PSA 4 Quality Assurance Summit

1. St. Johns Management Emergency Operations Center February 10, 2011 PSA 4 Quality Assurance Summit

2. Agenda • Welcome & Introductions • 2011 Monitoring Schedules • Reports • Nursing Home Transition • Request for Proposal • Training Schedules • PSA 4 Best Practices • Summary of 2010 Monitoring Visits • Technical Assistance • Forms / ElderSource Website • Open Discussions/Feedback / Conclusion

3. Welcome & Introductions 1 Bill Hardy, Director of Operations

4. ElderSource & Provider Agencies Together Everyone Achieves More

5. 2011 A New Year 2

6. 2011 Monitoring Schedule Medicaid Waiver, Programs & Finance New Monitoring Procedures Programs Medicaid Waiver on site longer – extended technical assistance New Monitoring Tools 2011 - A Fresh Start

7. Baker County COA - Feb 22,23,24 Clay County COA - March 28, 29,30 City of Jacksonville (Senior Services/Independent Living) - April 25,26,27 Urban Jacksonville - May 23,24,25 Jacksonville Area Legal Aid – June 9 St. Johns County COA - July 5,6,11 Nassau County COA - August 1,2,3 AHEC - Sept 6 Flagler County Social Services - October 10,11,12 COA of Volusia County - November 7,8,9,10 Community Legal Services of Mid-Florida - November 8 2011 Programs Fiscal Monitoring

8. 2011 Med-Waiver Monitoring • Clay CCOA - March 28,29,30,31 & April 1 • Baker CCOA – April 25, 26, 27, 28 , 29 • Urban Jacksonville – May 23,24,25,26,27 • Nassau CCOA – July 25,26,27,28,29 • Flagler County BCC – August 15,16,17,18,19 • St. Johns CCOA – September 12,13,14,15,16 • COA Volusia County – November 7,8,9,10,14

9. Reports 3

10. CIRTS Data Accuracy APS Encumbrance Report Outcome Measures Surplus Deficit Fiscal Reports NSIP

11. CIRTS Data Accuracy

12. APS Referrals Summary

13. Did the intake entity acknowledge receipt of the referral in ARTT on the same day the referral packet was received? 3 out 10 did not acknowledged the same day – without explanation to why Was a 701B assessment completed by the lead agency within 72 hrs. after the referral (Exception: if CARES completed a full assessment prior to referring to lead agency, another assessment is not required for services that do not exceed 30 days). 2 out of 10 did not have a 701B completed referral documented with in 72 hours in CIRTS Did the CCE Lead Agency initiate the emergency or crisis resolving service(s) recommended or agreed to by APS (not just case mgmt) within 72 hours of referral? 2 out of 10 did not have documentation that services that services were put in place (no documentation- log sheets) If the lead agency did not order the services that were recommended by the APS Protective Investigator, did APS and Case Manager Supervisor jointly review the case to resolve the issues? 2 out of 10 did not have narratives of communications with the APS Protective Investigator APS Summary 2010

14. Did the CCE Lead Agency enter the case status in ARTT fields #30, 31, 36 and 37 within 72 hours of referral? 5 out of 10 referrals did not have the fields populated with in 72 hours Were service units entered daily (not aggregately) for core services and case mgmt for the first 72 hours after APS referral and entered either daily or aggregated weekly for the next 27 days? 5 out of 10 were not entered in CIRTS correctly If services were refused by the client or delayed due to circumstances beyond control of the service provider, did the lead agency contact APS within 24 hours? 4 out of 10 had no evidence (documentation) of follow up contact with the APS investigator APS Summary 2010 cont..

15. APS Summary 2010 cont.. Does documentation indicate the Case Manager followed up with client or caregiver within 2 weeks on service arrangements and referrals ensuring services had begun? 2 out of 10 did not have documentation of follow up with client in reference to services Did the intake entity reassess the client and consult with APS prior to termination to determine if services could be safely terminated (eff.:12/19/07)? 3 out of 10 had no documentation of a visit at 30 days to evaluate the services Is a complete referral packet in the file (referral form, Adult Safety Assessment of Factors, Adult Safety Assessment of Overall Safety, Capacity to Consent Assessment (or CF-AA 1112 form if client lacks capacity), Court order (if services were court ordered)? (eff.: 12/19/07) 10 out 10 APS files had the completed referral package

16. 4 out of 10 Outcome Measures Not Achieved CARES (Imminent Risk) 69.77% (Goal 90 %) Imminent Risk Referrals Not Receiving a Service: Caregiver Likely 86.13% (Goal 89 %) Percent of caregivers and family assisted caregiver who self report they are very likely to provide care. Environment 65.22% (goal 79%) Percent of elders who are assessed with high or moderate risk environments who improved their environmental score on reassessment CCE/MW 5.0 months (goal 2.8 months) Average time in Community Care for the Elderly program for Medicaid probable consumers. Outcome Measures Overview 2009-2010 Results

17. 6 out of 10 Outcome Measures Not Achieved ADL 63.70% (Goal 65 %) Percent of new service recipients whose ADL assessment score has been maintained or improved. CARES (Imminent Risk) 61.58% (Goal 90 %) Imminent Risk Referrals Not Receiving a Service APS 87.82% (Goal 97 %) Percent of Adult Protective Services (APS) High Risk referrals that are in need of immediate services to prevent further harm who are served within 72 hours. As of Jan 31, 2011 Outcome Measures OverviewCurrently Achieving -2010-2011

18. Cont… Caregiver Likely 86.26% (Goal 89 %) Percent of caregivers and family assisted caregiver who self report they are very likely to provide care. Environment 74.74 % (goal 79.3%) Percent of elders who are assessed with high or moderate risk environments who improved their environmental score on reassessment Nutrition 54.29 % (goal 66.%) Percent of new service recipients with high risk nutrition scores whose nutritional status improved As of Jan 31, 2011 Outcome Measures OverviewCurrently Achieving -2010-2011

19. Surplus Deficit

20. Fiscal Reports ADI, CCE, EHEAP, HCE, OAA & RELIEF – due 8th Cirts reports must be submitted at the same time as expenditures report HCE Exception Report must be turned in each month regardless if there are any changes to be made for that month. Please note that if there is a new provider, name change or change of address – Fiscal needs the old information also. The providers system is based on client and the ElderSource system uses the caregiver. Surplus Deficit - due on the 10th CIRTS Data Accuracy – due the 20th of the following month you are reporting on. Service Cost reports - due February and August each year Annual Co-Payment Report – due July 30 each year

21. Currently added to C1 &C2 A different way of handling NSIP NSIP

22. Nursing Home Transition 4 Case Management

23. RFP – Municipality will no longer be exempt Request for Proposal 5

24. What’s on the schedule for 2011? Training Schedule 6

25. Tentative 701A – B Assessment Training Schedule • 1st Quarter March 15 - 16, 2011 • 2nd Quarter May 17 - 18, 2011 • 3rd Quarter August 16 – 17 • 4th Quarter November 15 – 16 • (2 day training)

26. 1st Quarter March 22, 2011 2nd Quarter June 7, 2011 3rd Quarter August 23, 2011 4th Quarter November 2, 2011 (1/2 day training) Tentative 701C Assessment Training Schedule

27. Menu Planning – Annual Training This must be done Annually. Food Safety All Food service staff and volunteers must receive semi-annual training for prevention of food borne illness. Staff and volunteers must be training prior to assuming food service assignments (DOEA programs & service handbook ch4-105) Menu Planning / Food Safety Training Schedule

28. PSA 4 Best Practices 7 What has worked for other agencies can work for you

29. Home Deliver Meal Coolers Vista Print Signs Charly Poniatowski, COA of Volusia County Home Deliver Meal Coolers - Plug in Al Rizer, Clay County Council on Aging MSDS – Material Safety Data Sheets Chemicals that are available for use at the nutritional site Joanne Hinkel, Flagler County Social Services

30. 2010 a Year in Review 8 Summary of 2010 Monitoring Visits

31. TRENDS Table report reviewed the following areas: M O N I T O R I N G Follow up from the last monitoring Positive and Noteworthy Activities Client Satisfaction Nutrition/Congregate Meal Site's Compliant Assessments Care Plan Case Narratives Home visits/Interview clients Etc. F I L E R E V I E W Findings /Recommendations Technical Assistance Quality assurance/Grievance Policy Assessments Care Plan Case Narratives Home visits/Interview clients Case management Billing Etc. F I N A N C I A L C O M P L I A N C E Financial/Accounting Files observe transportation route (if available) Etc. Help Us Help You – A Year in Review

32. TRENDS Table“Legend” represents compliance or noncompliance utilizing the following acronyms:

33. TRENDS TABLEExamples of Monitoring areas per county

34. Help Us Help You – A Year in Review • What does it mean to have • Quality Assurance…… • Provider Visits (announced or unannounced) • Findings • Recommendations • Technical Assistance • ElderSource helpline/Internet • Corrective Action Plan

35. Medicaid Waiver Trends A review of 65 randomly selected ADA waiver client files revealed compliance deficiencies in the following areas: 4 files did not document ElderSource approval to begin services; 9 files contained errors with the provider choice form; 6 files contained errors with the Fair Hearing form; 3 files did not document POA; 10 files did not contain proof of current financial eligibility; 2 files did not document a current 2515 form;

36. Medicaid Waiver Trends 1 file did not contain a 3008 form; 3 files contained a LOC gap; 22 files contained errors with the 701B; 5 files contained a missed or late 701B; 3 files did not contain a CM signature on the 701B; 4 files contained late or missed care plans; 1 file contained a care plan that was not signed by the CM; 2 files care plans did not meet assessed need;

37. 30 files care plans were not legible and maintained in detail; 14 files did not document quarterly reviews on the care plan; 21files contained errors and/or missing service authorizations; 23 files contained errors with CIRTS; 9 care plans were over the threshold and did not document CPR approval; 19 files contained problems with the narratives; 15 files did not document client condition; 2 files did not document service provision; Medicaid Waiver Trends

38. 10 files did not document service receipt; 13 files did not document client satisfaction; 17 files did not document monthly contact; 1 file did not document a quarterly face visit; 11 files did not contain comprehensive narratives; 33 files contained errors with paid claims. Medicaid Waiver Trends

39. Technical Assistance 9 How can we help you?

40. Technical Assistance Ideas REFER Assistive Eating Devices EHEAP Application and sample forms – on web Webinar – What would you like to see Job Shadowing

41. Have you looked at the ElderSource website lately? ElderSource Website / Forms 10

42. ElderSource Website Have you looked at the ElderSource website lately? Did you know you can access forms from the main page? - Provider Resources Did you know that you can access additional client resources from the website? What else would you like to see available on the website?

44. Provider Resources Assessment Forms: DOEA 701A - Sept 08 DOEA 701B - Sept 08 DOEA 701C - Sept 08 Care Plan Checklist: ElderSource APS file review checklist (jan2011) ALE case file review tool & ALE case file review tool - instructions ADA case file review tool & ADA case file review tool - instructions Fiscal: Surplus Deficit Form – Jan 2011 Annual Co-Payment Report Forms: Consumer Satisfaction Survey Results Summary Volunteer Activity Report CIRTS Data Accuracy – Jan 2011 Adaptive Eating Device – with list of items Schedule of Events Programs / Fiscal monitoring schedule Nutrition: How to Calibration a Thermometer Calibrating Probe Thermometer NPCR Nutrition Program Compliance Review (Feb. 2010) HDM Evaluation for frozen meals (DOEA 217) Information: Link up Florida – Providers that provider low cost telephone service. Assurance Discounted Cell Phone Service (English & Spanish) Notice of Instructions:

45. ElderSource Contact Information Summary / Open Discussion Q&A 11

46. ElderSource Contact Information • Main Number 904-391-6600 • Elder Helpline 904-391-6699 • Fax Number 904-391-6601 • Hearing Impaired – 904-391-6697 • Toll Free 888-242-4464 • www.myeldersource.org • 4160 Woodcock Drive, Jacksonville, FL 32207