State HCBS Waiver Quality Management Strategies
BACKGROUND
In response to Congressional criticisms of its failure to effectively monitor Medicaid home and community-based waiver services, in 2003 the Centers for Medicare and Medicaid Services (CMS) decided to revamp the Section 1915(c) waiver application's review and approval process.
One of CMS' central aims from the onset was to ensure that a state has in place a comprehensive system for overseeing and improving the quality of HCBS waiver services before its waiver application is approved. States are required in the new waiver application to demonstrate the capability of operating the proposed new/renewal waiver program in compliance with applicable federal statutory and regulatory requirements by completing a detailed new application template that includes an explanation of the state's quality management strategy. The latter requirement is found in Appendix H of CMS' new Section 1915(c) waiver application template. By including Appendix H with the application, CMS hopes to emphasize the importance of having a systematic method of monitoring and improving HCBS waiver services.
Under prior policy, states were required to offer CMS an assurance that the health and welfare of waiver participants would be safeguarded but they were not obligation to furnish any details regarding the steps that would be taken to ensure that this objective was achieved.
HCBS Quality Framework
In Appendix H, CMS outlines its expectations regarding the essential components of a comprehensive state quality management system. The framework views quality management as a cyclical process that begins with the "discovery" phase, proceeds to a "remediation" phase and closes with an "improvement" phase. The components of a comprehensive quality management system, as identified in CMS' Quality Framework, address the following domains of program design and execution:
1) Participant Access;2) Participant-Centered Service Planning and Delivery;3) Provider Capacity and Capabilities;4) Participant Safeguards;5) Participant Rights and Responsibilities;6) Participant Outcomes and Satisfaction; and7) System Performance.
Quality Management Strategy
Appendix H specifies that a state must include in Section 1915(c) waiver application a narrative description of its quality management strategy that is no more than ten-pages in length. A state's quality management strategy must include the following components:
1. A description of how the state will determine that each waiver assurance and requirement is met;
2. A description of the roles and responsibilities of the parties involved in measuring performance and making improvements. Such parties include (but are not limited to) the waiver administrative entities identified in Appendix A, waiver participants, advocates, and service providers.
3. A description of the processes employed to review findings from its discovery activities, to establish priorities, and to develop strategies for remediation and improvement.
4. A description of how the state compiles quality management information and the frequency with which the state communicates this information (in report or other forms) to waiver participants, families, waiver service providers, other interested parties, and the public.
5. A periodic evaluation of and revision to the Quality
Management Strategy.
In order to assist NASDDDS member state agency officials, the Association is posting copies of the quality management strategies submitted by the following states in connection with recent new and renewal waiver requests targeted to individuals with developmental disabilities. This web page will be updated periodically as other states complete and submit their quality management strategy summaries (or short synthesis of their strategies) and share copies with NASDDDS.
CONNECTICUT (MS Word)
Contact:
Laura Nuss
Director Of Strategic Leadership
Department of Mental Retardation
TEL: (860) 418-6130GEORGIA (MS Word)
Contact:
Darlene Meador, PhD
Program Director, Systems Change
Office of Developmental Disabilities
Division of Mental Health, Developmental Disabilities and Addictive Diseases
Georgia Department of Human Resources
Phone: (404) 657-1138
IOWA (MS Word)
Contact:
Marty Engle Pratt, LMSW
HCBS Quality Assurance Specialist
Iowa Medicaid Enterprise
TEL: (515) 725-1134KENTUCKY (MS Word)
Contact:
Alice Blackwell
Supports for Community Living
Waiver Manager Division
Kentucky Division of Mental Retardation
TEL: (502) 564-7702LOUISIANA (PDF)
Contact:
Dena Vogel
Director of Quality Management for HCBS Waivers
Office for Citizens with Developmental Disabilities
Louisiana Department of Health and Hospitals
TEL: (225) 342-9251
MICHIGAN (MI Choice Appendix H.doc & MI Choice Appendix H Grid.doc)
Jim Schwartz, Section Manager
Waiver Operations
Michigan Department of Community Health, Medical Services Administration
Bureau of Medicaid Financial Management & Administrative Services
TEL: (517) 355-5322
MISSOURI (MS Word)
Contact:
Margy Mangini
Director of Quality Assurance
Division of Mental Retardation and Developmental Disabilities
Missouri Department of Mental Health
TEL: (573) 526-2707
NEBRASKA (MS Word)
Contact:
Pam Hovis
Developmental Disabilities System
Nebraska Health & Human Services
TEL: (402) 471-8717
NORTH CAROLINA (MS Word)
Contact:
Vivian Leon
Division of Mental Health/Developmental Disabilities/Substance Abuse Services
North Carolina Department of Health and Human Services
TEL: (919) 715-2774
OHIO (PDF & MS Word)
Contact:
Susan Woods
Department of Mental Retardation and Developmental Disabilities
TEL: (614) 466-4437OKLAHOMA (OKQMSIHSW.doc & appendixHfinalrevised6-13.doc)
Contact:
Kristi Blackburn
Developmental Disabilities Services
Oklahoma Department of Human Services
TEL: (405) 521-6257
OREGON (MS Word)
Contacts:
DeAnna Hartwig, Waiver Manager
TEL: (503) 947-1180
Don Fries, Waiver Manager
TEL: (503) 945-6455
Dana Messman, Quality Assurance
TEL: (503) 945-5810
Federal Resource and Financial Eligibility Unit
Seniors and People with Disabilities
Department of Human ServicesPENNSYLVANIA (MS Word)
Contact:
Kelly A. Svalbonas
Statewide Waiver Coordinator/Policy Supervisor
Bureau of Quality Improvement and Policy
Pennsylvania Office of Developmental Programs
TEL: (717) 783-1003SOUTH CAROLINA (MS Word)
Daniel Davis
Director, Autism Division
Department of Disabilities & Special Needs
TEL: (803) 898-9609VERMONT (PDF)
Stephen Morabito
Quality Management Development Specialist
Agency of Human Services
Department of Disabilities, Aging, and Independent Living
Division of Disability and Aging Services
TEL: (802) 241-2659WASHINGTON (MS Word)
Contact:
Shannon Manion
Waiver Program Manager
Division of Developmental Disabilities
Aging and Disability Services Administration
Department of Social and Health Services
TEL: (360) 725-3445