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    Long-Term Care for Providers

    OLTL Waiver Service Quality Standards

    The Office of Long-Term Living (OLTL) embraces the concept of continuous quality improvement throughout the implementation of the OLTL waiver programs. Every long-term living provider is reviewed by OLTL to ensure they meet the quality standards established in the Support Services Waivers.

    Qualtiy Monitoring Measures

    • Responsible for ensuring the quality of services provided to individuals served by the OLTL
    • Quality Management
      Monitors the quality of OLTL's programs, following a continuous quality improvement process.
    • Quality Improvement Strategy
      Measures performance regarding service provision, and ensures the health and safety of participants. The strategy uses common quality management functions of discovery, remediation and improvement to identify non-compliance with standards, fix non-compliance with standards for individuals, and improve the system(s) to prevent future instances of non-compliance.

    The goals of Quality Management, Metrics & Analytics (QMMA) are:

    • To conduct quality monitoring of long term living programs and services to ensure compliance with Federal and State regulations
    • To use data analysis to measure effectiveness of program design and operations
    • To recommend strategies for Continuous Quality Improvement
    • To establish a quality improvement focus within OLTL based on the Six Waiver Assurances:
      • Level of Care (LOC)
      • Qualified Providers (QP)
      • Service Plan (SP)
      • Health and Welfare (HW)
      • Financial Accountability (FA); and
      • Administrative Authority (AA)
    • To support OLTL management in development and implementation of policies and protocols to achieve desired outcomes
    • To oversee the development of system-wide training for staff, providers and participants
    • To work effectively with other OLTL Bureaus, internal and external stakeholders, other State Agencies, contracted consultants, the Quality Council, and other individuals or entities regarding Quality Management activities.
    • The mission of QMMA is to meet these goals in a manner that will bring about maximization of the quality of life, functional independence, health and well being, and satisfaction of participants in OLTL programs and waivers.

    QMMA's work consists of quantifying, analyzing, trending, and making initial recommendations regarding priorities and specific quality improvements to OLTL systems, and then monitoring system improvement changes for effectiveness.

    The process for trending discovery and remediation information (data) begins with QMMA receiving the data from various points in the OLTL system. Database aggregation reports are created for QMMA to trend various aspects of quality including the six CMS quality assurances listed above. Additionally, QMMA reviews information gathered from field observations, record reviews, and consumer satisfaction surveys to support administrative data.

    Provider remediation activities are documented in Corrective Action Plans (CAPs) which are requested from providers by the QMETs to correct non-compliance issues. Internal remediation activities are documented in Quality Improvement Plans (QIPs) which are requested by the Quality Management Division for internal remediation within a single bureau. The CAPs and QIPs are then aggregated for QMMA to review, track trends, and suggest system changes. System changes are considered for the completion of a System Improvement Plan (SIPs) to document and implement system-wide changes.

    In order to prioritize the quality management issues, QMMA has assigned each of the six Waiver Assurances to a Quality Management (QM) Liaison to review the various quality reports through tracking and trending and determine possible causes of aberrant data or compliance issues. Quality data is gathered for performance measures from numerous sources, including provider monitoring by the QMETs, surveys, administrative data, etc., and aggregated for tracking and trending. The QM Liaison makes initial recommendations and prioritizes issues for problem solving or corrective measures. The QM Liaison reviews and response to aggregated, analyzed discovery and remediation information collected on each of the assurances. The QM Liaison meets on a regular basis with other bureaus within OLTL to discuss findings from the data reports, including trends. In addition to trending and analyzing for each waiver, this structure allows QMMA to trend and analyze across multiple waivers.

    QMMA internally reviews the assessments made by the QM Liaison. For those issues that are considered critical by the QM Liaison, an expedited process of review is implemented. The QMU summarizes the list of priorities and recommendations in a periodic report to present at the Quality Management Meeting (QM2). QM2 meets regularly during the month prior to Quality Council's meeting. The QM2 participants consist of appropriate QMMA staff, OLTL Bureau directors (or designee) and internal subject matter experts. The comments from the QM2 are considered and included in revised reporting for the Quality Council. The Quality Council is comprised of internal and external stakeholders, whose recommendations are reviewed by the Director of QMMA. The Director makes final recommendations as to action needed for system improvements to the Deputy Secretary of OLTL. The implemented system improvements return to the quality cycle through monitoring and remediation.

    Satisfaction Surveys

    The Office of Long-Term Living (OLTL) within the Pennsylvania Departments of Public Human Services (DHS is in the process of conducting a survey of participants currently enrolled in state programs that assist with home-based care. We are interested in gathering insight and experiences from our consumers so that we might work toward improving our services. The surveys and letter posted on this Web site are for informational purposes. OLTL is pleased to present the results of our surveys from 2011 through the present time. Older results can be found under the Archive heading below. These surveys cover participants in the Aging, Attendant Care Independence, COMMCARE and OBRA waiver programs.

    Quality Standards Resources

    Disclaimer: The Direct Service Provider Monitoring Tool and the Service Coordinator Monitoring Tool documents serve as a provider resource regarding the primary areas that the regional OLTL QMET monitor. Please note that the QMET monitoring process is subject to change as are the provided monitoring tool documents.

    Regulations

    Remark Replay Charts

    Attendent Care Waiver

    Aging Waiver

    COMMCARE Waiver

    Independence Waiver

    OBRA Waiver

    AIDS Waiver

    Provider Monitoring

    Quality Management Efficiency Teams (QMET)

    The authorized monitoring agent for the Office of Long-Term Living. The QMET ensures Home and Community-Based Service (HCBS) provider compliance with 55 Pa. Code Chapters 52, 1101 and 1150, as well as the CMS, approved HCBS waivers. The QMET works with enrolled HCBS providers of the Office of Long-Term Living (OLTL) for the Medicaid OBRA Waiver and the Act 150 program to efficiently balance service delivery with regulatory waiver and program compliance. The QMET monitoring review is effectuated in a consistent manner across the Commonwealth to promote and enhance the quality of services to OLTL waiver and program participants.