The Department of Developmental Services (DDS) and the Department of Health Care Services (DHCS) conducted the federal compliance monitoring review of the Home and Community-Based Services (HCBS) Waiver from March 18–27, 2019, at Valley Mountain Regional Center (VMRC). The monitoring team members were Kathy Benson (Team Leader), Bonnie Simmons, Corbett Bray, and Linda Rhoades from DDS, and Raylyn Garrett from DHCS.
Purpose of the Review
DDS contracts with 21 private, non-profit corporations to operate regional centers, which are responsible under state law for coordinating, providing, arranging or purchasing all services needed for eligible individuals with developmental disabilities in California. All HCBS Waiver services are provided through this system. It is the responsibility of DDS to ensure, with the oversight of DHCS, that the HCBS Waiver is implemented by regional centers in accordance with Medicaid statute and regulations.
Overview of the HCBS Waiver Programmatic Compliance Monitoring Protocol
The compliance monitoring review protocol is comprised of sections/components designed to determine if the consumers’ needs and program requirements are being met and that services are being provided in accordance with the consumers’ individual program plans (IPP). Specific criteria have been developed for the review sections listed below that are derived from federal/state statutes and regulations and from the Centers for Medicare & Medicaid Services’ directives and guidelines relating to the provision of HCBS Waiver services.
Scope of Review
The monitoring team reviewed a sample of 44 HCBS Waiver consumers. In addition, the following supplemental sample consumer records were reviewed: 1) three consumers whose HCBS Waiver eligibility had been previously terminated; and 2) ten consumers who had special incidents reported to DDS during the review period of January 1 through December 31, 2018. The monitoring team completed visits to six community care facilities (CCF) and 13 day programs. The team reviewed six CCF and 17 day program consumer records and interviewed and/or observed 39 selected sample consumers.
VMRC is in substantial compliance with the federal requirements for the HCBS Waiver program. Specific recommendations that require follow-up actions by VMRC are included in the report findings. DDS is requesting documentation of follow-up actions taken by VMRC in response to each of the specific recommendations within 30 days following receipt of this report.
Section I – Regional Center Self-Assessment
The self-assessment responses indicated that VMRC has systems and procedures in place for implementing the state and HCBS Waiver requirements addressed in the selfassessment criteria.
Section II – Regional Center Consumer Record Review
Forty-four sample consumer records were reviewed for 31 documentation requirements (criteria) derived from federal and state statutes and regulations and HCBS Waiver requirements. One criterion was rated as not applicable for this review. The sample records were 99 percent in overall compliance for this review. VMRC’s records were 98 percent in overall compliance for the collaborative reviews conducted in 2017 and in 2015.
Section III – Community Care Facility Consumer Record Review
Six consumer records were reviewed at six CCFs for 19 documentation requirements (criteria) derived from Title 17, California Code of Regulations. Criterion 3.4.b was rated 33 percent in compliance because two of the three applicable sample records did not contain semiannual reports of progress addressing and confirming progress on specific IPP objectives for which the facility is responsible. Criterion 3.5.b was rated 67 percent in compliance because one of the four applicable sample records did not contain quarterly reports of progress addressing and confirming progress on specific IPP objectives for which the facility is responsible. The sample records were 96 percent in overall compliance for 19 criteria on this review. VMRC’s records were 97 percent and 98 percent in overall compliance for the collaborative reviews conducted in 2017 and in 2015, respectively.
Section IV – Day Program Consumer Record Review
Seventeen consumer records were reviewed at 13 day programs for 17 documentation requirements (criteria) derived from Title 17, California Code of Regulations. The sample records were 99 percent in overall compliance for this review. VMRC’s records were 98 percent and 94 percent in overall compliance for the collaborative reviews conducted in 2017 and in 2015, respectively.
Section V – Consumer Observations and Interviews
Thirty-nine sample consumers, or in the case of minors, their parents, were interviewed and/or observed at their CCFs, day programs, or in independent living settings. The monitoring team observed that all of the consumers were in good health and were treated with dignity and respect. All of the interviewed consumers/parents indicated that they were satisfied with their services, health and choices.
Section VI A – Service Coordinator Interviews
Eight service coordinators were interviewed using a standard interview instrument. The service coordinators responded to questions regarding their knowledge of the consumer, the IPP/annual review process, the monitoring of services, health issues, and safety. The service coordinators were very familiar with the consumers and knowledgeable about their roles and responsibilities.
Section VI B – Clinical Services Interview
The Clinical Director was interviewed using a standard interview instrument. She responded to questions regarding the monitoring of consumers with medical issues, medications, behavior plans, the coordination of medical and mental health care for consumers, clinical supports to assist service coordinators, and the clinical team’s role on the Risk Assessment and Behavior Management Review Committees.
Section VI C – Quality Assurance Interview
A senior community services liaison was interviewed using a standard interview instrument. He responded to questions regarding how VMRC is organized to conduct Title 17 monitoring reviews, verification of provider qualifications, resource development activities, special incident reporting, and QA activities where there is no regulatory requirement.
Section VII A – Service Provider Interviews
Nine service providers at six CCFs and three day programs were interviewed using a standard interview instrument. The service providers responded to questions regarding their knowledge of the consumer, the annual review process, and the monitoring of health issues, medication administration, progress, safety and emergency preparedness. The staff was familiar with the consumers and knowledgeable about their roles and responsibilities.
Section VII B – Direct Service Staff Interviews
Six CCF and three day program direct service staff were interviewed using a standard interview instrument. The direct service staff responded to questions regarding their knowledge of consumers, the IPP, communication, service delivery, procedures for safety, emergency preparedness, and medications. The staff were familiar with the consumers and knowledgeable about their roles and responsibilities.
Section VIII – Vendor Standards Review
The monitoring team reviewed six CCFs and three day programs utilizing a standard checklist with 23 criteria that are consistent with HCBS Waiver requirements. The reviewed vendors were in good repair with no immediate health or safety concerns observed.
Section IX – Special Incident Reporting
The monitoring team reviewed the records of the 44 HCBS Waiver consumers and 10 supplemental sample consumers for special incidents during the review period. VMRC reported all special incidents for the sample selected for the HCBS Waiver review. For the supplemental sample, the service providers reported nine of the ten incidents to VMRC within the required timeframes, and VMRC subsequently transmitted nine of the ten special incidents to DDS within the required timeframes. VMRC’s follow-up activities for the 10 consumer incidents were timely and appropriate for the severity of the situation.
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