As a part of the grant activities of the Real Choice Systems Change grant from the Centers for Medicare & Medicaid (CMS), the need for a survey of consumers on the Consumer Directed Physically Disabled Waiver (also called the Consumer Directed or CD Waiver) was identified. This report provides the results of the in-home survey that was conducted by the Muskie School. The CD Waiver serves people age eighteen and older with severe physical disabilities that meet nursing facility level of care, are their own guardian and have the ability and desire to self-direct the personal care services they receive in their home. The waiver is an alternative option to institutional care and consumers choosing community-based care are informed of the risks and limits to the care available in the community benefit. Unlike nursing facilities, twenty-four hour a day care is not available within the program limits. The results of the survey identified some areas of focus and opportunities for increased training. The Maine Department of Health and Human Services now requires the service provider to include as part of the skills training process with the consumer: (a) the need to formulate an emergency
Findings from the CHOICES CEO Project's work, as well as a preliminary analysis of MaineCare (Medicaid) policies, are presented in this report. The focus of the report is personal care services through MaineCare funding, with a specific focus on services in the workplace. This preliminary report is designed to provide a basis for further research needed to determine personal care needs, demand, cost, benefit, or the impact of policies or practices.
Contained in the report is a review of the development of trust funds as a funding stream to provide services to individuals with brain injury with unmet needs. There are currently 19 active state trust funds. Trust fund revenue sources and the uses of those funds vary from state-to-state. Revenues from trust funds generally support the access and delivery of cognitive rehabilitation, registries, education, community supports and case management. The unmet needs and barriers of Maine residents with brain injury and their service providers were detailed in a recent state-wide needs assessment. In particular, case management, supported housing, vocational, and education are identified as high priority areas for resource development. The needs assessment recommendations include policy development, collaboration and coalition building to strengthen the service delivery system, coordination of services and supports, and the development of educational opportunities for clinicians, service providers, employers and general public. Recent developments in Maine such as a decreasing number of brain injury service providers, the implementation of a new medical model of reimbursement under MaineCare, and an expected return of recent military veterans with brain injury have prompted the Acquired Brain Injury Advisory Committee to renew focus on the development of a new funding stream to support unmet needs.
The Robert Wood Johnson Foundation contracted with the University of Southern Maine's Muskie School of Public Service to evaluate the community outreach and training efforts of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). This report provides a brief description of program, the evaluation methodology, and preliminary results from the first two years of the evaluation. The evaluation includes an assessment of: 1) implementation efforts across five demonstration sites, 2) contextual factors that may influence outreach efforts, and 3) specific outcomes related to the education and outreach activities.
A review of the 45 grant applications submitted to the Federal Office of Rural Health Policy for Fiscal Year 2005 demonstrated that the State Flex Programs are committed to quality and performance improvement, with 30 percent of requested funding across the states going toward a variety of quality and performance improvement activities spanning a range of clinical, operational, and financial themes. Categories of quality improvement activities included improving clinical, operational, and financial performance; financial and organizational performance; promoting a culture of quality improvement; participating in national quality efforts; implementing health information technology (HIT) systems; and addressing patient safety and satisfaction issues.
State activities acknowledge the different quality measurement needs of rural hospitals through the development of benchmarks and transfer protocols specific to CAHs and other small, rural hospitals. Some state programs proposed activities to build in-state knowledge and capacity and to assess current conditions, particularly in the areas of balanced scorecards, HIT, and patient safety. The Flex Program?s grant-making capacity supports a wide range of local initiatives designed to improve the quality of patient care and hospital operations.
This is the first in a series of papers synthesizing the ideas and practices of states as they improve the quality of home and community based services (HCBS) and supports for older persons and persons with disabilities. Building on the experiences and challenges of the QA/QI Systems Change grantees, the paper addresses four fundamental questions about quality management. The intent is to provide an account of current practice, and a structure for how states view their options. There are two parts to this document, a Discussion Paper and the Appendices, each contained in separate pdf files. The Appendices may be downloaded at http://muskie.usm.maine.edu/Publications/DA/HCBS_QMrolesAppendices.pdf