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HCBS Waiver system

Sound quality improvement strategies start with good data. Rushmore’s Quality Management System (QMS) provides the foundation upon which an effective analysis methodology can be developed. The QMS ensures objective and measurable reviews while supporting the gathering of accurate, valid and complete data for use in management reports for the evaluation of a Home and Community Based Services waiver.

Quality Management system
 Attributes of the system include:​

  • Leveraging technology to enable simultaneous gathering, compilation and reporting of data critical to remediation and system improvement;

  • Enabling discovery methods that are continuous and ongoing;

  • Engaging service providers in quality assessment activities;

  • Ensuring objective, consistent and reliable reviews;

  • Providing automated reporting of all data including HCBS waiver assurance performance measures;

  • Monitoring Transition Plans; and

  • Facilitating the development, progress and completion of corrective action plans. 

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The QMS assess compliance with state and federal regulations while precisely identifying the reason for an identified weakness in a performance measure.

The QMS employs a unique and innovative system of Elements and Causal Factors to define review protocols resulting in objective, consistent and reliable review findings. Encoded in the system is demographic information relative to the type of review (level of care, participant file review, qualified provider), assurance(s) and sub-assurance(s) reviewed, the overall review findings and factors associated with each performance measure found to be deficient.

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From the repository of information
gathered, reports are generated to measure, monitor and support continuous quality improvement by providing an additional level of detail in the quality assessment process that goes beyond “what went
wrong”. The reports identify the nature and frequency of the underlying issue(s) critical in formulating corrective action strategies that support and sustain true system improvement by:

  • Identifying performance measures in which deficiencies are occurring

  • Identifying the root causes of errors

  • Identifying training needs of case
    managers, service providers and state staff

  • Identifying areas for policy andprocedure clarifications.

Reports
Digital Work
Collating Data
Quality
enhancements

Rushmore’s QMS provides the State
with a comprehensive process to build quality into the administration of its 1915(c) Home and Community Based waivers. The QMS provides the State with a configurable off the shelf product (design) to capture, record and report data for each waiver appendix and subsequent
performance measures (discovery) that allows development of measures and processes at an individual participant or service provider level (remediation) to facilitate and monitor
implemented plans of
enhancement/correction by service provider and across the delivery system and revision of quality strategies (system improvement) as necessary.

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