QIS Program Review Tool Training July 2017 1 Our Mission - - PowerPoint PPT Presentation

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QIS Program Review Tool Training July 2017 1 Our Mission - - PowerPoint PPT Presentation

May 07, 2023 278 likes •807 views

QIS Program Review Tool Training July 2017 1 Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2 Housekeeping We are recording this session

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1

QIS Program Review Tool Training

July 2017

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Our Mission

Improving health care access and

  • utcomes for the people we serve

while demonstrating sound stewardship of financial resources

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Housekeeping

  • We are recording this session
  • Available on our website in the coming days
  • www.colorado.gov/ hcpf/ long-term-services-and-supports-

training#QIS

  • Please use chat panel to enter your questions
  • Files Panel
  • Click to download this presentation and handouts

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Experience Level

Rookie QIS Reviewer Veteran QIS Reviewer Just interested…

A B C

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Today’s Objectives

Tools of the Trade Program Review Tool Background Information

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Today’s Objectives

Tools of the Trade Program Review Tool Background Information

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Why are we doing this?

  • Ensure participants are receiving the

services and supports they need

  • CMS

requirement

  • Annual and periodic reports
  • Guide training development
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What are we looking for?

  • S

ix Federal Assurances

  • Level of Care
  • S

ervice Plan

  • Health and Welfare
  • Qualified Provider
  • Administrative Authority
  • Financial Accountability
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Role of the QIS Reviewer

  • Review only the provided certification spans

for the participant

  • QIS

Reviewers cannot review his or her own work

  • Okay if the participant is or has been on the

reviewer’s caseload, as long as the reviewer is not case manager of record during the review period

  • QIS

Reviewers should not make any changes to participant records

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What if I find something that needs to be changed?

  • For major concerns or unmet needs

identified, do full S ervice Plan Revision

  • QIS

Reviewers should not make any changes to participant records

  • Note minor changes, wait for CS

R or remediation

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New for 2017

  • S

implified Program Review Tool

  • S

ample participants will be populated for you in the tool

  • Reviews for all sample participants will be done within
  • ne program review tool
  • You will NOT have to create individual program

review tools for each participant

  • You will NOT have to copy and paste information

into an Aggregation workbook

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New for 2017

  • Bridge Go Live Dates
  • March 1, 2017 - Community Centered Boards
  • April 17, 2017 – S

ingle Entry Point Agencies

  • When reviewing data:
  • Review participant information

in the related system

  • Refer to the Data S
  • urce

identified in the instruction manual for each section

  • Department will help identify

participants in your sample that may have information in the Bridge

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Process

Data Pull QIS Review Super Aggregate Super Aggregate Analyze Trend Report

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Questions

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Today’s Objectives

Tools of the Trade Program Review Tool Background Information

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What your agency receives

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Participant Sample

  • Check for:
  • are the participants listed with your agency currently
  • are the participants listed on the correct waiver

EBD EBD

  • If not, notify Elaine Osbment or Emily Kelley immediately
  • Confirm you have completed this basic review
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Program Review Tool and Instructions

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Data Information Sheet

Optional!

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Submit Completed Program Review Tool

Due by September 8th!

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Timeline

  • Receive sample
  • Confirm receipt of the sample via email
  • Confirm all participants in your sample are currently

being served by your agency and are on correct waiver – contact Elaine or Emily either way – no changes after that

  • Receive Program Review Tool
  • September 8th – One completed Program Review Tool

due back to the Department

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Contacts

Elaine Osbment Emily Kelley Nancy Harris

Long-Term Services and Supports Waivers

  • Brain Inj ury Waiver (BI)
  • Children’ s Home and Community

Based S ervices Waiver (CHCBS )

  • Children With Life-Limiting

Illness (CLLI)

  • Community Mental Health

S ervices Waiver (CMHS )

  • Elderly, Blind or Disabled Waiver

(EBD)

  • S

pinal Cord Inj ury Waiver (S CI)

Elaine.Osbment@ state.co.us Division for Intellectual and Developmental Disabilities

  • Children’ s Extensive S

upports Waiver (CES )

  • Persons with Developmental

Disabilities Waiver (DD)

  • S

upported Living S ervices Waiver (S LS )

Emily.Kelley@ state.co.us Department of Human Services

  • Children’ s Habilitation

Residential Program Waiver (CHRP)

Nancy.Harris1@ state.co.us

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Find Tools Online

www.colorado.gov/hcpf/long-term-services-and- supports-training#QIS

For Our Providers Provider Services Training Long-Term Services and Supports Training QIS Heading

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Questions

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Today’s Objectives

Tools of the Trade Program Review Tool Background Information

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Program Review Tool

  • One tool…

… many participants

  • Participant

information is populated for you

  • Participant

information is locked

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Program Review Tool

One column for each participant

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Program Review Tool

  • Tabs for each

waiver

  • Participants listed

within each tab

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Other Changes

Before After

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Participant/Agency Information Rows 1-10

  • Rows 1-8
  • Contain participant information from your agency’ s sample
  • Populated by the Department
  • Agency cannot make changes in this section
  • Rows 9-10
  • Agency reports QIS

Reviewer name for that participant and Review Date

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Participant’s Residence = where the participant currently resides, which may include: the participant’s private home or their parent’s home if this is where the participant lives; an Alternative Care Facility; a Hospital; a Nursing Facility; etc.

0 ADL score = YES

Level of Care Rows 14-25

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Where to Find on the BUS

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ADL Example

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Good narrative statements include the following information:

  • Person-centered language
  • Use names, person first language
  • Information about person’s abilities instead
  • f only what services are needed
  • How information was obtained
  • Who is providing assistance
  • Frequency, scope and duration of

assistance needed

  • Assistive devices or Durable Medical

Equipment (DME) used

  • AVOID vague words

For more visit - www.colorado.gov/ hcpf/ long-term-services-and-supports-training - Under BUS Heading

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Service Plan Rows 28-33

No supports = No

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Where to Find on the BUS

  • Under S

ervice Plan Menu

  • Review S

ervice

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Where to Find on the Bridge

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  • From Main Menu

click on Bridge

  • Click on Client

Information

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Where to Find on the Bridge

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  • Type in Client ID
  • Click S

earch

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Where to Find on the Bridge

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  • View client information
  • Open tabs as needed
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Bridge Tip

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  • Click S

how All Button to see all tabs on screen

  • Click Hide All to

hide all tabs

  • Must do this each

time you click on an item in the tabs

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Bridge –Inventory of Needs

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Goals and Contingency Plan Rows 34-38

  • Participant’s service goals are complete
  • Personal goal has been documented and is individualized
  • Contingency plan is individualized and provides details of what the

participant will do in the event of an emergency. Need to have more than j ust call 911.

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BUS - Goals

  • S

ervice Plan

  • HCBS

S ervices Goals

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BUS - Goals

  • S

ervice Plan

  • Personal Goal

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Bridge –Goals

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  • Goals in the Bridge represent both S

ervice and Personal Goals

  • Goals should be tied to services
  • Can see more detail in services section
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BUS –Contingency Plan

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Service Plan Revisions Rows 40-44

KEY

  • First question is key to whether you will need to complete the other four

questions in this section

  • If a revision appeared necessary – answer Y

es on row 40 and then continue answering the next four questions

  • If a revision appeared necessary after the Bridge Go Live date for your agency –

contact Elaine or Emily for further instructions

  • If a revision did not appear to be necessary – answer No on row 40 and

mark N/ A for rows 41-44

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Critical Incidents Rows 47-48

KEY

  • Row 47 is the key question of this section
  • If anything in the review indicates that a Critical Incident either

was or should have been reported – answer Y es and move on to row 48

  • However, if there was no need for a critical incident report

during the review period, then you can answer No for 47 and not applicable (N/ A) for row 48

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Questions

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  • Receive sample
  • Confirm receipt of the sample via email
  • Confirm all participants in your sample are currently

being served by your agency and are on correct waiver – contact Elaine or Emily either way – no changes after that

  • Receive Program Review Tool
  • September 8th – One completed Program Review Tool

due back to the Department

Timeline

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Contacts

Elaine Osbment Emily Kelley Nancy Harris

Long-Term Services and Supports Waivers

  • Brain Inj ury Waiver (BI)
  • Children’ s Home and Community

Based S ervices Waiver (CHCBS )

  • Children With Life-Limiting

Illness (CLLI)

  • Community Mental Health

S ervices Waiver (CMHS )

  • Elderly, Blind or Disabled Waiver

(EBD)

  • S

pinal Cord Inj ury Waiver (S CI)

Elaine.Osbment@ state.co.us Division for Intellectual and Developmental Disabilities

  • Children’ s Extensive S

upports Waiver (CES )

  • Persons with Developmental

Disabilities Waiver (DD)

  • S

upported Living S ervices Waiver (S LS )

Emily.Kelley@ state.co.us Department of Human Services

  • Children’ s Habilitation

Residential Program Waiver (CHRP)

Nancy.Harris1@ state.co.us

www.colorado.gov/ hcpf/ long-t erm-services-and-supports-training#QIS

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Thank You for attending!