SCO Monitoring Process Overview Revised December No narration, music playing. Course Number:

Transcription

1 No narration, music playing. 1

2 This webcast includes spoken narration. To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation. The written version of the narration appears to the right of the screen. 2

3 Welcome to the SCO Monitoring Process Overview webcast. My name is Sonya Hipple. I am the SCO Monitoring Lead for the Office of Developmental Programs. 3

4 This training is part of a series of webcasts that are being provided to assist in preparations for each stage of the SCO Monitoring Process. These presentations are specifically targeted to the SCO and staff responsible for completing the monitoring process. During this webcast we will provide you with an introduction to the process as well as the need and intended purpose of SCO Monitoring including each stage of this process with general timeframes and expectations. In this and the other webcasts in this series, we will provide suggestions of what your agency can do to prepare for and successfully complete each stage of the process. 4

5 SCO Monitoring utilizes standard process tools and data collection documents to verify that providers are qualified and services are provided in compliance with the federal and state waiver requirements. SCO Monitoring also ensures that the Office of Developmental Programs policies and procedures and the current ODP Provider Agreement for participating in the Consolidated and P/FDS Waiver services are followed. 5

6 The statewide SCO Monitoring process was developed to support the CMS Assurances. Specifically, that the state demonstrates that it has designed and implemented an adequate system of assuring that all Waiver services are provided by qualified Providers, and that ODP retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local/ regional non state agencies and contracted entities. In addition, ODP must monitor SCOs to ensure each organization meets the conditions of the provider agreement with ODP. Lastly, the statewide implementation of this process allows ODP to ensure that all SCOs adhere to Chapter 51 and Waiver Assurances as well as important policies and procedures to ensure high quality of care for each individual enrolled in the program. 6

7 The SCO Monitoring process was developed in accordance with ODP s commitment to Continuous Quality Improvement. The focus of this commitment is to ensure that the quality of the waiver programs is improved on a continuous and on going basis rather than through a once a year cycle. There are four components to the Continuous Quality Improvement strategy as defined by CMS: Design, Discovery, Remediation and Improvement. Design speaks to developing the initial methodology to be used. Discovery looks at the data to determine areas of concern. Remediation refers to addressing/ correcting the problems identified in a timely manner. Improvement is adjusting the overall process based on new learning. 7

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9 This slide describes the process in two distinct phases. Beginning August 2013, the record review period for each SCO Monitoring Cycle will be the previous Fiscal Year. For example, the cycle that starts August 2014 will use the Fiscal year for record reviews. All SCOs who provide service to waiver participants as of the sample pull date (April 30 th each year), will be included in the SCO Monitoring Cycle. New SCOs, who do not provide services to waiver participants as of the sample pull date, will be included in the following year. In the Self Reporting Phase, SCOs use a standardized monitoring tool to self assess their compliance level across a variety of measures derived from the Chapter 51 and Waiver requirements, ODP and OMAP Provider Agreements, and ODP written policies and procedures. This information allows SCOs to plan their improvement strategies and enhance the quality of services delivered to the individuals they serve. Further, the Self Reporting Phase helps SCOs prepare for their On Site Monitoring. The data gathered from this phase also provides ODP with a baseline to track and trend statewide compliance of Providers across these measures. The On Site Monitoring is the ODP validation of the Self Reporting. ODP uses the same tool in the On Site Monitoring that was used by the SCO in the Self Reporting Phase. We will now look at each of these phases more closely. 9

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11 ODP randomly draws a sample of waiver individuals for use in the Self Reporting for each SCO and provides this list to the SCO at the start of the Self Reporting phase. The sample includes 2.5% of the waiver participants in the primary sample plus 5 additional people, in case any of the individuals in the primary sample are no longer receiving services or changed SCOs during the review period. The SCO Self Reporting tool is available for SCOs to use and to prepare for the on site monitoring by ODP. The SCO has from the first Monday in August to the last Friday in September to complete and submit the standardized tool to ODP. This tool uses a web based survey platform and once you click the submit button, all data is locked and cannot be changed. ODP recommends that the PDF or Word version be used as a working document and that a single person be responsible for entry and submission of the information to the online document. Each SCO can determine the best way to gather their information and should retain supporting documentation as needed to be available to ODP during the On Site Monitoring. The supporting documentation as specified on the SCO Checklist should be submitted to the Regional Lead when completing the tool. Completing the Self Reporting tool is an opportunity for SCOs to review their processes and policies to make necessary adjustments where remediation and improvement may be indicated. ODP suggests that when an SCO discovers a non compliance during Self reporting, that the SCO corrects this if possible. For example, if during the review the SCO finds Service Notes that have been marked billable but represent non billable activity, they should change these Service Notes to non billable. The Self Reporting Tool webcast is available as part of the SCO Monitoring Process series. 11

12 SCO Monitoring Guidelines were developed to assist SCOs in understanding the expectations of the monitoring process. The guidelines provide an explanation of the standards of compliance, source documentation, and what the SCO can do to remediate and ensure that they are in compliance. 12

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14 Regional ODP staff will contact the SCO to schedule and conduct the on site monitoring, then ODP completes the Final Monitoring Report that includes areas that may require Corrective Action. SCOs have the option to request an exit conference with ODP after receipt of the Final Monitoring Report. The purpose of this exit conference is to help SCOs understand the results of monitoring. Then ODP and the SCO will complete the Corrective Action Plan process as necessary. The On Site Monitoring webcast is available as part of the SCO Monitoring Process series. 14

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16 Performance Reports are reports provided by ODP to SCOs to provide information about compliance that is not always available through HCSIS. The performance reports are be updated and posted quarterly, and provided through the Pennsylvania Department of Public Welfare Internet DocuShare website. These reports should be reviewed by the SCO to identify areas they may need to focus efforts for remediation and improvement. These reports will be reviewed by ODP and in some cases ODP may follow up with SCOs if there are areas of concern identified. The Performance Reports for the SCOs will include separate reports for each measure for the past quarter. Keep in mind that the ongoing review of Performance Review Reports is an opportunity for both ODP and the SCO to engage in conversation and evaluation of performance and improvement of services. The SCO Performance Review Reports webcast is available as part of the SCO Monitoring Process series and is located in the resources section where you accessed this webcast. 16

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18 Take a look at the timeline for each of the stages of the annual Monitoring Process for SCOs. The On Site Monitoring process for SCOs is completed by April 30 th. ODP will continue to analyze the results and feedback from SCO Self Reports and identify revisions to process, tools, and sampling methodology as appropriate and warranted. 18

19 There are a number of things you can do to successfully prepare your agency and staff for this process. Make sure your administration and staff are aware of the process and understand the potential impacts. Use the PDF or Word version of the Self Reporting Tool as well as the supporting documents referenced in the tool to ensure agency documents and information are organized and available to support the completion of the Self Reporting Tool and the on site monitoring. Some examples of this include assuring that training records are up to date and agency policies align with the waiver requirements. 19

20 To help ensure that access to the web based Self Reporting tool is limited to authorized agency staff, requests for forgotten or lost passwords will only be sent to the identified Primary Contact. Requests to change the primary or secondary contact information must be submitted to the SCO Monitoring mailbox. The Listing of Registered SCO Contacts is available as a resource as part of the SCO Monitoring Process series. 20

21 Questions regarding the Monitoring Process should be directed to the Statewide SCO Monitoring mailbox listed on this slide and copied to your Regional SCO Monitoring Lead. A list of the ODP Regional SCO Monitoring Leads is available in the Resources section where you accessed this webcast. Please be sure to review the other webcasts in this series for more detailed information. 21

22 This webcast has been developed and produced by the Office of Developmental Programs Consulting System on behalf of the Pennsylvania Department of Public Welfare, Office of Developmental Programs. Thank you for participating in this lesson. 22