Quality

This letter is another in a series of CMS communications that support state efforts to improve the quality of services and supports provided through the Medicaid Home and Community-based Services waiver program. This communication announces three new items designed to assist states in enhancing oversight and operations: GAO Mortality Study in Developmental Disabilities, HCBS Quality Requirements Grid: A Technical Assistance Tool and the National HCBS Quality Enterprise award to Thomson Reuters.

The purpose of this report is to inform the efforts of states that are trying to develop and improve QA/QI systems by describing and analyzing how selected Systems Change Grantees went through this process. The initiatives examined fall into six categories: administrative technology and information technology; standards for services; discovery; remediation; workforce; and public information.

In Los Angeles County, personal care workers (PCW) that meet eligibility requirements can receive healthcare benefits. Since 2003, the Personal Assistance Services Council (PASC) of L.A. County has commissioned annual studies to examine how these benefits have effected retention and quality. Those studies are posted here along with an introductory letter. Visit the PASC website for updates.

This annual conference focuses on quality of services for people with developmental disabilities. Held Aug. 10-12 in Baltimore, this year’s conference featured agencies that have implemented person-centered planning and individualized support structures. One highlight was individuals who have developed their own micro-enterprises. In addition, innovations in policies, systems issues, and quality assurance methodologies were presented.

Direct care worker (DCW) training and education are challenging issues in all states. Iowa set up a taskforce to review existing requirements, streamline the process of training and education, and to establish a DCW registry by expanding the Iowa Nurse Aide Registry. The taskforce recommends classifying DCWs by function (rather than setting or population served) and developing a governing body, a single approved curriculum, and a certification system for all DCWs.

Use this presentation to learn how VT has measured the effectiveness of the Working People with Disabilities program. The primary cost measured was money spent on Medicaid claims and benefits counseling. This was compared with the earnings increases experienced by individuals in the program. The analysis found that every $1 spent on new Medicaid claims and benefits counseling, participant earnings increased by $1.23.

Policy makers and provider organizations continue to struggle to reduce turnover among direct-care workers in the long-term care field. Unfortunately, data elements used to measure turnover vary widely between programs and make it difficult to understand and counteract this problem. The authors discuss these challenges by drawing on their experience with the turnover tracking system of the Better Jobs Better Care Demonstration.

In January 2008, a small group of experts met to discuss challenges and recent changes to the early and periodic screening, diagnosis, and treatment (EPSDT) Medicaid benefit. Their discussion focused on helping states maximize children’s access to EPSDT care. They also covered ways to engage with primary care providers and to improve care coordination and quality measurement.

This graphic shows how information requests from or about people with long-term care needs are handled in Ohio. The illustrated processes include the information request, intake and referral, assessment, and follow-up and evaluation.

Health care experts from diverse fields give their opinions in this survey. The 196 leaders identified the most pressing long-term care (LTC) issues as development of the workforce, improving quality, and securing financing. 76% believe policymakers must urgently deal with the challenge of forming a sufficient supply of home and community-based services. Other themes dealt with include insurance, financial responsibility, a Medicare LTC benefit, and regulatory action.