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1、The Oklahoma Quality Management Strategy for service recipients of home and community-based waiver services will weave together various quality assurance and quality improvement activities using a three-tiered process. Tier 1 includes quality assurance processes that are implemented at the service r
2、ecipient/Case Manager/provider level. Tier 2 includes discovery and remediation processes implemented at the DDSD Program Manager/OHCA Level of Care Evaluation Unit/ DDSD Quality Assurance Unit level. Tier 3 is the DDSD State Office Division level and OHCA Medicaid Agency level and focuses on qualit
3、y improvement at a systems level.Tier 1: The first tier involves strategies to ensure service recipients, advocates, guardians, teams, Case Managers and providers have the tools to develop, implement and monitor quality services. At this level, quality assurance and improvement happens with service
4、recipients on an ongoing basis and is designed to safeguard service recipients. Tier 1 Quality Assurance Processes: * Provider training * Case Management supervision and training * Individual Plan development * Case management monitoring, coordination and monthly reviews * Case management informatio
5、n system (CCM) * Grievance procedures * Fair Hearing procedures * Home Records * Human Rights Committees * Health Advisory Team * Health Care Reviews * Physical Status Reviews * Medication Support Plans * Community Services Worker pre-employment screenings * Community Services Worker Registry * Crit
6、ical Incident System * Area and Provider Emergency On-Call Systems Tier 2: The second tier involves DDSD Program Managers, the OHCA Level of Care Evaluation Unit and the DDSD Quality Assurance Unit, as well as committees established to collect and analyze data and make program adjustments to improve
7、 service quality. At this level, the strategy is designed to collect and review data from Case Managers, providers, guardians, advocates, service recipients and teams on a wide variety of quality indicators and develop remediation and program improvement strategies to ensure that performance standar
8、ds and assurances are met. Tier 2 Discovery and Remediation Processes: * Person-Centered Evaluations * Provider Performance surveys * OK-AIM monitoring * Administrative Inquiries * National Core Indicators * Critical Incident Review Committee * Statewide Behavior Review Committee* Mortality Review*
9、Medication Event Review* Consumer Satisfaction Surveys * Data extracts from Plan of Care Authorization database and paid claims history. * CCM database reports * OHCA Surveillance and Utilization Review Systems * OHCA Level of Care 3% retrospective audit reviews * Performance Review Committee * Key
10、Indicator Report * Provider monitoringMonitoring and Oversight Activities not previously mentioned in Appendices B., C., D., G., and I., are as follows:Case Management Supervision and Training: A Case Manager ensures that individual needs are met through linkage, assessment, brokerage, advocacy, and
11、 monitoring activities. The Case Manager assists service recipients in gaining access to needed medical, social, educational, and other services and supports. The Case Manager 1) completes or arranges for necessary assessments to identify service recipient needs; 2) has overall responsibility for th
12、e development and updating of the Individual Plan and Plan of Care; 3) describes service options in sufficient detail to assure that the service recipient, or parent or guardian as applicable, is able to make an informed choice regarding services; 4) coordinates and monitors services to determine ef
13、fectiveness in meeting the needs of the service recipient; 5) has the authority to implement approved services prescribed in the Plan and to access emergency or crisis services as defined by policy; and 6) documents findings in the Client Contact Manager (CCM). In order to assure Case Managers have
14、the skills to complete these tasks, DDSD provides extensive competency-based training. The training curricula includes assessment, individual planning and team leadership skills, resource coordination, monitoring, and recognition of signs and symptoms of abuse, neglect, and exploitation and reporting responsibilities. The Case Management Competency Checklist identifies training components and is used by the Case Management Supervisor to document the Case Managers completion of required training. The Case Management Supervisor uses the Individual Plan Checklist to monitor th
