Post on 17-Jan-2016
Using CORE NDICATORSin Federal HCBS Reviews
Jon Fortune, Ed.DDavid Heath, MPA
Wyoming Developmental Disabilities Division& the Wyoming INstitute for Disabilities
(WIND-UCE)
HCBS Quality Framework ProtocolRed - Indicates that information gathered by Core Indicators
provides data that can be reviewed by CMS
Domain Sub-Domain
I. Participant Access A. Information/referralB. Enrollment
II. Participant-centered A. Participant-centered service planningService planning and B. Service DeliveryDelivery
III. Provider Capabilities A. Provider Networks & AvailabilityB. Provider QualificationsC. Ongoing Monitoring
HCBS Protocol (cont.)
Domain Sub-Domain
IV. Participant safeguards A. Abuse, neglect, exploitationB. Major & unusual IncidentsC. Housing & environmentD. Behavior interventionsE. Medication management F. Personal safety & securityG. Natural disasters
V. Participant rights & A. Grievances Responsibilities B. Due process
C. Fundamental Rights
HCBS Protocol (cont.)
Domain Sub-Domain
VI. Participant outcomes & A. Participant satisfaction Satisfaction B. Participant outcomes
VII. System performance A. System performance appraisalB. Continuous quality improvement
C. Cultural competencyD. Participant & stakeholder involvementE. Financial integrity
Several other features in addition to 150 core indicators helped:
• Use CARF…The Rehabilitation Accreditation Commission’s national standards for 3 waivers
• Individual waiver budget technology (DOORS)with good system architecture
* Extensive rules/training • RN, CDDN consultation • Published service provider site survey
reports http://ddd.state.wy.us
‘02 & ‘03 Results – Wyoming(Consumer Survey)
Wyoming’s performance was strong along four principal scales – community inclusion, support-related choices, personal choices, and service coordination
Satisfaction with Work/Day Satisfaction with Work/Day Program Program (Consumer Survey)(Consumer Survey)
20012001 20022002
89.1% (n=264)89.1% (n=264) -YES --YES - 94.2% (n=260)94.2% (n=260)
5.7% (n=17) 5.7% (n=17) -In between--In between- 4.3% (n=12) 4.3% (n=12)
5.0% (n=15) 5.0% (n=15) -NO--NO- 1.4% (n=4) 1.4% (n=4)
Satisfaction with ResidentialSatisfaction with Residential(Consumer Survey)(Consumer Survey)
20012001 20022002
89.4% (n=288) 89.4% (n=288) -YES--YES- 89.7% (n=272) 89.7% (n=272)
3.4% (n=11) 3.4% (n=11) -In Between--In Between- 5.6% (n=17) 5.6% (n=17)
7.1% (n=23) 7.1% (n=23) -NO--NO- 4.6% (n=14) 4.6% (n=14)
Case Management - 2002 Case Management - 2002 (Individually-Selected Service Coordination)(Individually-Selected Service Coordination)
(Consumer Survey)(Consumer Survey)
94.7% know their case manager94.7% know their case manager
93% say their case manager helps them 93% say their case manager helps them get things that they need if they askget things that they need if they ask
89.6% say that their case manager asks 89.6% say that their case manager asks them what they wantthem what they want
Case Management Case Management (Family Surveys)(Family Surveys)
80.9% (combined total)80.9% (combined total)
Satisfied With Services Provided by Case ManagerSatisfied With Services Provided by Case Manager
71.3% Adult/Family71.3% Adult/Family
89.1% Child/Family89.1% Child/Family
78.2% Family/Guardian78.2% Family/Guardian
(Thanks Washington State and Lisa Weber!!!)(Thanks Washington State and Lisa Weber!!!)
General InformationGeneral Information
91.6% (n=372) get the services that they need 91.6% (n=372) get the services that they need (66% of those answering were consumers)(66% of those answering were consumers)
3.1% of agency boards are consumers3.1% of agency boards are consumers
19.8% of boards are family members19.8% of boards are family members
Community Inclusion is high Community Inclusion is high (often @ 90%)(often @ 90%)
Choice and decision making was high Choice and decision making was high (most had input)(most had input)
Range of annual per person expenditure by living arrangement (2002)
Minimum Maximum Average Living Arrangement
$1,800 $187,270 $31,657 1 With parents or relatives
$32,700 $73,447 $58,745 2 Foster Home
$1,800 $109,187 $21,009 3 Independent in own home or rental unit
$1,800 $135,760 $36,361 4 Independent with regular home-based services or monitoring
$21,528 $185,432 $59,897 6 Semi-independent unit with supervisory staff in bldg.
$9,864 $299,134 $82,648 7 Group residence with staff providing care, supervision and training
$26,500 $173,130 $75,570 8 Personal care facility with staff providing care, but no training or nursing services
Mortality, Serious Injury and Mortality, Serious Injury and Abuse/Neglect (2002)Abuse/Neglect (2002)
CMS reviewers liked: CMS reviewers liked:
NCI definitions of abuse/neglect NCI definitions of abuse/neglect (and that (and that information was broken down in respect to restraints, injuries, and information was broken down in respect to restraints, injuries, and “substantiation”)“substantiation”)
NCI breakdown of mortality NCI breakdown of mortality (by age and total (by age and total number in each population bracket)number in each population bracket)
NCI breakdown and definition of crimes NCI breakdown and definition of crimes (forcible rape, aggravated assault, larceny theft)(forcible rape, aggravated assault, larceny theft)
673 Workers Needed Today
Direct service staff members $5.66 Need $10.23(Core Indicator: staff pay and turnover)
Funded July 1, 2002 Wyoming Legislature
Turnover rate: 50%
HELP WANTED
Contact Informationhttp://www.hsri.org/cip/core.html
National Core Indicators Web Site
Jon Fortune, Ed.Djfortu@state.wy.us
307-777-7115
David Heath, MPAdaheath@uwyo.edu
307-766-2609
DDD Wyoming Web Sitehttp://ddd.state.wy.us
http://wind.uwyo.edu/wycip/Wyoming Core Indicators Web Site