On-Site Review Activities for FY16 by the Division of Developmental Disabilities

Helping Families. Supporting Communities. Empowering Individuals.
Illinois Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.15.063

On-Site Review Activities for FY16 by the Division of Developmental Disabilities
August, 2015

Purpose

This Information Bulletin is being issued to outline changes in on-site review activities conducted by the Division of Developmental Disabilities' (DDD) Bureau of Quality Management (BQM) for state fiscal year 2016 (July 1, 2015 - June 30, 2016). These changes will accommodate the DDD's transition to a more person-centered outcome-based review process while maintaining compliance with Medicaid Home and Community-Based Services (HCBS) Waivers and expectations of the National Core Indicators (NCI) project.

Background

Since fiscal year 2011, DDD has used review tools that evaluate compliance with the Home and Community-Based Services (HCBS) Waivers, as well as contractual agreements between the Illinois Department of Human Services and provider agencies. Recognizing the need to enhance person-centered outcome-based measures to more fully evaluate service quality, DDD will generally limit review activity during FY16 to the gathering of data for the randomly selected waiver samples required for performance measure reporting to Medicaid and conducting National Core Indicator surveys with a sample of adults served through the Adults with Developmental Disabilities waiver. This will result in reduced time-demands on provider agencies and allow the focus to shift to the development of person-centered outcome measures and the processes to gather that information.

During this period, DDD will collaborate with stakeholder workgroups to develop a more person-centered outcome-based review process. Ample opportunities will be provided for input into the new process and to train provider agency staff, ISC agencies, and other stakeholders in the review process prior to implementation of the new outcome measurement process.

Process and Procedures

A random, statistically valid sample of Waiver participants has been identified for each of DDD's three Medicaid Waivers. Initial review activity during FY16 will focus on gathering data for each of these participants to assess compliance with waiver performance measures. During the FY16 review period the participant sample will be limited to the pre-selected waiver sample and agency scores will not be issued. Information will be gathered through a combination of unannounced on-site reviews and desk audits of documentation requested of and submitted by provider agencies.

  1. For all service providers, data gathered will focus on verifying that:

    • Service plans address all identified needs and preferences
    • All risks identified in the risk assessment are addressed
    • Service plans are approved by the Independent Service Coordinator(ISC), Qualified Intellectual Disabilities Professional (QIDP), and guardian
    • Service plans are updated at least annually
    • Individuals receive all services outlined in the service plan
    • Critical incidents are addressed
    • Service plans address access to needed healthcare
    • All imposed rights restrictions are justified and appropriately addressed
  2. For individuals in the Adults with Developmental Disabilities wavier sample:

    • A National Core Indicators interview and associated background information will be completed
  3. For all Independent Service Coordination (ISC) agencies, data gathered will focus on:

    • Annual redeterminations
    • Level of care documentation
    • Visiting notes
    • Choices of providers
    • Completion of forms IL462-1238 Home and Community-Based Services for Individuals with Developmental Disabilities Choice of Supports and Services and IL462-1203 Determination Summary and Presentation and Selection of Service Options (DDPAS-10)
    • Provision of abuse, neglect, and exploitation information to the individual, guardian, and family
    • PUNS completion (both initial and annual updates)
  4. For Waiver-funded services not licensed or certified by IDHS's Bureau of Accreditation, Licensure, and Certification, BQM will also examine:

    • Employee background checks (at time of hire and annually)
    • Employee abuse and neglect training, including both frequency of training and relevancy of training materials

Provider agencies will receive a written report of all findings. Corrective action will be required for issues that are not corrected while review staff are on-site.

During this transition period, DDD will continue to conduct on-site reviews of medication administration (Rule 116) at Community Integrated Living Arrangements (CILAs), Community Living Facilities (CLFs), and Child Group Home providers. Such reviews will be unannounced and may not always coincide with other review activity. In addition, DDD will continue to conduct focused reviews as needed to respond to concerns received from various stakeholders.

Prior to the implementation of an outcome measurement process, training and technical assistance will be available to providers to assist with personal outcome discovery for waiver participants and to assist with the development of supports needed to promote desired outcomes.

These changes in the review process for the Division's Bureau of Quality Management will not change processes for licensure and certification reviews conducted by the Bureau of Accreditation, Licensure, and Certification for CILA and Developmental Training (DT) providers.

Questions may be addressed to Jayma Bernhard Page, Quality Review Section Manager, (217) 785-6172, Jayma.Bernhard@Illinois.gov.

Tools for Use for this Process 

Effective Date

This Information Bulletin is effective immediately.