isp monitoring 2014 - lesson 1 printable version pd

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Course Number: 005-15-01

ISP Monitoring 2014 - Lesson 1

This webcast includes spoken narration.

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The written version of the narration appears to the right of the screen.

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Certificates of Achievement will be available to Administrative Entity staff, Providers, Supports Coordinators (SCs), and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course.

For SCs and SC Supervisors, course requirements include successful completion of a pre‐test and post‐test.

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Hello, my name is Sonya Hipple and I am the Supports Coordination Organization (SCO) Lead for the Office of Developmental Programs (ODP). This webcast is the first of five lessons in the course Individual Support Plan (ISP) Monitoring 2014.

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ISP Monitoring 2014 is the second course in a series about monitoring and it builds on the first part of the series, Introduction to ISP Monitoring, released October 1, 2013. If you have not taken that course, I strongly recommend you do so before continuing with this webcast. The Introductioncourse is available on the ODP Consulting System Website; the ODP Information Centers for Administrative Entities (AEs), Providers, and Support Coordination Organizations (SCOs); and on the Supports Coordinator Curriculum (SCC) website in Professional Development.

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The content for this course was developed by ODP in order to ensure compliance with Pennsylvania’s Waiver Agreement with the Centers for Medicare and Medicaid Services. The Waiver Agreement is the primary source of information for ISP Monitoring requirements.

In addition, ODP held statewide conference calls with SCOs in February 2014 to learn the methods they have developed that help meet requirements for monitoring. As a result, this webcast includes both ODP policy and expectation in meeting monitoring requirements as well as the example methods put forward by SCOs that they have found effective. The content of the five lessons has been reviewed and approved by ODP.

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Supports Coordinators (SCs) are familiar with different uses of the word monitoring. The three roles of supports coordination are to locate, coordinate, and monitor services. Monitoring in this context is broad: it’s a function that SCs perform for every individual they support regardless of funding or services. There are also other ways monitoring is performed. For example, ODP is expected to perform specific monitoring and oversight activities. In the context of this training, however, monitoring refers to one specific activity: the responsibilities outlined in the Consolidated and Person/Family Directed Supports Waivers to monitor delivery and effectiveness of services. We’ll refer to this type of monitoring as ISP Monitoring.

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This training is part of 2014 ODP SC and SC Supervisor Required Training. It is also strongly recommended for AEs and Providers in order to fulfill their responsibilities along with SCs to ensure monitoring is thorough, completed on time, and issues are addressed.

ISP Monitoring requires the active collaboration and commitment of the individual, family, SC, Providers, and other team members. The SC’s supervisor also plays a role in supporting the SC to resolve issues and ensure requirements are met. When there are issues that require their involvement to resolve, the AE and ODP may become involved. Although it is the SC’s responsibility to coordinate and conduct ISP monitoring, he or she is one member of a network of support with interconnecting roles and responsibilities.

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Let me give you an idea of the information we’ll cover in the five webcasts that are part of this training.

First, we’ll clarify information from the Introduction to ISP Monitoring released in 2013. The first lesson will also cover information about roles and responsibilities in ISP Monitoring.

The second lesson will provide insight into the revised Annotated ISP Monitoring Tool. Lesson 3 will focus on issues and comments, including expectations for documentation. Next, we’ll talk about monitoring services and supports, progress toward outcomes, and service utilization. Throughout the first four lessons, we’ll include information SCOs shared during the conference calls with ODP in February, 2014. In lesson 5, we’ll provide more examples of practices SCOs use to be successful at meeting monitoring requirements.

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This course includes information from several sources. They are located in the Resources section of the course. These documents are available in full by using the link provided. Before printing, be aware that several of them are large, in particular, the Waivers; you may choose to view them online.

• ODP Bulletin #00‐10‐06, Supports Coordination Services

• Consolidated and Person/Family Directed Supports Waivers

• Annotated ISP Monitoring Tool

• Individual Support Plan Manual

• Department of Public Welfare Chapter 51, Office of Developmental Programs Home and Community‐Based Services

The webcast also references the Guidelines for Supports Coordination Organization Monitoring. This document is not linked within the course; if you would like to look at a copy of the Guidelines, talk with your SC supervisor.

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I’m going to begin by addressing questions that ODP has received since the Introduction ISP Monitoring training was released in 2013. Then, I’ll talk about requirements under the Harry M. Settlement Agreement that connect to monitoring.

Next, the webcast will provide a brief overview of the concepts in the Introduction to ISP Monitoring course. Finally, we’ll talk about how the monitoring process is a shared responsibility of the individual, caregiver, Providers, and SC, as well as the AE, and ODP.

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Since the Introduction to ISP Monitoring was released, ODP has received requests for clarification from SCOs on two specific issues:

1. Using phone contacts to complete monitoring requirements and

2. Location of monitoring visits

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Phone contacts are an acceptable method of conducting monitoring, but only for individuals enrolled in the Person/Family Directed Support (P/FDS) Waiver. Monitoring by phone is not an acceptable method for individuals receiving Consolidated Waiver services. Monitoring by phone is not to be used as the only method of monitoring for people receiving P/FDS Waiver services. The Waiver also requires that face‐to‐face monitoring be conducted in specific locations, according to the individual’s living situation. ODP strongly advises SCOs to become familiar with the requirements for face‐to‐face monitoring visits before determining whether a specific monitoring visit can be conducted by phone. Information on location and frequency of visits (including phone calls) can be found in the P/FDS Waiver available on the Department of Public Welfare website.

Even if conducting monitoring by phone will meet the requirement, the SC should use good judgment in determining whether a phone contact is the best option: the SC may decide that it’s important to assess a situation in person. If an individual requests a face‐to‐face visit, this should be honored by the SC.

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The 2013 Introduction to ISP Monitoring training emphasized that SCs are required to vary location of monitoring visits for individuals in the Consolidated Waiver who receive a monthly service. You’ll recall that there must be a minimum of three face‐to‐face monitoring visits every three calendar months; at least one is to take place at the individual’s residence, one at his or her day service, and one at any place agreeable to the individual.

Some SCOs asked if this meant that two consecutive visits cannot be at the same location. ODP clarifies that the intent of the Waiver in varying location of monitoring is that all settings should be visited to assess health, safety, and services and supports across the individual’s life. Varying location also provides the individual with the opportunity to comment on satisfaction in all areas of life. It may be unavoidable that two consecutive monitoring visits occur in the same location. Sometimes, it may be even be advisable for the SC to monitor the site of the previous monitoring due to issues documented by the SC. This will allow the SC to complete the necessary follow‐up as expected.

However, in order to ensure the SC has a complete understanding of the individual’s health and safety, the effectiveness of services and the individual’s satisfaction, the SC should make every effort to vary the location of monitoring visits. Variation in location should be something that the SC and SC Supervisor review regularly to ensure it meets the intent of the waiver.

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The Harry M. Settlement Agreement focuses on communication access for people who are deaf and receiving Consolidated Waiver Services. The Settlement includes specific expectations for SCOs, Providers, and AEs supporting individuals who receive or are in need of Enhanced Communication Services (or ECS). SC Required Training (ODP Deaf Services) and information on the Settlement and responsibilities for SCOs was released on April 3, 2014. Additional Enhanced Communication Services Job Aids and Captivate trainings are located on the Home and Community Services Information System (HCSIS) Learning Management System (LMS). The process for requesting ECS will be released through ODP Communications.

I encourage you to review the training and material to get the complete picture. For the purposes of this webcast, I’m going to highlight two requirements that are directly associated with ISP Monitoring. Again, to emphasize the point, responsibilities under the Harry M. Settlement involve more than monitoring and are included in the training on that topic.

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The first requirement identifies how to provide communication support when performing activities associated with supports coordination. Notice that the training on the Settlement Agreement gives the reason – so that the individual is fully able to participate – and that it lists specific examples of SC responsibilities, including monitoring visits. This reinforces the person‐centered nature of ISP Monitoring, which is about whether or not the ISP is being implemented as outlined and includes the individual’s satisfaction with how services and supports are being delivered. Ensuring that communication support is available at the time of the monitoring visit promotes and encourages that the person’s perspective will be included and documented.

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If an SC is conducting monitoring for an individual who meets the criteria outlined in the Settlement Agreement (as defined in the training) the expectation is that the SC will include a review of the communication supports the individual is receiving or, in some cases, identify the need for new or different communication supports. We haven’t yet spoken in detail about the ISP Monitoring Tool, but there are a number of ways to include information on communication supports while monitoring. Communication supports could be an essential part of determining if the individual’s health and safety needs are adequately met; for example, are communication supports adequate so that expression of distress or discomfort is well understood by people supporting the individual?

When the SC documents information about consumer satisfaction, it could include the individual’s perspective: how does he or she feel about the quality of communication supports? Or, communication supports could be addressed when the SC is documenting information about Individual Support Plan Status: are there barriers to necessary services being available when needed, such as difficulty finding interpreter services?

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The Settlement Agreement requires that, for those individuals who meet criteria, ISP Monitoring should identify if there are issues that need to be addressed and resolved. SCOs should contact the Deaf Services Coordinator (DSC) if the SC has difficulty finding a provider to meet a communication need identified in the ISP or the SC becomes aware that a communication assistance need is not being met as specified in the ISP.

Later in the training, we’ll talk in detail about identifying and acting on issues that are revealed in the monitoring process. When we get to that topic, keep in mind that potential issues include communication supports.

For the remainder of this webcast, I’ll turn the narration over to Amy Hines of the Office of Developmental Programs Consulting System.

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Thank you, Sonya. My name is Amy Hines. I am a Consultant with the Office of Developmental Programs Consulting System, or OCS. I’m going to provide a basic review of concepts from the Introduction to ISP Monitoring course released in 2013 and talk about the collaborative responsibilities in the monitoring process.

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Introduction to Individual Support Plan Monitoring covered the basic responsibilities of ISP Monitoring, beginning with how it is based in the Centers for Medicare and Medicaid Services, or CMS, Waiver Assurances and the Consolidated and Person/Family Directed Support Waiver Agreements between CMS and Pennsylvania. The training explained the connection between the Individual Support Plan and monitoring: the ISP is the map that the team will follow in supporting the person, while monitoring is checking the compass to see if the plan is still on track or if adjustments need to be made. Introduction to Individual Support Plan Monitoring focused on requirements for monitoring frequency and location for both the Consolidated and Person/Family Directed Support Waivers and provided examples of how to prepare, conduct, and follow up on ISP Monitoring. The training also included information on issues and comments, with examples.

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As previously mentioned, even though coordinating and completing ISP Monitoring is the responsibility of the SC, effective monitoring that addresses issues, examines effectiveness of the ISP, and leads to improvement of the individual’s quality of life (in ways he or she finds satisfactory) depends not only on the SC, but also on individuals, families, Providers, AEs, and ODP. When issues are serious and require immediate intervention, the network may even extend beyond the ODP system to include local authorities. The SC is an integral part of the network that supports the individuals.

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We’ve already established that the primary source documents for understanding ISP Monitoring requirements are the Consolidated and Person/Family Directed Support Waivers. ODP Bulletin #00‐10‐06, Supports Coordination Services, also provides important information by describing monitoring as “a means to assure the individual is receiving the appropriate quality, type, duration, and frequency of services and supports outlined in the ISP.” The Bulletin also states that Supports Coordinators “monitor supports and services to ensure that individuals are safe and that they are receiving needed and desired supports and services.” These are primary responsibilities within monitoring and they reinforce the connection between the ISP and monitoring: follow‐up to determine if the ISP is being implemented as outlined and in a way that promotes health, safety, and the quality of life desired by the individual. In turn, the issues revealed during monitoring can often lead the team back into planning to review and, perhaps, revise the ISP.

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Look at two more excerpts from the Bulletin. These add an additional and important perspective on the purpose of monitoring. If the individual does not have control, freedom, and self‐determination in his or her life, SCs have little power themselves to make these changes; they must be promoted and supported by everyone in the individual’s life. This is a responsibility the SC shares with the individual, family, providers of service, and members of the community.

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Think about a time when you, as an SC, identified a serious issue during monitoring that required follow‐up. What did you do? Did you enlist the support of your supervisor, other staff in your SCO, the AE, or Provider administration?

Now consider how complex it is at times to coordinate a monitoring visit that works for everyone’s schedules – individual, family, and Provider. The other team members share a responsibility with you, the SC, in the monitoring process and you rely on the fact that everyone understands that scheduling that visit is a mutual obligation. Although meeting requirements for frequency and location of monitoring, coordinating follow‐up on issues and documentation is primarily the SC’s obligation – ISP Monitoring is not a solo act. The SC is not acting by him or herself but relying on others to collaborate with scheduling, completing monitoring, identifying issues, and developing and implementing a plan to address concerns.

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Individuals and families, by virtue of the fact that they receive waiver services, need to cooperate with monitoring, since one requirement of continuing waiver services is to monitor according to waiver requirements. This includes allowing visits to occur at all specified locations, including the residence, and working with the SC to address and resolve issues. This includes the family home.

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Similarly, Providers that serve individuals understand that their funding comes with the condition that they implement the ISP as written, cooperate with the SC in scheduling monitoring visits, share information, and collaborate to address issues.

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Collaboration in ISP Monitoring goes beyond the individual, family, Provider and SC. Itextends to the AE and ODP, especially when issues of imminent risk are identified or when issues of any nature are not resolved. Both ODP and the AE can support resolution of issues by providing guidance or resources, when available. The role of ODP and the AE connect directly to the CMS Assurances in the waiver agreement.

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So, we’ve talked about the collaboration between individuals, families, Providers, SCs, SCO staff, AEs, and ODP to ensure monitoring is completed and that issues are acted upon. What are the principles that guide effective monitoring?

At its foundation, ISP Monitoring is a person‐centered process that focuses on the unique needs of one individual at a time.

• Is the plan being implemented in a way that promotes health, safety, and well‐being? Is health and safety balanced with the individual’s ability to pursue what is important to him or her? Is the individual satisfied with services, supports, and progress toward outcomes?

• Does everyone involved in the monitoring process keep in mind that the individual is always the primary focus and remain objective in evaluating the effectiveness of the ISP?

• Is necessary information shared? Are people communicating openly? Is the process transparent?

• Do the people supporting the individual understand their obligations in the monitoring process, from scheduling to following through on agreed‐upon actions?

• Does follow‐up demonstrate that the individual’s team is committed to resolving issues and increasing satisfaction and improving quality of life in ways the individual wants?

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This webcast has been developed and produced by the Office of Developmental Programs Consulting System on behalf of the Pennsylvania Department of Public Welfare, Office of Developmental Programs.

Thank you for participating in this lesson.

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isp monitoring 2014 - lesson 1 printable version pd

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