Quality Assurance and Quality Improvement in Home and Community-Based Services (QA/QI)

ARKANSAS

Target Population

Persons who participate in Arkansas' home and community-based (HCBS) 1915(c) waiver programs.

Geographic Focus

Statewide, apart from the pilot, which will take place in a designated area.

Primary Focus

Develop a sustainable systemwide quality management (QM) system, that meets the requirements of the Centers for Medicare & Medicaid Services (CMS) HCBS Quality Framework, for all of the State's HCBS waivers. Twenty percent of waiver participants will be surveyed annually with the Participant Experience Survey during the grant period, and a feasibility study will be conducted to provide a framework for developing a single incident reporting management system that will interface with the existing Department of Human Services (DHS) Incident Reporting and Information System (IRIS). These activities will lead to improvement in the areas of participant-centered service planning and delivery, participant safeguards, and participant outcomes and satisfaction.

Goals, Objectives, and Activities

Goal: Develop a systemwide QM strategy for waiver participants by implementing the CMS HCBS Quality Framework design features and quality functions.

Objectives/Activities

  • Perform a comprehensive assessment of current quality assurance and quality improvement (QA/QI) activities within individual programs.
  • Develop a comprehensive QM Strategy Document for home and community services that specifically addresses quality issues in each of the seven focus areas of the CMS HCBS Quality Framework.

Goal: Develop an integrated data system that collects, analyzes, and generates relevant, useful, and timely QM information and activity.

Objectives/Activities

  • Evaluate the HCBS data collection systems currently in use for consistency and reliability and identify their commonalities and differences.
  • Develop and implement a uniform data system for collecting and reporting data for all waiver services.
  • Conduct a feasibility study to provide a framework for developing a single incident reporting management system for all waivers.
  • Establish "data-driven/data-based" performance standards and benchmarking.

Goal: Design and implement a methodology to secure participant feedback information to apply quality assurance and quality improvement strategies for the State's HCBS waivers.

Objectives/Activities

  • Establish a QA/QI task force to identify quality measures.
  • Conduct participant experience surveys with at least 20 percent of waiver participants annually in a designated pilot area.
  • Conduct waiver participant focus groups to determine consumer definitions of quality and outcomes.
  • Establish a volunteer peer counseling and mentoring program in a designated pilot area in conjunction with the Nursing Facilities Transition Grant HCBS Ombudsman Program to help participants make informed decisions in directing their services.
  • Develop educational materials for participant use in self-directed services.
  • Develop a strategy to assure effective backup plans to ensure delivery of all necessary services and improve the response time of waiver staff to reported participant problems.

Key Activities and Products

  • Develop a comprehensive systemwide QM plan for all HCBS services that can be replicated for all Department services.
  • Design and implement a single, automated data collection and analysis system for all HCBS waivers that generates reliable and timely reports to allow for informed program decisions and establishment of performance standards.
  • Provide a framework for developing a comprehensive incident reporting system to determine trends and patterns of complaints, investigations, and outcomes.
  • Design and implement participant feedback mechanisms to assess satisfaction with waiver services, identify participant outcomes, and assist the State in designing QA/QI strategies.
  • Disseminate educational materials to support participants in directing their own services.
  • Implement a peer counseling and mentoring program for HCBS waiver participants.

Consumer Partners and their Involvement in Implementation Activities

  • The QA/QI Task Force, comprising waiver participants, their family members or guardians, advocates, provider agencies, and other stakeholders, will (1) provide input for program design and the establishment of provider standards; (2) recommend strategies for participant access, safeguards, rights and responsibilities, and remediation procedures; and (3) assist the State to assess participant satisfaction and identify measurable outcomes such as health status, service effectiveness, and personal security.
  • Consumers will assist in developing materials about HCBS waiver services, specifically those related to consumer-directed services, and assist in developing the volunteer peer counseling and mentoring program for waiver participants.

Public and Private Partners and their Involvement in Implementation Activities

  • The Arkansas Area Agencies on Aging, Pathfinders, the ARC of Arkansas, Easter Seals of Arkansas, the Disability Rights Center, the Spa Area and Delta Resource Independent Living Centers, AARP, Arkansas Governor's Developmental Disabilities Council, and the Arkansas Independent Living Council will participate on the grant's QA/QI Task Force. Other partners will be added as initiatives are developed.
  • A subcontractor will be hired to conduct a comprehensive assessment of current quality-related activities within individual Division of Aging and Adult Services and Division of Developmental Disabilities HCBS programs.

Advisory Body, Committee, or Task Force

  • The grant's interdepartmental Quality Management (QM) Committee, comprising staff from the Division of Aging and Adult Services, the Division of Developmental Disabilities, the Division of Medical Services, the Division of Children and Families, Adult Protective Services, and the Office of the Director, will guide the development of the QM strategic plan and oversee the operation of the QM process.
  • The QA/QI Task Force will be involved in all stages of problem analysis, planning, implementation, monitoring, and evaluation of activities.
  • The Governor's Integrated Services Task Force has been involved in the development of the grant and will continue to be involved in the activities of implementation and evaluation.

Formative/Process Evaluation Activities

A QM manager will be hired to oversee Departmentwide QM activities to ensure consistency and adequate supervision of the QM process. Grant activities will be monitored by the QA/QI Task Force.

Summative/Outcome Evaluation Activities

Surveys (in a designated pilot area) and focus groups will be conducted with waiver participants to assess satisfaction with waiver services, identify participant outcomes, and assist the State in designing QA/QI strategies.

Strategies to Ensure Sustainability

The grant will lead to a fundamental alteration in all HCBS waivers and the development of a more comprehensive approach to ensure the health and welfare of the 10,762 participants in the five Arkansas HCBS 1915(c) waiver programs.

  • DHS will maintain the integrated data system developed during the grant period, after initial improvements and changes are made for enhancement. The system will provide a foundation upon which the State can continue to build a comprehensive quality assurance and quality improvement system for all its waiver programs.
  • The pilot program for the volunteer peer counseling and mentoring program will be expanded into other areas of the State through the efforts of advocacy organizations. The successful relationships created by this proposal will highlight the value of this kind of collaboration and lead to expansion statewide.
  • Initial costs for developing and purchasing materials for the consumer-directed services will be funded by the grant. Continued costs associated with purchasing and distributing them after 3 years will be absorbed by DHS through the individual waiver programs.
  • The QM strategy for HCBS waivers will be sustained by the anticipated cost savings associated with monitoring participant services more closely, correcting service delivery problems in a more timely fashion, and curtailing duplication of quality assurance efforts by staff located in different departments.
  • A cost analysis will be developed to look at the total costs for surveying participants with the Participant Experience Survey and sustaining this activity.