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MI Choice Quality Assurance Review

(MICQAR)

Center on Frail and Vulnerable Elders The University of Michigan School of Nursing

Ann Arbor, Michigan

Donna Algase PhD, RN, FAAN, FGSA: Principal InvestigatorRosemary Ziemba, PhD, RN: Project Director

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MICQAR GOAL for Entrance Conference

To educate attendees on the MICQAR review process for selected Center for Medicare/Medicaid Services (CMS) standards.

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Objectives, Entrance Conference: Attendees will…

Identify the Quality Assurance Measures for MI Choice Waiver.

Understand the HCBS CMS Quality Framework and the implications for the MI Choice Waiver.

Engage in dialog to improve systems of supports and services coordination for the participant.

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The MICQAR Reviewers

Karen Hesselberg, MA, RN Claire Michelini MS, RN Rosemary Ziemba, RN, PhD Audrey Smith, RN Sue McVeigh, RN Theresa Staton, RN

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Michigan Department of Community Health

Mike Head- Long Term Care Director

James Schwartz Elizabeth Gallagher Pamela McNab Carol Hansen, RN Laurie Goldi, RN

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History of MICQAR

Began in January, 2005 University of Michigan School of Nursing was asked to conduct

Quality Assurance Reviews Only program in USA to contract with a school of nursing Major innovations

Aim is to be more educational, & less regulatory Resource model to share model practices Teach students in health professions about MI Choice Automation of review tool

2006: Automation into PICQAR organized standards from MDCH/ CMS Quality Framework

to reflect reviewer and care management work flow.

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The Review Process Review period: October 1, 2005 through September 30, 2007 (looking

at 10/05 to present for home visits)

Chart reviews Simple random sampling Standards & sources

Home visits Participant interviews Schedule and forms

Exit conference - MICQAR sends reports to MCDH. MDCH sends two separate reports (FY 2006 & FY 2007)

at the same time to the Waiver Agency. Waiver Agency has 30 days to respond with a SINGLE corrective

action plan to cover both years.

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MICQAR Review Tool

Changes related to automating the tool.

Scoring

0-Not evident 1-Partially evident 2-Evident 3-Exemplary Practice Not Applicable

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Identification of Model Practices

PILOT TESTING: A rating of “3” will be given for exemplary practice.

Model practices will be shared in the Exit Conference.

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The MICQAR Website

Live Date: To Be Announced The MICQAR website will include:

News for Waiver agencies Literature and resources Meeting minutes and notices (QMC, PCP,

etc..) Model Practices Your suggestions

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Exit Conference

Purpose The exit conference is an overview of major

findings summarized by the MICQAR team Exemplary or model practices Challenges faced by the agency Opportunities for improvement

Opportunity for Agency feedback

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MICQAR DISCLAIMER To be read at the entrance and exit conference: (DEFINITION: Exit

conference takes place after all the specified records and home visits are completed. The purposes of the exit conference are to: 1) summarize MICQAR findings and impressions; 2) elicit Agency response to findings; 3) provide opportunity for Agency to comment on review process. The exit conference is informal and unofficial. That is, the complete and official recommendations and citations will be provided to the Agency pending full analysis of MICQAR ratings and commentary by the Michigan Department of Community Health. However, in the exit conference, the RN reviewers will exercise informed judgment to provide an overview of clinical, managerial, and administrative characteristics that lead to best practices, minimal standards, or sub-standard practices.

Please note: MICQAR staff will report serious situations (e.g., neglect, abuse, or exploitation)

requiring immediate attention to WA when identified during the review. MICQAR staff will provide CM’s opportunity to provide additional information on-

site. MICQAR staff will provide feedback that can potentially improve services for

specific participants as applicable during the case analyses. MICQAR staff will verify opportunities for improvement in individual participant

cases as they arise. Communication between reviewers and WA program and QA directors will serve throughout the review to prevent misunderstanding or oversight of additional documentation, etc.

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Questions for you..

Identify the Care Management Model used in your agency

What is your Service area? Please furnish a list of Contract Providers and

explain how choice is provided Tell us how your participant record is

organized Please furnish us with any NEW additions to

your admission packet and forms.

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Other critical information needed…

Area restaurant recommendations!

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MICQAR Staff to contact

Rosemary Ziemba, Project Director rzie@umich.edu 734 763-0923

Mobile phone: 313 303-1285

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Who to call if Questions during the review.

Call or email Elizabeth Gallagher MDCH

gallaghere@michigan.gov

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Last words… …from you

In about two weeks, agency will receive forms with which to evaluate MICQAR.

The evaluations will not affect your review results.

THANKS!!