labor

Policy-Embedded IT Drives Review & Policy-Embedded IT Drives Review & ResponseResponse

System Supports Administrative FunctionsSystem Supports Administrative Functions

Value Added for State and Local PartnersValue Added for State and Local Partners

Essential FunctionsEssential Functions

Provider Screening, Service Monitoring, Provider Screening, Service Monitoring, Transparent ReportingTransparent Reporting

Systems-Level Review of Local ActivitySystems-Level Review of Local Activity

ID & Target Improvement OpportunitiesID & Target Improvement Opportunities

Efficient Data Management & Program Efficient Data Management & Program ReportingReporting

Develop Provider Qualification

ReviewCertify/

Enroll Providers

MN HELP Directory

Contract Eliminatio

n

2012

2013

Develop Complaint

Management

Development and Rollout Vision Development and Rollout Vision

Develop Routine Field Review

2014

Q-1

Work AheadWork AheadPolicy Development to Support Monitoring Policy Development to Support Monitoring

Functions & State/Local CoordinationFunctions & State/Local Coordination

Business Process Analysis & Rework Business Process Analysis & Rework Supporting Transition to Centralized SystemSupporting Transition to Centralized System

Development of Core IT InfrastructureDevelopment of Core IT Infrastructure

Development of Training to Support Development of Training to Support ImplementationImplementation

UpshotUpshot

Participants: Access to Qualified ProvidersParticipants: Access to Qualified Providers

Providers: Uniform Statewide Requirements Providers: Uniform Statewide Requirements Eligible if Qualified & Eligible if Qualified &

CompliantCompliant

Local Partners: Efficient, Consistent Oversight Local Partners: Efficient, Consistent Oversight

Access to Statewide Provider DataAccess to Statewide Provider Data

Additional Opportunities Additional Opportunities Lead Agency/Provider Training Opportunities & Lead Agency/Provider Training Opportunities &

Delivery Methods- Tues. 8:30 AM Delivery Methods- Tues. 8:30 AM Commons Commons DoubletreeDoubletree

New Licensing Standards – Tues. 8:30 AM New Licensing Standards – Tues. 8:30 AM RiverviewRiverview

Rate Setting Methodologies Overview – Tues. 1:30 Rate Setting Methodologies Overview – Tues. 1:30 PMPM Ballroom A Ballroom A

Provider Enrollment for HCBS Waiver Providers – Provider Enrollment for HCBS Waiver Providers – Wednesday 9:45-12:00 & 12:45-3:00 Wednesday 9:45-12:00 & 12:45-3:00 McDonnell McDonnell BB

ResourcesResourcesPEPSI Website:PEPSI Website: http://www.dhs.state.mn.us/dhs 144650

PEPSI Email:PEPSI Email: DHS.DSD.pepsi@state.mn.us

DSD Resources : DSD Resources : http://www.dhs.state.mn.us/id_003540

MNHelp:MNHelp: http://www.mnhelp.info