Skip to content

Resources for DADS service providers

The Texas Money Follows the Person Demonstration Proposal

Doing business with DADS home

Other DADS resources

Part 5: Attachments and Appendices

Appendix I: Quality Management Matrix

Quality Focus Area 1 – Level of Care and Participant Access
Desired Outcome: Individuals have access to home and community-based services and supports in their community.
Responsible Entity	Focus Area	Quality Domain or Assurance	Quality Indicator	Discovery Method and Frequency of Measurement
MFP Provider	Assurance 1.1	An evaluation of level of care (LOC) is provided to all applicants for whom there is a reasonable indication that services may be needed in the future.	Percent of LOC’s completed.	LTC Portal – Monthly Report.
MFP Provider	Assurance 1.2	Enrolled participants are reevaluated at least annually or as specified in its approved waiver.	Percent of LOC’s that are Completed.	LTC Portal – Monthly Report.
MFP Provider	Assurance 1.3	The process and instruments described in the approved waiver are applied to determine LOC.	Percent of time the Assessment Form as prescribed for the program is used to determine LOC.	LTC Portal – Monthly Report.
MFP Provider	Assurance 1.4	The state monitors level of care decisions and takes action to address inappropriate level of care determinations.	Percent of LOC found to be incorrect.	LTC Portal – Monthly Report. DADS’ monitoring of MFP Provider – Annual.
MFP Provider	Information and Referral	Participants and families can readily obtain information concerning the availability of services, how to apply and, if desired, offered a referral.	Number of participants provided a service referral.	DADS survey to random sample of individuals and families – Annual
MFP Provider	User Friendly Process	Intake and eligibility determination processes are understandable and user friendly.	Percent of participants who felt the determination process was understandable and user friendly.	Survey to random sample of individuals and families.
MFP Provider	Referral to Community Resources	Applicants who need services but are not eligible for them are linked to other community resources.	Number of applicants determined not eligible for services are referred to other community resources.	Survey to random sample of individuals and families. MFP Provider reports to DADS – Quarterly.
MFP Provider	Individual Choice of Services	Each participant is given timely information about available services to exercise his or her choice in selecting between HCBS and institutional care services.	Amount of time between initial inquiry and date the Freedom of Choice document is signed.	DADS’ monitoring of MFP Provider – Annual.
MFP Provider	Prompt Initiation	Services are initiated promptly when the applicant is determined eligible and selects services.	Percent of POC’s that are initiated within the required timeframe.	LTC Portal – Monthly Report.

Quality Focus Area 2 – Plan of Care and Participant-Centered Service Planning
Desired Outcome: Services and supports are planned and effectively implemented in accordance with each participant’s unique needs, expressed preferences and decisions concerning his/her life in the community.
Responsible Entity	Focus Area	Quality Domain or Assurance	Quality Indicator	Discovery Method and Frequency of Measurement
MFP Provider DADS RS DADS A&I	Assurance 2.1	POC’s addresses all participant’s assessed needs (including health and safety risk factors) and personal goals, either by type of service or other means.	Percent of participant records evidencing that the service coordinator initiates, coordinates, and facilitates the person-directed planning process to meet the desires and needs as identified by the individual and LAR.	DADS’ monitoring of MFP Provider – Annual.
MFP Provider DADS RS DADS A&I	Assurance 2.2	The State monitors POC development in accordance with its policies and procedures and takes appropriate action when it identifies inadequacies in the development of POCs.	Percent of participants whose POC evidences development of the POC in accordance with State policy and procedure.	DADS’ monitoring of MFP Provider – Ongoing.
MFP Provider DADS RS DADS A&I	Assurance 2.3	POCs are updated/revised when warranted by changes in the waiver participant’s needs.	Percent of participant records evidencing updated/revised POC when individual needs warrant changes.	DADS’ monitoring of MFP Provider – Ongoing
MFP Provider DADS RS DADS A&I	Assurance 2.4	Services are specified by type, amount, duration, scope and frequency and are delivered in accordance with the POC.	Percent of POC’s that provide all program components authorized in an individual’s POC.	DADS’ monitoring of MFP Provider – Annual.
MFP Provider DADS RS DADS A&I	Assurance 2.5	Participants are afforded choice: 1) between waiver services and institutional care and 2) between/among waiver services and providers.	MFP provider is the individual's or LAR's choice if that service provider is qualified. Amount of time between initial inquiry and date the Freedom of Choice document is signed.	DADS’ monitoring of MFP Provider – Annual. QAI Experience Survey – Annual.
MFP Provider DADS RS DADS A&I	Participant Direction	Participants have the authority and are supported to direct and manage their own services to the extent they wish.	Percent of participants who are offered the ability to manage their own services. Percent of participants who choose to manage their own services.	DADS’ monitoring of MFP Provider – Annual. QAI Data Mart – Monthly.
MFP Provider DADS RS DADS A&I	Ongoing Service and Support Coordination	Participants have continuous access to assistance as needed to obtain and coordinate services and promptly address issues encountered in community living.	Percent of participants who have had a POC revision due to changing needs.	LTC Portal – Monthly Report.
MFP Provider DADS RS DADS A&I	Ongoing Monitoring	Regular, systematic and objective methods – including obtaining the participant’s feedback – are used to monitor the participant’s well being, health status, and effectiveness of the service in enabling the individual to achieve his or her personal goals.	Results of the QAI Experience Survey.	MQ Experience Survey – Annually.

Quality Focus Area 3 - Qualified Providers - Capacity and Capabilities
Desired Outcome: There are sufficient service providers and they possess and demonstrate the capability to effectively serve participants.
Responsible Entity	Focus Area	Quality Domain or Assurance	Quality Indicator	Discovery Method and Frequency of Measurement
DADS RS	Assurance 3.1	The State verifies, on a periodic basis, that MFP providers meet required licensing and/or certification standards and adhere to other state standards.	Percent of program MFP providers that are qualified by licensing, certification, and state regulations.	Licensing Surveys - Routinely.
DADS A&I	Assurance 3.2	The State monitors non-licensed/non-certified MFP providers to assure adherence to waiver requirements.	Percent of MFP providers monitored within specified timeframes for adherence to program requirements.	Contract Monitoring – Routinely.
DADS RS DADS A&I	Assurance 3.3	The State identifies and rectifies situations where providers do not meet requirements.	Percent of MFP provider reviews resulting in corrective action to address non-compliance with requirements related to provider qualifications.	Contract Monitoring – Routinely. Licensing Surveys – Routinely.
DADS RS	Assurance 3.4	The state implements its policies and procedures for verifying that training is provided in accordance with state requirements and the approved program requirements.	Percent of reviews that include review of training information.	Licensing Surveys – Routinely.
DADS	Provider Networks and Availability	There are sufficient qualified providers to meet the needs of participants in their communities.	MFP provider actively recruits new providers as necessary.	DADS - Ongoing DADS Complaint Database.

Quality Focus Area 4 - Health and Welfare - Participant Safeguards
Desired Outcome: Participants are safe and secure in their homes and communities, taking into account their informed And expressed choices.
Responsible Entity	Focus Area	Quality Domain or Assurance	Quality Indicator	Discovery Method and Frequency of Measurement
DADS RS DFPS MFP PROVIDER	Assurance 4.1	The state, on an ongoing basis, identifies and addresses and seeks to prevent instances of abuse, neglect and exploitation.	Percent of records with evidence personnel are trained and knowledgeable of acts constituting ANE, the requirements to report allegations of ANE, and methods to prevent ANE.	DADS monitoring of MFP PROVIDER – Annual. Licensing Surveys – Routinely. DFPS Reports on ANE – Monthly.
DADS RS DFPS MFP PROVIDER	Assurance 4.1	The state, on an ongoing basis, identifies and addresses and seeks to prevent instances of abuse, neglect and exploitation.	Percent of MFP Providers that comply with the requirement to not employ service providers who are not eligible due to information contained within criminal history checks, the nurse-aide registry or the employee misconduct registry.	DADS monitoring of MFP PROVIDER – Annual. Contract Monitoring – Routinely.
DADS RS DFPS MFP PROVIDER	Assurance 4.1	The state, on an ongoing basis, identifies and addresses and seeks to prevent instances of abuse, neglect and exploitation.	Percent of case records with evidence complaint procedures were provided to consumers.	MFP PROVIDER reports to DADS – Annual.
DADS RS DFPS MFP PROVIDER	Assurance 4.1	The state, on an ongoing basis, identifies and addresses and seeks to prevent instances of abuse, neglect and exploitation.	Percent of participant records reviewed evidencing the participant or LAR was informed orally and in writing of the process for filing complaints about service coordination, service provisions, and complaints about ANE.	MFP PROVIDER complaint procedures are provided to consumers in writing and through oral interpretive services.
DADS RS	Restrictive Interventions	Restrictive interventions - including chemical and physical restraints - are only used as a last resort and subject to rigorous oversight	Number of citations for restrictive interventions.	Licensing Surveys – Routinely.
DADS RS	Medication Management	Medications are managed effectively and appropriately.	Number of citations for inappropriate medications management.	Licensing Surveys – Routinely.
DADS RS	Natural Disasters and other Public Emergencies	There are sufficient safeguards in place to protect and support participants in the event of natural disasters or other public emergencies.	Number of citations for no emergency back-up plan.	Licensing Surveys – Routinely.

Quality Focus Area 7 - Administrative and Fiscal - System Performance
Desired Outcome: The system supports participants efficiently and effectively and constantly strives to improve quality.
Responsible Entity	Focus Area	Quality Domain or Assurance	Quality Indicator	Discovery Method and Frequency of Measurement
DADS	Assurance 7.1	The Medicaid agency or operating agency conducts routine, ongoing oversight of the waiver program.	The operating agreement identifying policy-setting and oversight responsibilities is on file.The operating agreement is reviewed for updates. The operating agreement is current.The need to update operating agreements is identified.The operating agreement has been updated.DADS monitors implementation of the agreement to ensure the operating agency executes provisions.The operating agency reports the results of its monitoring activities to the State Medicaid Agency. The operating agency submits the results of its monitoring to the State Medicaid Agency annually via the CMS 372 report.	Review of operating agreements and monitoring activity reports by DADS. DADS submits the results of its monitoring oversight annually via the CMS 372 report.
DADS	Assurance 7.2	Consumer claims are coded and paid according to the MFP waiver reimbursement methodology.	Percent of correctly coded claims reimbursed according to reimbursement methodology.	Claims Management System – Routinely.
DADS	Assurance 7.3	Codes used to bill participant claims are appropriate for the service provided.	Percent of dollars reimbursed for services provided to a participant that are correctly coded.	Claims Management System – Routinely. DADS monitoring of MFP PROVIDER – Annual.
DADS RS DADS QAI DADS A&I	System Performance Appraisal	The service system promotes the effective and efficient provision of services and supports by engaging in a systematic data collection and analysis of program performance and impact.	Per Capita costs. Avoidable emergency room visits and hospitalizations, nursing home or ICF/MR admission rate. Mortality rate. Accurate prior authorization of services. Appropriate billing edits. Review of POC and actual service utilization. Desk billing audits. Random billing audits.	MFP PROVIDER review DADS Compliance Monitoring QAI Data Mart QAI – Experience Survey Annual
MFP PROVIDER DADS A&I DADS RS DADS QAI	Quality Improvement	There is a systemic approach to the continuous improvement of quality in the provision of services.	Per Capita costs. Avoidable emergency room visits and hospitalizations, nursing home or ICF/MR admission rate. Mortality rate. Accurate prior authorization of services. Appropriate billing edits. Review of POC and actual service utilization.Desk billing audits. Random billing audits.	MFP PROVIDER Reports DADS monitoring of MFP PROVIDER – Annual. DADS Compliance Monitoring - Routinely QAI Data Mart - Routinely QAI Experience Survey – Annual.
MFP PROVIDER DADS A&I DADS RS DADS QAI	Quality Improvement	There is a systemic approach to the continuous improvement of quality in the provision of services.	DADS with Annual Improvement Goals, performance measures and timeframes to demonstrate goals are being met.MFP PROVIDER meets semi-annually with DADS to review progress in achievement of annual goals.	DADS reviews and approves annual goals of MFP PROVIDER - Annual. DADS reviews progress towards goals and takes any necessary corrective action. – Routinely.
MFP PROVIDER DADS A&I DADS RS DADS QAI	Participant and Stakeholder Involvement	Participants and other stakeholders have an active role in program design, performance appraisal, and quality improvement activities.	Number of participant and/or stakeholder meetings to discus design, performance, appraisal and quality improvement activities.	MFP PROVIDER Report and DADS Compliance Review – Routinely. DADS Virtual Quality Consortium
MFP PROVIDER DADS	Cultural Competency	The service system effectively supports participants of diverse cultural and ethnic backgrounds.	Services are available in all parts of Service Area regardless of ethnic background and with respect and dignity of culture.	MFP PROVIDER Report and DADS Compliance Review – Routinely.
DADS	Financial Integrity	Financial accountability is assured and payments are made promptly in accordance with program requirements.	Percent of payments made in error. Percent of payments made outside the required timeframe.	DADS – Monthly.

Updated: April 24, 2009