Round II Findings

The following findings are taken from the HCBS Lead Agency Review Summary Report for lead agencies reviewed between July 2012 and May 2015. A total of 83 lead agencies (87 counties and two tribes) were reviewed during the second round of the Lead Agency Review. Over the past three years, a large amount of data has been collected through the review of these lead agencies, including the review of 6,446 case files and talking to 1,117 lead agency staff.

Click here to view the Round II summary report (2012 to 2015). Click here to view individual lead agency reports for Round II.

Click here to view individual lead agency reports for Round III, which is currently in progress.

Case Management

Case managers play a significant role in providing quality services and advocacy for waiver participants.

  • Case managers work across lead agency departments and disciplines to serve participants. By working together with other units, case managers are better able to navigate the system on behalf of waiver participants and ensure participant needs are being met.
  • Case managers have regular contact with participants and their families, which allows them to maintain strong relationships and monitor the participant’s health and safety needs. On average, case managers visited participants 3.9 times in the 18 months prior to the lead agency’s waiver review site visit.

Assessment and Care Planning

A majority of the care plans reviewed contained detailed information addressing the required elements.

  • Lead agencies have seen improvements in results for completing assessments within required timelines since the first round of reviews. Seventy-six percent (76%) of assessments/screenings across programs were completed within the required timelines.
  • A majority (82%) of care plans were written using participant-friendly language which could include using the participant’s name and avoiding use of acronyms or medical jargon. In addition, 68% of care plans included individualized and meaningful goals.

Case File Technical Compliance

Three lead agencies case files were found to be 100% compliant with all requirements. Lead agencies have 60 days after their review to submit evidence that they had brought all cases reviewed into full compliance.

  • The areas where lead agency case files were most frequently found to be compliant include: current DD screening documents (98%), OBRA Level One documentation (98%), and participants’ acknowledgement of choice in services (96%).
  • Certain areas of case file compliance posed challenges for lead agencies; only 71% of case files contained documentation of current right to appeal information and 79% had complete emergency back-up plans.

Internal and External Relationships

Case managers are connected to their communities and aware of resources available. Case managers develop close working relationships with providers, which allow them to collaborate to meet the needs of participants.

  • Most lead agencies (71%) indicated in the Quality Assurance Plan (QA) survey that they always have case managers document provider performance, and that case managers always provide oversight to providers on a systematic basis (69%).
  • 82% of providers surveyed indicated they submit monitoring reports to the lead agency, and 87% indicated that they received the needed assistance when it was requested from the lead agency most or all of the time.

Provider Service Capacity and Development

Although waiver programs present the opportunity and flexibility for lead agencies and providers to develop new and creative services, progress in emerging areas has been slow.

  • Lead agencies are partnering with providers to develop creative housing solutions for participants including incorporating assistive technology so that participants can have more independent living situations. However, the percentage of waiver participants served at home remained level from 2011 to 2013 for AC/EW (75% in 2011 and 2013) and DD participants (35% in 2011 and 2013), but fell slightly for CCB (63% in 2011 and 62% in 2013).
  • Lead agencies are working to create more meaningful employment opportunities for participants by building relationships with local businesses. However, the percentage of working age adults employed and earning at least $250 per month improved only marginally between 2011 and 2013 for CCB (from 10% to 11%) and DD participants (from 22% to 23%).

Non-Enrolled Vendor Monitoring

In order to improve access and vendor choice for waiver participants, many lead agencies act as the pass through billing agent for non-MHCP enrolled vendors.

  • Since this change to DHS and lead agency operations is new, the review of the non-enrolled vendor monitoring process is meant to be educational and advisory. DHS is not issuing corrective actions for the requirement at this time. However, if any non-compliance is identified, the lead agency is required to remediate any required documentation.
  • DHS continues to issue guidance and sample templates via the CBSM to assist lead agencies in documenting that non-enrolled vendors meet all applicable service standards.

Waiver Allocation and Management

Some lead agencies had room in their budgets to enhance services or add more participants to programs.

  • In the first year, 11 of 24 lead agencies (46%) were given the recommendation to reduce their budget reserve because they had a more than adequate allocation left to manage risks associated with new high cost participants while also providing services to current participants. However, by the third year, only nine out of 30 lead agencies (30%) were issued this recommendation.
  • Over the course of Round II, several lead agencies have developed alliances with other nearby counties to pool and manage their allocations. This allows them to serve more participants with the waiver programs while better managing risk.