iowa department of human services iowa medicaid enterprise … · 2017-01-25 · iacp sfy16 annual...

IACP SFY16 Annual Project Report Shelly Chandler

Executive Director

7025 Hickman Road Suite 5•Urbandale Iowa 50322 •P (515) 270-9495 • www.iowaproviders.org

Iowa Department of Human Services

Iowa Medicaid EnterpriseHCBS Provider Training and Technical Assistance

FY16 Annual Project Report Completed By: Shelly Chandler Executive Director Iowa Association of Community Providers 7025 Hickman Road, Suite 5 Urbandale, Iowa 50322 515-270-9495 [email protected] Identification Information: Project Name: HCBS Waiver and Habilitation Services Training and Technical Assistance Contract #: MED-15-013 Organization: Iowa Association of Community Providers (IACP) Project Director: Shelly Chandler Address: 7025 Hickman Road, Suite 5, Urbandale, Iowa 50322 Telephone Number: 515-270-9495 E-mail Address: [email protected] Fax Number: 515-270-1035 Other Staff Working on Project: Gayla Harken, Outreach Director Phone #: 515-270-9495 Lisa Schwanke, Medicaid Compliance Specialist Phone #: 515-270-9495 Megan Hartwig, DirectCourse TA Specialist (No longer with IACP) Teri Freeman, Communications Director Phone #: 515-270-9495 Ben Woodworth, Training Director Phone #: 515-270-9495 Michelle Van Maaren, Medicaid Compliance Specialist (No longer with IACP) Brita Nelson, DirectCourse/Medicaid TA Specialist Phone #: 563-380-0151 Julie Fuller, Administrative Assistant Phone #: 515-270-9495


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Scope of Work and Progress:TECHNICAL ASSISTANCE

GENERAL ACTIVITIESDuring SFY16, members of IACP’s Technical Assistance team engaged in the following activities pursuant to the contract:

1. Monitored Medicaid rules to keep providers informed and to advocate for improved services and relationships between all partners of the Medicaid system. Members of the Technical Assistance (TA) team monitored the legislative rules process to be able to inform providers of upcoming changes impacting service delivery.

2. The TA team met regularly throughout SFY16 with state managed care entities to continue communication and clarify processes associated with the transition to managed care.

3. Outcomes Project - Members of the IACP Technical Assistance team met regularly with

representatives from ISAC, DHS, and regions to develop and plan a statewide outcomes and data collection project. The group is known as QSDA (Quality Services Data Assessment). This voluntary project was modeled after Polk County Health Services Quality Improvement Plan. Initial data collection focused on somatic care, employment, community inclusion, and community living. Regions are encouraged to tie pay for performance to these standards. The quality measures were taken from CRA 5-Star Quality who provided training to all stakeholders. FY16 created a baseline for data collection. Data has been analyzed and areas/trends identified to guide future TA training topics.

QSDA numbers from the statewide outcome project to date:

# of Users: 427

# of Providers: 156

# of Clients with at least one outcome: 3,810

Additional areas of data collection that have started this FY include days of homelessness, days incarcerated, and hospital days. Although our providers are not the source of this information, it is helping to create a more comprehensive


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picture of quality of life indicators for Medicaid members.

4. Managed care was a major focus of the TA team during SFY16. Providers had many

questions regarding how the transition to managed care would affect HCBS service delivery across the state. The TA team provided education about the Medicaid Modernization initiative for providers. This effort continues to be ongoing as we assist providers with understanding the processes associated with working with the new Medicaid partners. TA staff have routine contact with the MCOs and IME to assist with transitional issues and to provide clarification during the transition period.

5. TA staff conducted provider surveys of IHH implementation experience. The results

were utilized to inform conversations with MCO and providers staff, including formulation of questions covered during two IHH/provider group meetings. These meetings were well attended and provided the foundation for future learning collaborations between all stakeholders.

6. TA staff met with Department staff regularly to review a variety of topics, local compliance trends, legislative rules/updates, national regulation changes, and current training needs.

7. Use of FileMaker database software continued in SFY16. Compilation of this data led to creation of a frequently asked questions and answer document posted to the public portion of the IACP website. This resource has positively impacted direct TA questions by providing information that is easily accessible to providers.

8. Senate File 2013 mandates the use of Evidence Based Practices across providers. TA,

in conjunction with regional partners, conducted a statewide survey of understanding and implementation of Evidence Based Practices to determine future training needs and implementation. (See attachment) Based on this survey, the TA team contacted Kevin Martone from the Technical Assistance Collaborative to do an overview of all the EBPs listed in this legislation and a more indepth discussion of permanent supportive housing and supported employment. These EBPs were identified as most likely starting points for statewide implementation that would involve most HCBS providers. (See attachment)

9. Technology implementation progress - Dr. Anne Cameron from AO Strategies was contracted to do a basic technology study of providers, families, and members around


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their use of technology in their lives. This study provided TA with baseline information to identify appropriate topics and subject matter experts to train and promote the use of technology as a way to increase independence and communication.

10. The TA team hosted six RCF meetings to discuss implementation and impact of HCBS

settings final rule. The outcome has been that a significant number of larger facilities have either downsized or started providing services in the community.

11. The TA Team successfully shaped DIA rules to not impede HCBS intent by creating

artificially high standards for medication administration. Started routine meetings with DIA to discuss how HCBS and managed care will impact these providers. Dialogue continues to develop a better understanding of values associated with HCBS.

12. The three-quarter time TA staff position was vacated in December. The decision was

made to offer short-term contracts to various subject matter experts to further the team’s ability to provide state-of-the-art training for providers.

MARKETING

1. The IACP TA program and trainings were marketed in many ways. While IACP has access to well over 150 Medicaid providers through member contacts, significant effort was made to market program availability to all enrolled HCBS & Habilitation providers. These efforts included:

a) Posting of TA contact information and training dates on public portions of the IACP

website. b) Training notices mailed to each provider on the Medicaid provider listing obtained

from IME. c) Presence of staff, tabletop displays, and marketing materials at the IACP Annual

Convention, the Mental Health Convention, the Iowa Psychiatric Rehabilitation Summit, and the Make your Mark! ID Action conference.

d) Advertisement and distribution of information at each SFY16 regional training event for providers on how to access technical assistance services.

e) Attempting further dissemination of materials by requesting stakeholder contacts lists from organizations such as Magellan, DD Council, ISAC, etc.

f) Reminders about training and availability of TA technical assistance and trainings were also sent to providers through the DirectCourse newsletter.


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g) Letters were sent to agencies that received a less than three-year HCBS review to offer assistance from the TA team. (See attachment)

IACP TECHNICAL ASSISTANCE TRAININGSThroughout the year, IACP’s TA staff provided trainings in a variety of settings. Trainings ranged from group meetings to regional trainings and web-based content delivery. This year, the TA staff trained 3,743 individuals. This is a 49% increase over SFY15.

State Fiscal Year Attendance

SFY12 784

SFY13 1807

SFY14 2080

SFY15 2519

SFY16 3743

Attendance at IACP TA training sessions, since the program’s inception in 2012, is 10,933 individuals. Details on each type of training follow. Regional Trainings

1. This reporting year, IACP TA facilitated eight regional trainings. All regional training curricula are web-ready in accordance to IME requirements. These have been sent to IME personnel. In addition, resources from the regional trainings are publicly available on the IACP website. All training materials were submitted to the Agency for approval a minimum of two weeks prior to date of first material presentation. (Please see sample training notices attached)


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2. Training topics by month of regional training: (See attached marketing flyer example)

October 2015

Iowa Outcomes Project: Steps for ImplementationQuestions and AnswersManaged Care: What We Know Now

April 2016

Rights, Restrictions and ResponsibilitiesMedicaid Waste, Fraud & AbuseHCBS Settings StandardsQuestions and Answers

3. General regional training attendance totaled 763 provider staff. Of those attending, 24%

were not IACP members.

4. Training evaluations were distributed at each regional training session. Examples of some provider commentary feedback are as follows:

● The dedication and friendliness of the trainers is evident.

● I will be using some of the compliance information to update our agency training.

● Presenters communicate very clearly. Focus on detail of important areas rather than

trying to cover too much.

● I appreciate the calmness of the presenters in regard to the changes with the MCOs and the information about the small details that they will be looking for.

● It is very helpful to have things clarified. The information that the trainers provide helps our agency determine the best practices to follow and alerts us to things we should be addressing.

● Thank you so much for all the help you have given me I appreciate it more than you know!

● I really appreciate how responsive and patient you always are with my inquiries.


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● The presenters are all so personal and don't hold anything back. This makes the atmosphere fun and makes me want to learn what they have to say. It is also helpful that the presenters are very open on their knowledge of topics covered/questions asked. If they didn't know the answer, they didn't pretend to know.

● I want to thank the Technical Assistance team for doing this for us providers! You are wonderful!

● I greatly appreciate your staff's diligence in finding answers while also providing a little humor along the way!

Centralized TrainingsIACP’s TA team held three centralized trainings/meetings reaching a total of 491 provider staff.

August 2015 – 5-Star Quality - Mike Mayer and Derrick Dufresne of Community Resource Alliance presented on operationalizing community engagement through “The Ask”. They have presented internationally on topics related to planning, community services, and transition.

October 2015 – IHH Meeting May 2016 – Evidence-Based Practices - This training covered needed information around the implementation of Evidence Based Practices (EBP) as required by SF 2315. Regions are charged with implementing and measuring EBPs and associated fidelity across their regions. The Technical Assistance Collaborative from Boston will be presenting an overview of all seven SAMHSA EBPs. They will focus on Supported Employment and Permanent Supportive Housing and how to apply them across community based service providers and measure results. (See attached flyer)

Web-Based TrainingsAddition of web-based training offered as part of the regularly scheduled TA offerings allowed a wider reach of provider staff with a quicker turnaround time. In addition, relevant trainings were recorded and posted both on the public portion of the IACP website as well as through the DirectCourse system. 2,537 provider staff were reached through this avenue of training.


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Date Training AttendanceJuly 2015 Trauma Informed Care Part 2 147July 2015 Outcomes Project 136July 2015 Outcomes Project 128September 2015 Substitute Decision Making 127October 2015 Outcomes Project 32November 2015 Trauma Informed Care Part 2 107January 2016 Substitute Decision Making 199February 2016 Documentation 502March 2016 Managed Care 430April 2016 Substitute Decision Making 63April 2016 Employment 345Ongoing Medicaid Waste, Fraud and Abuse 14June 2016 Accessing MCO Auths 259June 2016 IHH Meeting Agenda Planning 48 TOTAL 2,537

Links to trainings posted on IACP website, TA trainings section:

Office of Substitute Decision Making - OSDM General Info and Substitute Decision-Making Basics - https://attendee.gotowebinar.com/register/937939861433358082

Office of Substitute Decision Making - Guardians and Parents as Guardians - https://attendee.gotowebinar.com/register/3548417962607342594

Office of Substitute Decision Making - Powers of Attorney. https://attendee.gotowebinar.com/register/5208798168293364226

New HCBS Employment Rules - https://attendee.gotowebinar.com/register/558566574270312708

HCBS Documentation - https://attendee.gotowebinar.com/register/3667406013665215746

Medicaid Waste, Fraud, and Abuse - https://attendee.gotowebinar.com/register/2745392947883518466


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Trauma Informed Care Part 1 - https://attendee.gotowebinar.com/register/7073949218007518721

Trauma Informed Care Part 2 - https://attendee.gotowebinar.com/register/9205330518401892866

Managed Care Authorizations – https://attendee.gotowebinar.com/register/6646688902362191364

Individual Provider Trainings

1. The TA team conducted seven individual trainings to HCBS and Habilitation provider agencies. Topics included engagement, service planning, HCBS rule changes, and documentation.

HCBS WAIVER AND HABILITATION TECHNICAL ASSISTANCE

1. The IACP Technical Assistance team responded to 981 TA inquiries during SFY16. This represents an increase from all previous contract years. This increase can mainly be attributed to the transition to IAHealthLinks managed care.

Year-to-year data:

State Fiscal Year # of TA InquiriesSFY2012 269SFY2013 657SFY2014 708SFY2015 540SFY2016 981

Total 3,155

2. The average response time for HCBS TA inquiries was 1.5 calendar days, with a range of 0 to 45 days.

3. Cumulative areas of overall requested assistance were as follows:


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ON-LINE LEARNING SYSTEMS GENERAL INFORMATION/ACTIVITIES

1. The IACP DirectCourse program offers Iowa providers training from: a) The College of Direct Support (CDS) b) The College of Employment Services (CES) c) The College of Recovery and Community Inclusion (CRCI) d) The College of Personal Assistance and Caregiving (CPAC) These curricula are delivered through the Elsevier Performance Learning Management System (LMS).


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2. The 103 organizations utilizing the learning management system have enrolled over 30,000 learners serving over 18,500 Medicaid members. Those Medicaid members are receiving services through the following funding streams:

3. Since Iowa began utilizing DirectCourse (CDS), learners have completed 618,355

lessons. Of those lessons, 220,178 were completed during SFY16.


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4. SFY16 monthly training completion by number of lessons:


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5. Use of FileMaker software began SFY13 with building a database for all DirectCourse technical assistance and informational inquiries. Use of this system continued through SFY16.

6. The DirectCourse newsletter was completed and sent to agency admins. (See example attached)

7. A voluntary staff certification program using trainings available on DirectCourse has

been developed through assistance with staff from the University of Minnesota Institute on Community Inclusion. Work on this program began in SFY15, with rollout of the pilot occurring May 2015. The pilot finalized in SFY16. Full rollout did not occur given the transition to managed care. Evaluation and conversation with providers showed that the timing was not right at this time. However, the framework and system features are built and ready to roll out at a future date.

8. IVRS Certifications

SFY15 - IVRS Training Certifications issued during SFY15: 23 for Job Coaching, 1 for Employer Development, and 30 for the Dual Certificate (Job Coaching and Employer Development).SFY16 - IVRS Training Certifications issued during SFY16: 22 Job Coaching, 6 for Employer Development, and 28 for the Dual Certificate (Job Coaching and Employer Development).

9. Relias was utilized, on a trial basis, by a number of mental health centers to access

training that addressed working with members who have mental illness. (See attached report)

DIRECTCOURSE: SYSTEM USE AND TECHNICAL ASSISTANCE

1. IACP DirectCourse staff are available to work individually with providers throughout the state, providing implementation and technical assistance as needed by each agency. This process of training and support is part of what Elsevier staff attributes to Iowa’s system rollout being the most successful of any state contract.


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Contacts noted in the graph include on-site implementation/consultation, web-based consulting and technical assistance, and basic Q&A regarding system use.

2. Lesson completion data showed the most frequently used lessons during SFY16 came

from: CDS: Universal PrecautionsCDS: Health Insurance Portability and Accountability Act (HIPAA)CDS: Direct Support Professionalism: Practicing ConfidentialityCDS: Cultural Competence: What is Cultural Competence?CDS: SafetyCDS: Individual Rights and Choice

DIRECTCOURSE: MARKETING

1. IACP staff marketed the DirectCourse program at the IACP Annual Convention in May 2016. This event was open to all HCBS and Habilitation providers regardless of membership or affiliation with IACP. In addition, outreach and education regarding the DirectCourse system was provided through advertisement at IACP monthly advisory meetings and at each of the regional TA trainings. Information regarding DirectCourse curricula and Elsevier Performance Manager Learning Management System (LMS) is also posted and available to any visitor on the IACP website.


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DIRECTCOURSE: RECENT CURRICULA ADDITIONS TO IOWA-SPECIFIC SITE:

Trauma Informed Care Part 1 - IACP Hosted Gladys Noll-AlvarezTrauma Informed Care Part 2 - IACP Hosted Gladys Noll-AlvarezHCBS Documentation - IACP TA TeamMedicaid Waste, Fraud and Abuse - IACP TA teamOffice of Substitute Decision Maker (OSDM) Series - IACP hosted staff from OSDM Part 1: General Substitute Decision Making Part 2: Guardianship and Parents as Guardians Part 3: Powers of Attorney Part 4: Financial Substitute Decision MakingDementia CareThis course will provide learners with information about dementia in a number of areas: dementia as a disease, the signs and symptoms of dementia, the different ways dementia affects a person’s health and behavior, how a caregiver can take care of his or her health, ways to find a home care provider for the first time, and how family caregivers can better communicate with home care providers.• Lesson 1: What Is Dementia? • Lesson 2: Symptoms of Dementia • Lesson 3: Diagnosis and Treatment of Dementia • Lesson 4: Caregiver Health • Lesson 5: Reducing Caregiver Stress • Lesson 6: Caregiver Burnout • Lesson 7: Respite Care • Lesson 8: Finding a Paid Provider for the First Time • Lesson 9: Hiring a Paid Provider for the First Time • Lesson 10: Communication Between Family Caregivers and Providers • Lesson 11: Long-term Care Options • Lesson 12: Dementia and Communication • Lesson 13: Dementia and Memory Loss • Lesson 14: Dementia and Depression • Lesson 15: Understanding Dementia-Related Behaviors • Lesson 16: Challenging Behaviors: Agitation, Repetition, and Wandering • Lesson 17: Challenging Behaviors: Aggression, Hallucinations and Perception Problems, and

Paranoia • Lesson 18: Sexual Activity and Behavior • Lesson 19: Nutrition and Hydration • Lesson 20: Bowel and Bladder Care • Lesson 21: Sleep Issues and Sundowning • Lesson 22: Personal Care • Lesson 23: Dementia and Medications • Lesson 24: Physical and Social Activity • Lesson 25: Identifying and Preventing Abuse • Lesson 26: Home Safety • Lesson 27: Ambulation and Fall Prevention


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SUMMARYThe transition to Medicaid managed care was a major focus for the TA team during FY16 and is expected to be for FY17 as well. The addition of webinars has made training more accessible to a greater range of provider staff than regional trainings alone. DirectCourse continues to be an efficient and timely means of training DSPs and has facilitated increased disbursement of other training material from IACP’s TA team. The addition of the Relias Learning System also creates a new option for persons who wish to take advantage of an additional online education option; it is expected that this product will be made available to more providers in the next year.

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