Attachment XI Setting Assessment Process

CFCO CBAS PPC HCBA MSSP MCWP IHO DDS ALW

Waiver Name

X

X

X

X

Each

Yea

r

Site Visit Frequency

X X

X X

X

Each

24

Mon

th

X X X X X X X X X

Fede

ral A

ssur

ance

Rev

iew

X X X X X X X X

Nur

se

Monitoring Team Staff

X X X

X X

X X

Prog

ram

Ana

lyst

X X

x

X

Soci

al W

orke

r X X X X X X X X X

HC

BS S

ettin

g C

ompl

ianc

e

Other Compliance

X

X X X X X X

Prov

ider

Sel

f- Su

rvey

Val

idat

ion

X X X X

X

X

CA

Lice

nsin

g an

d C

ertif

icat

ion

Stan

dard

s

X X X

X

Stan

dard

Ag

reem

ents

X X X X X X X X X

Cor

rect

ive

Actio

n Pl

an

for N

on-c

ompl

ianc

e

X X X X X X X X X

CAP

App

rova

l Bas

ed o

n Ve

rific

atio

n of

Issu

e R

esol

utio

n

X X X X X X X X X

Tech

nica

l Ass

ista

nce

and

Trai

ning

MONITORING & OVERSIGHT

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Please note: The nurse, program analyst and social worker who make up the monitoring team staff, are program staff. They do not provide direct services to the individuals and do not work for the providers. The frequency of the activities under “Other Compliance,” occur at the same frequency listed under site visit frequency.

Assessment Process

CFCO CBAS PPC HCBA MSSP MCWP IHO DDS ALW

Waiver Name

X

Non

e Site Visit Notification

X

One

Wee

k N

otic

e

X X

X X

30 D

ays

Not

ice

X

X

6 W

eeks

Not

ice

X

60 D

ays

Not

ice

X X X X X X X X X

Parti

cipa

nt R

ecor

ds R

eque

sted

Prio

r to

Vis

it X X X X X X X X X

Entra

nce

Con

fere

nce

M

X X X X X X X X X

Parti

cipa

nt R

ecor

d R

evie

w

X X X X X

X

Rev

iew

of B

illing

Rec

ords

X

X

Vend

or R

ecor

d R

evie

w

X X X X

X X X X

Rev

iew

of A

dmin

istra

tive

Rec

ords

X

X

X

Rev

iew

of P

eer a

nd In

tern

al R

evie

w P

roce

ss

X X

X X

Mem

ber a

nd/o

r Gua

rdia

n In

terv

iew

s

X X X

X X X X

Staf

f Int

ervi

ews

X X X

X

Rev

iew

Spe

cial

Inci

dent

Rep

orts

X X

X

Rev

iew

Par

ticip

ant E

xper

ienc

e Su

rvey

s

X X X X X

X

X

Parti

cipa

nt H

ome

Visi

t Con

duct

ed

X

X X X

X X

Asse

ssm

ent o

f Mem

bers

' Res

iden

ces

that

ar

e Pr

ovid

er O

wne

d/C

ontro

lled

ON-SITE MONITORING PROTOCOLS

X X X X X X X X X

Rev

iew

of F

indi

ngs

and

Tren

d An

alys

is (M

OS

team

)

X X X

X X

X

Tech

nica

l Ass

ista

nce

X X X X X X X X X

Exit

Con

fere

nce

X X X X X X X

X

M&O

Rep

ort I

ssue

s w

ithin

60

Day

s of

Exi

t Con

fere

nce

Setting Assessment Process

Page 2 of 14

Setting CBAS

Page 3 of 14

Page 1 of 2 of CBAS

Provider Self-Survey % Sampled Frequency Method of Distribution

100% of Centers

6 months prior to certification expiration date

(Ongoing every two-years during center’s certification renewal process)

U.S. Mail

Member Self-Survey Validation % Sampled Frequency Method of Distribution CDA administers a survey to up to a 10% sample of participants at each center during a face-to-face interview. Sample includes participants randomly selected for chart review during certification renewal onsite survey by CDA staff.

At time of onsite certification renewal survey by CDA staff.

(Ongoing every two years during center’s onsite certification renewal survey)

Face-to-face interview of sampled participants by CDA survey staff during the center’s onsite certification renewal survey.

Setting Assessment Process

Setting CBAS

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100% of At time of Completed by CDA nursing Centers certification and analyst staff during (2016-2018) renewal survey onsite surveys. Staff will

review center administrative and health records, interview center staff and members / caregivers or representatives, and observe program activities.

N/A N/A N/A

On-Site Assessment Validation Care Management Entity Self-Survey % Sampled Frequency Method of Completion % Sampled Frequency Method of Distribution

100% of Centers

At time of center'sonsite certification renewal survey. (Ongoing every two years during center's onsite certification renewal survey)

Completed by CDA nursing and analyst staff during onsite certification renewal surveys. Staff reviews center administrative and health records, interviews center staff and participants/caregivers or authorized representatives and observes program activities.

Setting CBAS

Page 5 of 14

Page 2 of 2 of CBAS

All CBAS centers are required to complete the Provider Self-Assessment survey at the time of their certification renewal application. All CBAS centers receive an onsite validation of compliance by CDA survey staff, with corrective action plans required where non-compliance is identified. Initial compliance determination activities concluded on December 31, 2019. Centers completed their corrective action plans as of March 31, 2020. CDA’s monitoring and onsite validation of compliance of all CBAS centers is ongoing every two years during each center’s certification renewal period and continuing beyond March 17, 2023.

Additional Comments

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On-site Assessment Validation % Sampled Frequency Method of Completion

100% of the 38 MSSP Sites (2016-2018)

At time of UR by CDA. Completed by CDA UR team.


N/A N/A N/A

Member Self-Survey Validation % Sampled Frequency Method of Distribution

100% of the MSSP Waiver Members selected each year during CDA's UR process. (See Additional Comments)

At time of CDA UR. Members will return the assessment to CDA by mail.

Mailed by CDA staff.

MSSP Care Management Agency Setting

Additional Comments

Care Management Entity Self-Survey % Sampled Frequency Method of Distribution

100% of the 38 MSSP Sites (2016-2018)

Fall 2016 Survey Monkey

CDA conducts a two-year UR cycle so that all 38 MSSP Sites are reviewed every two years. CDA uses a sample size of 375 MSSP Waiver Member records each year as required by the MSSP Waiver.

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MSSP Service Settings for Congregate Meals and Adult Day Care (ADC)


100% of MSSP Service Vendors for Congregate Meals and ADC (2016- 2018).

At time of UR by CDA. U.S. Mail


100% of the Waiver Members who receive either Congregate Meals or ADC or both annually.

At time of UR by CDA. U.S. Mail

On-Site Assessment Validation % Sampled

100% of the Waiver Members who receive either Congregate Meals or ADC annually.

Frequency At time of UR by CDA.


N/A N/A N/A

Additional Comments

CDA conducts a two-year UR cycle so that all 38 MSSP Sites are reviewed every two years.

Setting

Method of Completion Completed by CDA UR team.

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As listed in STP Appendix B for HCBS DD Waiver & 1915(i)


Statistically valid sample by provider type. # = Residential - 365; Child Day Care - 50; Day-Type - 320; Work Activity Program- 86

Q4 2016 and ongoing U.S. Mail, website download, email.


With every onsite review

Once every two years.

Either direct survey or hand-delivered by DDS staff.

Additional Comments

Onsite assessments, complaint investigations, existing monitoring and oversite processes will include consumer interviews.

Setting

On-Site Assessment Validation % Sampled Frequency Method of Completion For initial onsite validation, the state will assess a statistically valid sample of settings. For ongoing monitoring, the state will assess a random sample of settings.

Ongoing monitoring will occur during biennial site visits conducted by monitoring teams.

As identified in Statewide Transition Plan


N/A N/A N/A

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Assisted Living Waiver (ALW) - RCFEs/ARFs/HHAs


N/A N/A N/A


N/A N/A

On-Site Assessment Validation % Sampled Frequency

Statistically valid Q4 2016 and ongoing sample

Method of Completion As identified in Statewide Transition Plan


N/A N/A N/A

An assessment tool was developed from CMS exploratory questions and was used to assess each setting, to determine the current level of compliance with the Final Rule. DHCS through the Integrated Systems of Care Division (ISCD) ensures ALW individuals receiving services’ health and safety needs are continuously met, monitored, and safeguarded. These assurances are reflected through annual monitoring and oversight reviews (audits) of ALW providers. DHCS conducts Quality Assurance (QA) on-site reviews of the Residential Care Facilities for the Elderly (RCFE), Adult Residential Facilities (ARFs), Home Health Agencies (HHA) in the Public Subsidized Housing (PSH) setting, and Care Coordination Agencies (CCA) providing ALW services.

Additional Comments

Setting

N/A

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In-Home Operations Waiver (IHO) - Care Management

Provider Self-Survey

% Sampled Frequency Method of Distribution

N/A N/A N/A

Member Self-Survey Validation

% Sampled Frequency Method of Distribution

N/A N/A N/A

All care management services are provided by DHCS. The annual audit conducted verifies that the services are member driven and directed by the member. The current Menu of Health Services (MOHS) and Plan of Treatment (POT) are required to be signed by the member and in each member's file and this is verified during the annual audit conducted by DHCS.

All services are provided in the home and validation that the home is compliant with HCBS rules is done through the home and safety evaluation which is completed prior to waiver enrollment and any time the member changes residence.

Additional Comments

Setting

On-Site Assessment Validation % Sampled Frequency Method of Completion

N/A N/A N/A

Care Management Entity Self-Survey % Sampled Frequency Method of Distribution Statistically valid sample size

Once per year during annual audit.

U.S. Mail

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Home and Community Based Alternatives Waiver (HCBA - CLHF and ICF/DD-CNCs

Provider Self-Survey % Sampled Frequency Method of Distribution 100% Q4 2016 and

ongoing U.S. Mail, website download, email.

Member Self-Survey Validation % Sampled Frequency Method of Distribution 100% of cases At time of annual

Visit by DHCS. Direct survey delivered by DHCS staff.

Please note the HCBA Waiver was formerly known as the Nursing Facility/Acute Hospital Waiver (NF/AH).

Additional Comments

Setting


100% Q4 2016 and ongoing Direct survey by DHCS during the annual visit.


N/A N/A N/A

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Home and Community Based Alternatives Waiver (HCBA) - Care Management


N/A N/A N/A


N/A N/A N/A

Please note the HCBA Waiver was formerly known as the Nursing Facility/Acute Hospital Waiver (NF/AH).

All care management services are provided by DHCS. The annual audit conducted verifies that the services are member driven and directed by the member. The current Menu of Health Services (MOHS) and Plan of Treatment (POT) are required to be signed by the member and in each members file and this is verified during the annual audit conducted by DHCS.

All other services are provided in the home and validation that the home is compliant with HCBS rules is done through the home and safety evaluation which is completed prior to waiver enrollment, and any time the member moves residence.

Additional Comments

Setting


N/A N/A N/A

Care Management Entity Self-Survey % Sampled Frequency Method of Distribution Statistically valid sample size

Once per year During annual audit.

U.S. Mail

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Setting Community First Choice (CFCO) 1915(K)


N/A N/A N/A

Member Self-Survey Validation % Sampled Frequency Method of Distribution N/A N/A N/A

Routine scheduled reviews confirm whether or not 1) recipient needs are correctly assessed, and, 2) the documentation is in compliance with State and county requirements. Routine scheduled reviews consist of desk reviews and home visits, and must include cases from all district offices and all case workers involved in assessments and/or reassessments. The cases chosen for a home visit must have already received a full desk review as part of a routine scheduled case review. Counties are required to complete a minimum number of case reviews each year. CDSS notifies counties of their minimum required number of desk reviews for the next fiscal year each April. The required number is based on a county’s caseload and QA staffing allocation. The minimum required number of home visits is 20% of the required desk reviews.


20% Q4 2016 and ongoing On-site reviews are completed by QA staff.


N/A N/A N/A

Additional Comments

Attachment XI Setting Assessment Process

Documents

Transcript of Attachment XI Setting Assessment Process