Provider certification of applicable Home and Community Based waiver services is reviewed through person-centered and organizational outcomes. Each outcome in the tool contains measurable indicators. Each indicator has a rating, which consists of, at least, met or not met. Many indicators also have an additional rating of not applicable (N/A) to the person being reviewed. For example, if the person does not need a behavior support plan, those indicators will be coded as N/A.
There are interpretive guides under most of the indicators that are intended to be helpful to both the provider whose services are being reviewed and to the Quality Reviewers conducting the review. These guides include questions and methods that reviewers will engage in to collect information. These guides do not limit the reviewer from asking other questions or using other information gathering activities that may be necessary during a review. These guides can be found here (link to the PCR tool and guidance for each applicable waiver service, should be located in QMD policies).
Review Team
The review team for a certification review is composed of Quality Reviewers from the Quality Management Division (QMD). In general, the review team consists of two or more reviewers, except if the sample is very small (as determined by the number of waiver services provided) and all the services are provided in one location.
One Quality Reviewer serves as team leader for the review. Quality Reviewers who may have a conflict of interest (i.e. family member in organization, past employment within 5 years, consultant relationship within 5 years) may not be considered as a member of the team for that provider. Quality Reviewers must maintain inter rater reliability at 85 percent to conduct a PCR review.
Sampling
The sample of individuals to be included in the review will be both representative of and proportional to a duplicated count of people receiving residential, work/day supports and supported employment services. The sample is designed so as not to exclude individuals who were included in the previous PCR of the provider.
Within these parameters the sample will be selected. The selection will ensure that at least 10 percent of the people in each provider’s service are selected. A sample number greater than 10 percent will be required for those services that have less than 10 people. The formula applied for these groups will be 10 percent of the total, plus one.
The numbers will be rounded up to create a sample number. For example, when there are five people in a service, the sample will be two, which is 40 percent of all people serviced (5 x 0.1 + 1). Once the sample size is determined, a representative sample will be selected, unless extenuating circumstances require modifications.
Below are links to prepare and appeal evaluations: