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Quality Assurance in Home and Community-Based Waiver Services
Overview
The Department of Human Services (DHS) provides most of its long-term care services outside of facilities such as nursing homes or institutions. These home and community-based services allow seniors, adults with physical disabilities, and people with developmental disabilities to lead healthy, satisfying and productive lives among family and friends.
The diversity and scope of services available throughout the state would not be possible without Medicaid’s home and community-based waiver program. Medicaid is the largest source of funding for medical and health-related services for people with limited income. In general terms, the Medicaid waiver program allows individuals eligible for Medicaid who need the kind of long-term care and assistance provided by hospitals, nursing homes or intermediate care facilities for the mentally retarded (ICF/MR) to choose to receive care and assistance at home or in other community settings instead.
DHS, through Seniors and People with Disabilities (SPD), operates several waivers to provide home and community-based services. SPD carries out or oversees strategies to safeguard all individuals in these services while accommodating each waiver’s unique design and the characteristics of service systems for each target population.
These strategies engage state and local partners, consumers, and advocates in an overall approach to quality management that continues to grow and change.
Learn more about the national Medicaid waiver program and its quality initiatives directly from the Centers for Medicare and Medicaid Services (CMS), the Federal office that approves and regulates the program.
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Home and community based waiver services:
Aged/elderly or adults who have physical disabilities
Details about these services, including eligibility and access, can be found in the Choosing and Funding Long-term care section of our site.
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Home and community based waiver services:
Individuals with developmental disabilities
Model Medicaid Waiver Services—Children’s Intensive In-Home Services
Details about these services, including eligibility and access, can be found in the Children’s Intensive In-Home Services section of our site.
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Comprehensive Services for Children and Adults
Details about these services, including eligibility and access, can be found in the Support for Adults with Developmental Disabilities and the Supports for Children with Developmental Disabilities sections of our site.
Support Services for Adults
Details about these services, including eligibility and access, can be found in the Support Services for Adults with Developmental Disabilities section of our site.
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Reports and Reviews
- Protective Services
- Aged and Physically Disabled
- Developmentally Disabled
- State and local provisions for response to reports of abuse
- Office of Investigations and Training: Annual Abuse Allegations Reports
- Serious Event Review Team (SERT)
The Serious Event Review Team (SERT) system is built around a web-based means of recording certain incidents and obtaining local and statewide reports about individuals, circumstances, and outcomes associated with those incidents. The system also brings state and local teams together to a) Review licensing and certification issues, individual outcomes, and trends; b) Propose action to remediate or avoid problems; and c) Analyze the effects of actions taken.
Authorized users (e.g. county developmental disability program service coordinators, QA coordinators, investigators, SPD county relations or licensing staff) may log on to a secure site to add or update incidents, produce or review aggregate reports, receive updates on programs with licensing or certification issues, upload local SERT team meeting notes, and review state SERT team meeting notes.
- Home and Community Based Services (HCBS) Waiver Review
SPD conducts an annual review of individual records to determine whether basic conditions for waiver service participation have been met. SPD selects a random sample of waiver service recipients to be reviewed. Each Waiver has their own process for conducting the annual reviews, usually conducted at the local level. Reviewers record what corrective action, if any, is required and when corrections have been completed. The results of these reviews are submitted to SPD for entry into a central database and for aggregation into reports of findings.
- Aged and Physically Disabled
- Developmentally Disabled
- Annual HCBS Title XIX Waiver Review
- Support Services Field Reviews
SPD’s Adult Support Services Coordinators conduct reviews of brokerage services to supplement information available through waiver and certification reviews. The reviews are conducted in two parts: program and service issues during one period and administrative and organizational issues in another.
- Licensing and Certification
- Aged and Physically Disabled
- Developmentally Disabled
Waiver services are provided by qualified providers. SPD has procedures for licensing or certifying provider organizations. Minimum expectations for all individual providers—whether self-employed, independent contractor, or an employee of the service recipient—are set in applicable service rules. The foundation for all service providers is an approval to work from DHS based on a review of criminal history.
- Senior and People with Disabilities Reports
Various data reports about Oregon seniors and people with disabilities are available on the web. Reports and data are available on the web.
- Aged and Physically Disabled
- Developmentally Disabled
- Direct Care Staffing
Organizations that provide assistance for individuals to remain in the community submit information to SPD about their staffing turnover.
- Employment Outcomes
Organizations that provide assistance for individuals to work and participate in other community activities regularly submit information to SPD about outcomes of their services. This Employment Outcomes System information helps state and local quality assurance committees evaluate progress related to integration, independence, and productivity of individuals in these services.
- Centers for Medicare and Medicaid Services (CMS) Reviews
CMS must assess each Home and Community-Based waiver program in order to determine that State assurances are met. CMS provides a final report of findings that may require some corrective actions. The state responds with a corrective action plan (CAP).
- January 2007 Review of the ICF/MR Comprehensive Services (#0117.90.R3) and Support Services (#0375.01) Waivers
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Quality Advisory Committees
Quality Assurance Committees advise Seniors and People with Disabilities regarding quality assurance in home and community-based waiver services for people who are aged or who have physical disabilities (APD) and waiver services for people with developmental disabilities (DD). Each committee includes representatives of providers, local operating agencies, providers, advocates, and consumers. The committees typically address:
- Quality assurance plans and progress;
- Reports of program performance and quality of care; and
- Recommendations for improvements in protective services, access to services, and meeting individual needs.
Resources and Contacts
Critical Questions Workbook (CQW), June 2005
While Community Developmental Disability Programs are not required to use this workbook, the tools in the book were created to help carry out local quality assurance activities required by Oregon Administrative Rule. Quality assurance coordinators and committees from around the state and at different stages of quality management system development contributed to the initial 2005 product. Additional refinements are expected as state and local systems evolve. The workbook offers structure, process, and tools for reviewing and commenting on results of information gathered by the CDDP and on the effectiveness of corrective actions. Each section of the workbook is designed for use separately or in combination with other sections.
- Access entire CQW (158 pages): (PDF)
- Access CQW by section:
- CQW - Contents and Preface (5 pages): (PDF)
- CQW Section 1 - Introduction (16 pages): (PDF)
- CQW Section 2 – Workbook Pages (58 pages): (PDF) or (Word)
- CQW Section 3 – Orientation for QA Committee Members (10 pages): (PDF)
- CQW Section 4 – Quality Component Lists and Rating Forms (48 pages): (PDF) or (Word)
- CQW Section 5 – Process and Results Rating Forms (33 pages): (PDF) or (Word)
- CQW Section 6 – Sample Helpful Forms (29 pages): (PDF) or (Word)
Local Quality Assurance Resource Manual, June 2005
This resource manual is another tool that CDDPs are not required to use, but which was specifically developed to help carry out local quality assurance activities required by Oregon Administrative Rule. Each chapter states the current requirements for a particular element of a local quality assurance program and offers suggestions, samples, or direction to additional resources. As with the Critical Questions Workbook, June 2005, quality assurance coordinators from around the state contributed to this initial 2005 product and will have opportunities for further contribution as systems mature.
- LQARM Updates
- June 2007
- LQARM Chapter 1 Additional Information (11 pages): (Word )
- Access entire LQARM 2005 version (173 pages): (PDF)
- Access LQARM 2005 version by Chapter:
- LQARM - Contents and Preface (5 pages): (PDF)
- LQARM Chapter 1 - Introduction Local QA Program (18 pages): (PDF ) or (Word)
- LQARM Chapter 2 - Local Quality Plans (30 pages): (PDF ) or (Word)
- LQARM Chapter 3 - Local QA Committees (25 pages): (PDF ) or (Word)
- LQARM Chapter 4 - Compiling, Analyzing and Presenting Data (50 pages): (PDF ) or (Word)
- LQARM Chapter 5 - Measuring Customer Satisfaction (24 pages): (PDF ) or (Word)
- LQARM Chapter 6 - Improving Quality (20 pages): (PDF ) or (Word)
- LQARM Glossary (5 pages): (PDF )
CMS Real Systems Change QA/QI Grant 2003-06
SPD is currently working with Human Services Research Institute and its collaborators---Oregon Rehabilitation Association, Oregon Technical Assistance Corporation, and Loki Innovations---to improve methods for measuring health, safety, risk management, and consumer satisfaction for individuals who direct services in their own homes. The project, funded by a Centers for Medicare and Medicaid Services Real Choice Systems Change grant, began October 2003 and is scheduled for completion September 2006.
- Report of Consumer Survey Field Test
Other Helpful Links
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