QA&I Changes for ODP Fiscal Year 2018/19

ODP released Communication Number 060-18, which provides a summary of changes related to Cycle 1, Year 2 of the Quality Assessment & Improvement (QA&I) Process for the 2018/19 Fiscal Year and posting of revised QA&I resource materials on the MyODP Training & Resource Center.

The QA&I process is based on a three-year cycle. All entities are required to complete a Self-Assessment every year and to participate in an onsite review at least once per cycle. FY 2018/19 begins the second year of Cycle 1 of the QA&I process. To prepare for Cycle 1, Year 2, ODP has made several changes to the QA&I process based upon a review of processes and tools that were used in Cycle 1, Year 1, the 55 Pa. Code Chapter 51 regulations, the Administrative Entity Operating Agreement, and changes to Federal regulation requirements. In addition, changes and clarifications were made to the processes and tools based on feedback received from AEs, SCOs, and Providers.

ODP has made the following changes to the QA&I process document:

• The due date for submission of QA&I self-assessment for all entities is August 31.
• Requirement for use and completion of QA&I Review Spreadsheet.
• Inclusion of Agency with Choice (AWC) Financial Management Services (FMS) QA&I.
• Inclusion of Claim and Service Documentation Review.
• Revisions made to the Terms & Definitions section to clarify current definitions established and include additional definitions regarding Claim and Service Documentation Sample, Individual Interview, and Level of Care.
• New section added regarding Technical Assistance.
• In the Individual Interviews section, a requirement was added for Assigned AEs to complete and data enter individual interview responses into a web-based platform for provider organizations scheduled for an onsite review.
• Clarification provided in the Remediation, Improvement, and QM Plans section regarding time frames, remediation activities, and plans to prevent recurrence (PPR).
• Clarification provided in the Comprehensive Report regarding what information will be included, review and response by entities, and information posted on ODP website.
• Changes made to the QA&I Process Timeline based on time frames updated throughout QA&I Process document.
• Enhancements to various QA&I templates.

As a reminder, any changes to the primary and/or secondary contacts should be submitted via the ODP Quality Assessment & Improvement Contact Information Form. It is the responsibility of the entity to ensure that this information remains up to date (refer to Announcement Number 056-18).

ODP made the following changes to the standard AE tool:

• Questions were renumbered to separate data and policy questions from record review questions.
• Guidance has been updated on some questions to provide additional clarification.
• Three demographic questions were added to the tool to gather identifying information from the AE.
• Other questions have been added based on current ODP requirements.
• NA options regarding data and policy and record review questions have been added as applicable.

ODP made the following changes to the standard SCO tool:

• Questions were ordered based on subject matter.
• Guidance has been updated on some questions to provide additional clarification.
• Questions have been removed based on current ODP requirements.
• NA options regarding data and policy and record review questions have been added as applicable.

ODP completed the following changes to the standard Provider tool:

• Questions added in Demographic section to capture services rendered by a Provider and whether or not the Provider is an AWC FMS provider.
• Questions were renumbered to separate data and policy questions from record review questions.
• Question regarding Quality Management Plan revised to align with AE and SCO QA&I Tools.
• “Remediation by exception” added where applicable to take into consideration the inability to remediate non-compliance due to staff no longer being employed, or the individual is no longer receiving services from the Provider organization.
• Nine questions have been added regarding the Home and Community-Based Services Settings Final Rule. These questions have been labeled exploratory and are not scored.
• Two additional questions have been added regarding employment services; these questions have been labeled exploratory and are not scored.
• Guidance to the training questions has been updated regarding review of staff and administrative staff.
• NA options regarding data and policy and record review questions have been added as applicable.

The updated resources and materials for Cycle 1, Year 2 of QA&I are available by logging onto the MyODP Training & Resource Center. As a reminder, any information regarding the QA&I Process can be accessed under the following path on MyODP: Resources > ODP Information > QA&I Process.

NOTE: There may be other changes to the QA&I processes. ODP will update the MyODP website and distribute communications to the field regarding those changes.

Please direct any questions, issues, or concerns to your QA&I Regional Coordinator listed below and CC the QA&I mailbox.

• Central Region: Robyn Seville
• Northeast Region: Rachel Toman
• Southeast Region: Roger Crisanty
• Western Region: Cleva (Renee) Bruno