What is the difference between Quality Assurance and Quality Enhancement?
The difference relates to a name change. For a number of years, the section within the Regional Office that was responsible for contracted agency performance surveys and follow-up was called Quality Enhancement. Our name has been changed to Quality Assurance as we have shifted to a more centralized organization with supervision coming from the Central Office. Our focus of responsibility has also changed somewhat – we now concentrate on the process of surveying, with the follow-up function being assigned to other Regional Office staff.
What is the CMS Quality Framework and how does it relate to DIDD’ provider performance survey tools?
The CMS Quality Framework is a monitoring tool to evaluate a state’s performance in meeting assurances and requirements for its waiver services. There are several areas of focus in the framework including participant access, participant-centered service planning and delivery, provider capacity and capabilities, participant safeguards, participant rights and responsibilities, participant outcomes and satisfaction, and system performance. These are to be reviewed as they relate to the overall quality management functions of design, discovery, remediation and improvement.
DIDD has constructed its Quality Assurance tools to ensure that provider performance is measured in a similar fashion as that which is done by CMS. DIDD has established ten quality domains that are the foundation of its Quality Management System. These domains somewhat mirror the focus areas of the Quality Framework. They form the basis for DIDD monitoring functions that produce the data used to measure success in achieving outcomes. These domains are: access and eligibility, individual planning and implementation, safety and security, rights, respect and dignity, health, choice and decision-making, relationships and community membership, opportunities for work, provider capabilities and qualifications and administrative authority and financial accountability.
Why are independent clinical providers exempted from quality assurance surveys?
The independent clinical providers are not exempted from surveys. A sample of these providers is selected for survey each year, utilizing a three-year cycle.
DIDD has a resource issue – the number of providers has grown at a much faster rate than the regional QA surveyor staff. This is an attempt to address that resource issue. It is hoped that this will be a temporary measure. More frequent surveys may be conducted for any provider at the discretion of DIDD, if this is necessary to determine quality service provision and provider compliance.
What are consultation surveys?
For new agencies that have not yet been involved in a Quality Assurance survey, the regional QA survey team will conduct an initial consultation survey after service provision begins. Although this is considered an informal survey process, the provider must correct any serious health and safety issues identified during the consultation survey. After the initial consultation survey, the provider with be added to the regular survey schedule.
What is the Service Recipient Comprehensive Record?
The Comprehensive Record contains all information relevant to planning, implementing and evaluating the provision of services and supports specified in the Individual Support Plan (ISP). The contents of the Comprehensive Record will vary, depending upon the types of services that are required to support the person supported in the community setting. Portions of the Comprehensive Record may be kept in different locations, including provider administrative offices or the person supported's home, depending on the nature and age of the documentation/information contained in the record.