Quality Assurance Review Team (QRT) End-of-Year Report 2022 Summary

VA

DD

Waiver

Quality

Assurance

Program:

Quality

Review

Team

(QRT)

 End Of Year

Report

 Update

to

the

QIC

Nicole DeStefano

Waiver Network Supports Director

DDS Mission:

Assure that individuals with developmental disabilities have access to

quality supports and services when and where they need them.

DBHDS

Vision:

life

of

possibilities

for

all

Virginians.

Sept 2023

DBDHS 2022 QRT End of Year Report

Background:

Related Authorities

•

Per VD I-35.6 of the Settlement Agreement and outlined in the CSB Performance

Contract, each CSB must review and provide feedback on the QRT EOY report

annually.

•

This requirement is met via publication of the QRT EOY Report posted on the DBHDS

Website: https://dbhds.virginia.gov/wpcontent/uploads/2022/05/FINAL-QRT-End-

of-YearReport-7-1-2020-v-6_30-2021.pdf.

•

CSB’s provide feedback on this report annually via Survey Monkey questionnaire.

Sept 2023

DBDHS 2022 QRT End of Year Report

Background:

Waiver

Assurances

•

–

Administrative

Authority

The

State

Medicaid

agency

is

involved

in

the

oversight

of

the

waiver

and

is

ultimately

responsible

for

all

facets

of

the

program.

•

Level

of

Care

Persons

enrolled

in

the

waiver

have

needs consistent

with

an

institutional

level

of

 care.

•

Service

Plan

Participants

have

service

plan

that

is

appropriate

to

their

needs

and

services/supports

are

delivered

as

specified

in

the

plan.

•

Qualified

Providers

Waiver

providers

are

qualified

to

deliver

services/supports.

•

Health

and

Welfare

Participants’

health

and

welfare

is

safeguarded

and

monitored.

•

Financial

Accountability

Claims

for

waiver

services

are

paid

according

to

state

payment

methodologies.

Sept 2023

DBDHS 2022 QRT End of Year Report

Background:

Quality Review Team

DBHDS and DMAS have the primary responsibility for monitoring waiver assurances

through the Quarterly Review Team (QRT).

•

The QRT uses data from provider and CSB reviews to monitor waiver performance

 quarterly and demonstrate compliance to CMS.

•

Compliance demonstrated through Performance Measures (PM’s)

that relate to assurances/sub-assurances.

•

Provider data is used to ensure remediation occurs where needed,

identify trends and areas where systemic changes are needed, and

identify quality improvement initiatives.

•

CMS reviews QRT data to ensure the state has sufficient evidence to demonstrate

compliance with waiver assurances.

•

Annual QRT data is made available to the public on the DBHDS website.

Sept 2023

DBDHS 2022 QRT End of Year Report

About

the

Data

•

Data

 should

represent

averages

across

all

three

waivers

population.

•

QMR

Sampling

Methodology:

provider,

service,

and

individual record

level.

•

Data

represents

snapshot

of

compliance

for

PM;

different

providers

sampled

each

quarter.

•

Trends

inferred

when

persisting

over

several

quarters

or

years.

•

Improvements

in

performance

typically

demonstrated

over

2-

quarters

or

year’s

review.

•

Remediation

required

to

be

implemented

each

quarter

(6

months

max

per

DOJ

SA).

Sept 2023

DBDHS 2022 QRT End of Year Report

PM’s

Below

Compliance

SFY

•

Performance

Measure

C5

Number & percent of non-licensed/noncertified provider

agency DSPs who have criminal background checks as specified in policy/regulation

with satisfactory results.

(DMAS)

•

Performance

Measure

C8

Number and percent of provider agency staff meeting provider

orientation training requirements (DMAS)

•

Performance

Measure

C9

Number

and

percent

of

provider

agency

direct

support

professionals

(DSPs)

meeting

competency

training

requirements.

•

Performance

Measure

D1

Number

and

percent

of

individuals

who

have

Plans

for

Support

that

address

their

assessed

needs,

capabilities

and

desired

outcomes.

(DMAS)

•

Performance

Measure

D3

Number

and

percent

of

individuals

whose

Plan

for

Supports

includes

risk

mitigation

strategy

when

the

risk

assessment

indicates

need.

•

Performance

Measure

D6

Number

and

percent

of

individuals

whose

service

plan

was

revised,

as

needed,

to

address

changing

needs.

Sept 2023

DBDHS 2022 QRT End of Year Report

PM’s

Below

Compliance

SFY

•

Performance

Measure

D7

Number

and

percent

of

individuals

who received services in

the frequency specified in the service plan.

•

Performance

Measure

D11

Number

and

percent

of

individuals who received services in

amount specified in the service plan.

•

Performance

Measure

D13

Number

and

percent

of

individuals whose Plan for Supports

include risk mitigation strategy when the risk assessment indicates a need.

•

Performance

Measure

G4

Number

and

percent

of

individuals who receive annual

notification of rights and information to report ANE

•

Performance

Measure

G10

Number

and

percent

of

participants 19 and younger who had

an ambulatory or preventative care visit during the year.

Sept 2023

DBDHS 2022 QRT End of Year Report

2022 QRT

Performance

Below Compliance

Sept 2023

DBDHS 2022 QRT End of Year Report

FY

DD

Waiver

Performance

Measures

Below

86%

Threshold

Ongoing

Recommendations

to

the

QIC

•

Continuous recommendation from previous years.

•

Develop

statewide,

intra-

agency

processes

to

expand

the

reach

to

all

DDW

providers

so

that

existing

first

line

remediation

is

more

effective.

•

Develop

the

capacity

within

the

state

for

more

innovative,

on-

demand

training

resources.

•

Invest

in

ongoing

improvement

and

maintenance

of

database

solutions

to

streamline

data

reporting capability

Sept 2023

DBDHS 2022 QRT End of Year Report

2022 QRT Performance Below Compliance

Sept 2023

DBDHS 2022 QRT End of Year Report

QRT Transition to DMAS

•

Discussions arose in March/April 2023 of DMAS’ interest in assuming the

responsibilities of QRT and the data collect and reports of data. Implementation

occurred starting July 1, 2023.

•

DMAS Office of Community Living Quality Analyst will become the new point of

contact for matters QRT.

•

Transition period across the next year will continue until a stable understanding of

the Performance Measures and the data associated.

Sept 2023

DBDHS 2022 QRT End of Year Report

Questions?

•

Who to contact:

•

Nicole.DeStefano@DBHDS.Virginia.gov

•

804-971-6383

Sept 2023

DBDHS 2022 QRT End of Year Report

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The Quality Assurance Review Team (QRT) plays a crucial role in monitoring waiver assurances for individuals with developmental disabilities in Virginia. The QRT utilizes data from provider and Community Services Boards (CSB) reviews to ensure compliance with waiver performance measures and to identify areas for improvement. The report outlines the responsibilities of the QRT, feedback mechanisms from CSBs, and the importance of quality supports and services. Annual data from the QRT is publicly available on the Department of Behavioral Health and Developmental Services (DBHDS) website for transparency and accountability.

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VA VA DD Program: Program: Quality 2022 2022 End Of Year End Of Year Report DD Waiver WaiverQuality QualityReview Report Update Quality Assurance Assurance Review Team Team(QRT) Update to (QRT) to the the QIC QIC Nicole DeStefano Nicole DeStefano Waiver Network Supports Director Waiver Network Supports Director DDS Mission: DDS Mission: Assure that individuals with developmental disabilities have access to quality supports and services when and where they need them. DBHDS DBHDS Vision: Vision: A life of possibilities for all Virginians. Sept 2023 DBDHS 2022 QRT End of Year Report 1

Background: Related Authorities Per VD I-35.6 of the Settlement Agreement and outlined in the CSB Performance Contract, each CSB must review and provide feedback on the QRT EOY report annually. This requirement is met via publication of the QRT EOY Report posted on the DBHDS Website: https://dbhds.virginia.gov/wpcontent/uploads/2022/05/FINAL-QRT-End- of-YearReport-7-1-2020-v-6_30-2021.pdf. CSB s provide feedback on this report annually via Survey Monkey questionnaire. Sept 2023 DBDHS 2022 QRT End of Year Report 2

Background: Waiver Assurances A A Administrative Administrative Authority oversight of the waiver and is ultimately responsible for all facets of the program. B B - - Level Level of of Care Care - Persons enrolled in the waiver have needs consistent with an institutional level of care. C C - - Service Service Plan Plan - Participants have a service plan that is appropriate to their needs and services/supports are delivered as specified in the plan. D D - - Qualified Qualified Providers Providers - Waiver providers are qualified to deliver services/supports. G G - - Health Health and and Welfare Welfare - Participants health and welfare is safeguarded and monitored. I I - - Financial Financial Accountability Accountability - Claims for waiver services are paid according to state payment methodologies. Authority - The State Medicaid agency is involved in the Sept 2023 DBDHS 2022 QRT End of Year Report 3

Background: Quality Review Team DBHDS and DMAS have the primary responsibility for monitoring waiver assurances through the Quarterly Review Team (QRT). The QRT uses data from provider and CSB reviews to monitor waiver performance quarterly and demonstrate compliance to CMS. Compliance demonstrated through Performance Measures (PM s) that relate to assurances/sub-assurances. Provider data is used to ensure remediation occurs where needed, identify trends and areas where systemic changes are needed, and identify quality improvement initiatives. CMS reviews QRT data to ensure the state has sufficient evidence to demonstrate compliance with waiver assurances. Annual QRT data is made available to the public on the DBHDS website. Sept 2023 DBDHS 2022 QRT End of Year Report 4

About the Data Data should represent 2022 averages across all three waivers population. QMR Sampling Methodology: provider, service, and individual record level. Data represents a snapshot of compliance for a PM; different providers sampled each quarter. Trends inferred when persisting over several quarters or years. Improvements in performance typically demonstrated over 2-3 quarters or a year s review. Remediation required to be implemented each quarter (6 months max per DOJ SA). Sept 2023 DBDHS 2022 QRT End of Year Report 5

PMs PM s Below Below Compliance Compliance SFY SFY 2022 2022 Performance Performance Measure agency DSPs who have criminal background checks as specified in policy/regulation with satisfactory results. (DMAS) Performance Performance Measure Measure C8 C8: Number and percent of provider agency staff meeting provider orientation training requirements (DMAS) Performance Performance Measure Measure C9 C9: Number and percent of provider agency direct support professionals (DSPs)meeting competency training requirements. Performance Performance Measure Measure D1 D1: Number and percent of individuals who have Plans for Support that address their assessed needs, capabilities and desired outcomes. (DMAS) Performance Performance Measure Measure D3 D3: Number and percent of individuals whose Plan for Supports includes a risk mitigation strategy when the risk assessment indicates a need. Performance Performance Measure Measure D6 D6: Number and percent of individuals whose service plan was revised, as needed, to address changing needs. Measure C5 C5: Number & percent of non-licensed/noncertified provider Sept 2023 DBDHS 2022 QRT End of Year Report 6

PMs PM s Below Below Compliance Compliance SFY SFY 2022 2022 Performance Performance Measure the frequency specified in the service plan. Measure D7 D7: Number and percent of individuals who received services in Performance Performance Measure amount specified in the service plan. Measure D11 D11: Number and percent of individuals who received services in Performance Performance Measure include risk mitigation strategy when the risk assessment indicates a need. Measure D13 D13: Number and percent of individuals whose Plan for Supports Performance Performance Measure notification of rights and information to report ANE Measure G4 G4: Number and percent of individuals who receive annual Performance Performance Measure an ambulatory or preventative care visit during the year. Measure G10 G10: Number and percent of participants 19 and younger who had Sept 2023 DBDHS 2022 QRT End of Year Report 7

2022 QRT Performance Below Compliance FY FY 2022 2022 DD DD Waiver Waiver Performance Performance Measures Measures Below Below 86% 86% Threshold Threshold C5 44% C8 73% C9 58% D1 58% D3 52% D6 73% D7 71% D11 83% D13 80% G4 84% G10 66% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Percent Met Sept 2023 DBDHS 2022 QRT End of Year Report 8

Ongoing Recommendations to the QIC Continuous recommendation from previous years. Develop statewide, intra-agency processes to expand the reach to all DDW providers so that existing first line remediation is more effective. Develop the capacity within the state for more innovative, on-demand training resources. Invest in ongoing improvement and maintenance of database solutions to streamline data reporting capability Sept 2023 DBDHS 2022 QRT End of Year Report 9

2022 QRT Performance Below Compliance Comparison of Overall Performance Measures Not Met SFY 202 1/2022 88% C5 44% 78% C8 73% 60% C9 58% 84% D1 58% 77% D3 52% 75% D6 73% 93% D7 71% 77% *D9 93% 99% D11 83% 96% D13 80% 85% *G1 86% 71% *G4 84% 67% G10 66% 0% 20% 40% 60% 80% 100% 120% 2021 2022 Sept 2023 DBDHS 2022 QRT End of Year Report 10

QRT Transition to DMAS Discussions arose in March/April 2023 of DMAS interest in assuming the responsibilities of QRT and the data collect and reports of data. Implementation occurred starting July 1, 2023. DMAS Office of Community Living Quality Analyst will become the new point of contact for matters QRT. Transition period across the next year will continue until a stable understanding of the Performance Measures and the data associated. Sept 2023 DBDHS 2022 QRT End of Year Report 11