ࡱ> { pbjbjzz 4x|hDD8Ti  =i?i?i?i?i?i?i$hkncicixiPPPj=iP=iPPOlT ͽ2kQ()ii0iQn$nPTTnV8LA6Pw,%ciciHinD d: Department of Health and Human Service Office of Substance Abuse and Mental Health Services Fourth Quarter State Fiscal Year 2013 Report on Compliance Plan Standards: Community August 1, 2013  Compliance Standard  Report/UpdateI.1Implementation of all the system development steps in October 2006 Plan As of March 2010, all 119 original components of the system development portion of the Consent Decree Plan of October 2006 have been accomplished or deleted per amendment. I.2Certify that a system is in place for identifying unmet needsSee attached Cover: Unmet Needs August 2013 and Unmet Needs by CSN for FY13 Q4. Found in Section 7. I.3Certify that a system is in place for Community Service Networks (CSNs) and related mechanisms to improve continuity of careThe Departments certification of August 19, 2009 was approved on October 7, 2009. I.4Certify that a system is in place for Consumer councilsThe Departments certification of December 2, 2009 was approved on December 22, 2009. I.5Certify that a system is in place for new vocational services The Department certification of September 17, 2011 was approved November 21, 2011. I.6Certify that a system is in place for realignment of housing and support services All components of the Consent Decree Plan of October 2006 related to the Realignment of Housing and Support Services were completed as of July 2009. Certification was submitted March 10, 2010. The Certification Request was withdrawn May 14, 2010. I.7Certify that a system is in place for a Quality Management system that includes specific components as listed on pages 5 and 6 of the planDepartment of Health and Human Services Office of Adult Mental Health Services Quality Management Plan/Community Based Services (April 2008) has been implemented; a copy of plan was submitted with the May 1, 2008 Quarterly Report. A new quality improvement plan for 2013-2018 is being developed with anticipated release in the fall of 2013. II.1Provide documentation that unmet needs data and information (data source list page 4 of compliance plan) is used in planning for resource development and preparing budget requests Unmet needs reports are posted on the SAMHS website on a quarterly basis in order to inform discussions and recommendations to the Department for meeting unmet needs. Budget submissions to the Governor and the Legislature are in part built on data regarding unmet needs. This is reflected in the financial documents submitted to DAFS. II.2Demonstrate reliability of unmet needs data based on evaluation See Cover: Unmet Needs and Quality Improvement Initiatives August 2013 and the Performance and Quality Improvement Standards: FY13 Quarter 4 for quality improvement efforts taken to improve the reliability of the other and CI unmet resource data. SAMHS will undertake a review of the reliability of the unmet needs data in the fall of 2013. From this review, a plan will be developed to provider training and technical assistance on identifying, recording and implementing services for unmet needs. II.3Submission of budget proposals for adult mental health services given to Governor, with pertinent supporting documentation showing requests for funding to address unmet needs (Amended language 9/29/09) The Director of SAMHS provides the Court Master with an updated projection of needs and associated costs as part of his ongoing updates regarding Consent Decree Obligations.II.4Submission of the written presentation given to the legislative committees with jurisdiction over DHHS which must include the budget requests that were made by the Department to satisfy its obligations under the Consent Decree Plan and that were not included in the Governors proposed budget, an explanation of support and importance of the requests and expression of support (Amended language 9/29/09)See above.II.5Annual report of fb88Care Expenditures and grant funds expended broken down by service area fb88Care and Grant Expenditure Report for FY11 and FY12 was provided in the May 2013 report. III.1Demonstrate utilizing QM SystemSee attached Cover: Unmet Needs August 2013 and the Performance and Quality Improvement Standards: August 2013 for examples of the Department Utilizing the QM system. III.1aDocument through quarterly or annual reports the data collected and activities to assure reliability (including ability of EIS to produce accurate data)This quarterly report documents significant data collection and review activities of the SAMHS quality management system. III.1bDocument how QM data used to develop policy and system improvementsSee compliance standards II.3 and II.4 above for examples of how quality management data was used to support budget requests for systems improvement. IV.1100% of agencies, based on contract and licensing reviews, have protocol/procedures in place for client notification of rights Contract and licensing reviews are conducted as licenses expire. A report from DLRS is included; during the last quarter 6 of 6 agencies had protocol/procedures in place for client notification of rights.IV.2If results from the DIG Survey fall below levels established for Performance and Quality Improvement Standard 4.2, 90% of consumers report they were given information about their rights, the Department: (i) consults with the Consumer Council System of fb88 (CCSM); (ii) takes corrective action a determined necessary by CCSM; and (iii) develops that corrective action in consultation with CCSM. (Amended language 1/19/11)The percentage for standard 4.2 from the 2012 DIG Survey was 89.9% (up from 88.6%in 2010). These data are posted on the SAMHS website and provided to the Consumer Council of fb88. SAMHS staff have been meeting to address the methodology used for the survey and to boost consumer participation in the survey to be distributed in the fall of 2013. IV.3Grievance Tracking data shows response to 90% of Level II grievances within 5 days or extension. Grievances have been responded to consistently over time. During the third quarter there were 2 Level II grievances filed; they were responded to within the 5 day period (100% compliance). IV.4Grievance Tracking data shows that for 90% of Level III grievances written reply within 5 days or within 5 days extension if hearing is to be held or if parties concur. Reporting began in the 1st quarter of calendar year 2008. Standard has been consistently addressed. There have been no Level III grievances filed in FY13. IV.590% hospitalized class members assigned worker within 2 days of request - must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 5-2. This standard was not met in FY3Q4. IV.690% non-hospitalized class members assigned worker within 3 days of request - must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 5-3. This standard has not met for the prior 4 quarters. IV.795% of class members in hospital or community not assigned within 2 or 3 days, assigned within an additional 7 days - must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 5-4. This standard has not been met for the prior 4 quarters. IV.890% of class members enrolled in CSS with initial ISP completed within 30 days of enrollment - must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 5-5. The standard consistently met since FY08. IV.990% of class members had their 90 day ISP review(s) completed within that time period - must be met for 3 out of 4 quartersSee attached Performance and Quality Improvement Standards: August 2013, Standard 5-6. This standard has not been met for the past 4 quarters. IV.10QM system includes documentation that there is follow-up to require corrective actions when ISPs are more than 30 days overdue Monitoring of overdue ISPs continues on a quarterly basis. As the data has been consistent over time and the feedback and interaction with providers had lessened greatly, reports are now created quarterly and available to providers upon request. Providers were notified of this change on May 18, 2011. Providers are notified when reports are run. Some do request copies. Feedback has been minimal. IV.11Data collected once a year shows that no > 5% of class members enrolled in CS did not have their ISP reviewed before the next annual review The 2012 data analysis indicates that out of 1,398 records for review, that 84 (6%) did not have an ISP review within the prescribed time frame. IV.12Certify in quarterly reports that DHHS is meeting its obligation re: quarterly mailings On May 14, 2010, the court approved a Stipulated Order that requires mailings to be done only semi-annually in 2010, moving to annually in 2011 and thereafter, as long as the number of unverified addresses remains at or below 15%. The most recent mailing was sent in early December 2012. Percentage of unverified addresses remains below 15%. IV.13In 90% of ISPs reviewed, all domains were assessed in treatment planning - must be met for 3 out of 4 quartersSee Section 9 Class Member Treatment Planning Review, Question 2A. This standard has been met in 3 of the past 4 quarters. The current percentage is 95.9%.IV.14In 90% of ISPs reviewed, treatment goals reflect strengths of the consumer - must be met for 3 out of 4 quartersSee attached Performance and Quality Improvement Standards: August 2013, Standard 7-1a and Class Member Treatment Planning Review, Question 2B Standard has been met continuously since the first quarter of FY08. IV.1590% of ISPs reviewed have a crisis plan or documentation as to why one wasnt developed - must be met for 3 out of 4 quartersSee attached Performance and Quality Improvement Standards: August 2013, Standard 7-1c (does the consumer have a crisis plan) and Class Member Treatment Planning Review, Question 2F Standard met since the beginning of FY09 IV.16QM system documents that SAMHS requires corrective action by the provider agency when document review reveals not all domains assessedSee Section 9 Class Member Treatment Planning Review, Question 6.a.1 that addresses plans of correction. In 53.1% of cases, SAMHS required a correction action plan from providers.IV.17In 90% of ISPs reviewed, interim plans developed when resource needs not available within expected response times - must be met for 3 out of 4 quartersSee attached Performance and Quality Improvement Standards: August 2013, Standard 8-2 and Class Member Treatment Plan Review, Question 3F. This standard has been met in 4 out of the 4 quarters. IV.1890% of ISPs review included service agreement/treatment plan - must be met for 3 out of 4 quartersSee attached Performance and Quality Improvement Standards: August 2013, Standard 9-1 and Class Member Treatment Plan Review, Questions 4B & C. This standard has not met in 3 of the past 4 quarters. IV.1990% of ACT/ICI/CI providers statewide meet prescribed case load ratios - must be met for 3 out of 4 quarters Note: As of 7/1/08, ICI is no longer a service provided by DHHS. See attached Performance and Quality Improvement Standards: August 2013, Standard 10.1 and 10-2 Community Integration -- standard met since the 2nd quarter FY08. ACT standard met for the 2nd, 3rd and 4th quarters FY10; the 1st, 2nd and 4th quarters FY11; all 4 quarters of FY12, and all 4 quarters of FY13. IV.1990% of ICMs with class member caseloads meet prescribed case load ratios - must be met for 3 out of 4 quartersICMs work is focused on community forensic and outreach services. Individual ICMs no longer carry caseloads. Should this change in the future, SAMHS will resume reporting on caseload ratios.IV.2090% of OES workers with class member public wards - meet prescribed caseloads must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 10-5. This standard has not been met in the last 4 quarters.IV.21Independent review of the ISP process finds that ISPs met a reasonable level of compliance as defined in Attachment B of the Compliance Plan IV.225% or fewer class members have ISP-identified unmet residential support - must be met for 3 out of 4 quarters and See attached Performance and Quality Improvement Standards: August 2013, Standard 12-1 Standard met for the 4th quarter FY08; the 1st, 3rd and 4th quarters of FY09; all quarters of FY10 and FY11; all 4 quarters of FY12 and all 4 in FY13. IV.23EITHER quarterly unmet residential support needs for one year for qualified (qualified for state financial support) non-class members do not exceed by 15 percentage points those of class members OR if exceeded for one or more quarters, SAMHS produces documentation sufficient to explain cause and to show that cause is not related to class status andUnmet residential supports do not exceed 15 percentage points of Class Members. Data are normally reported in July. This report was produced in October this year but, in order to ensure data continuity, it uses only data that would have been reported in July. Reporting for this standard will be done again in July 2013. See attached report Consent Decree Compliance Standards IV.23 and IV.43IV.24Meet RPC discharge standards (below); or if not met document reasons and demonstrate that failure not due to lack of residential support services 70% RPC clients who remained ready for discharge were transitioned out within 7 days of determination 80% within 30 days 90% within 45 days (with certain exceptions by agreement of parties and court master) See attached Performance and Quality Improvement Standards: August 2013, Standards 12-2, 12-3 and 12-4 Standard met since the beginning of FY08. IV.2510% or fewer class members have ISP-identified unmet needs for housing resources - must be met for 3 out of 4 quarters and See attached Performance and Quality Improvement Standards: August 2013, Standard 14-1 Standard met in FY13 and 21 out of the last 26 quarters.IV.26Meet RPC discharge standards (below); if not met, document that failure to meet is not due to lack of housing resources. 70% RPC clients who remained ready for discharge were transitioned out within 7 days of determination 80% within 30 days 90% within 45 days (with certain exceptions by agreement of parties and court master) See attached Performance and Quality Improvement Standards: August 2013, Standard 14-4, 14-5 & 14-6 Standard 14-4 met since the beginning of FY09, except for Q3 FY10. Standard 14-5 met for the 2nd, 3rd and 4th quarters FY09; the 2nd and 4th quarters of FY10; all quarters of FY11; all 4 quarters of FY12; and 4 quarters of FY13. Standard 14-6 met for the 2nd and 4th quarters FY09; the 2nd and 4th quarters FY10; all of FY11; 4 quarters of FY12, and 4 quarters of FY13. IV.27Certify that class members residing in homes > 8 beds have given informed consent in accordance with approved protocol Results reported in Performance and Quality Improvement Standards: July 2010 Report, Standard 15-1 This standard has been met since 2007. SAMHS submitted an amendment request to the court master to modify this requirement on November 23, 2011. The court master approved SAMHS request to hold the 2011 annual review in abeyance pending a decision on the amendment request. IV.2890% of class member admissions to community involuntary inpatient units are within the CSN or county listed in attachment C to the Compliance Plan See attached Performance and Quality Improvement Standards: August 2013, Standard 16-1 and Community Hospital Utilization Review Class Members 1th Quarter of Fiscal Year 2013. In FY10: 1st quarter 88.2% (15 of 17); 2nd quarter 81.8% (9 of 11); 3rd quarter 82.4% (14 of 17); and 4th quarter 90.9% (20 of 22). In FY11: 88% (22 of 25) in the 1st quarter; 75% (9 of 12) in the 2nd quarter; 78.9% (15 of 19) in the 3rd quarter and 80% (12 of 15) in the 4th quarter. In FY12: 76.2% (16 of 21) in the 1st quarter 63.6% (14 of 22) in the 2nd quarter 77.8% (7 of 9) in the 3rd quarter 73.7% (14 of 19) in the 4th quarter IN FY13: 100% (19 of 19) in the 1st quarter 92.9% (13 of 14) in the 2nd quarter 86.7% (13 of 15) in the 3rd quarter IV.29Contracts with hospitals require compliance with all legal requirements for involuntary clients and with obligations to obtain ISPs and involve CSWs in treatment and discharge planning See IV.30 below IV.30Evaluates compliance with all legal requirements for involuntary clients and with obligations to obtain ISPs and involve CSWs in treatment and discharge planning during contract reviews and imposes sanctions for non-compliance through contract reviews and licensing All involuntary hospital contracts are in place.IV.31UR Nurses review all involuntary admissions funded by DHHS, take corrective action when they identify deficiencies and send notices of any violations to the licensing division and to the hospital SAMHS reviews emergency involuntary admissions at the following hospitals: fb88 General Medical Center, Spring Harbor, St. Marys, Mid-Coast Hospital, Southern fb88 Medical Center, PenBay Medical Center, fb88 Medical Center/P6 and Acadia. See Standard IV.33 below regarding corrective actions. IV.32Licensing reviews of hospitals include an evaluation of compliance with patient rights and require a plan of correction to address any deficiencies. 13 Complaints Received 11 Complaints investigated 1 Substantiated 1 Plan of correction sought 0 Rights of Recipients ViolationsIV.3390% of the time corrective action was taken when blue papers were not completed in accordance with terms 90% of the time corrective action was taken when 24 hour certifications were not completed in accordance with terms 90% of the time corrective action was taken when patient rights were not maintainedSee attached Performance and Quality Improvement Standards: August 2013, Standards 17-2a, 17-3a and 17-4a and Community Hospital Utilization Review Class Members 3rd Quarter of Fiscal Year 2013. Standards met for FY08, FY09, FY10 and FY11; FY12 Standards met for FY13 IV.34QM system documents that if hospitals have fallen below the performance standard for any of the following, SAMHS made the information public through CSNs, addressed in contract reviews with hospitals and CSS providers, and took appropriate corrective action to enforce responsibilities obtaining ISPs (90%) creating treatment and discharge plan consistent with ISPs (90%) involving CIWs in treatment and discharge planning (90%)See attached report Community Hospital Utilization Review Performance Standard 18-1, 2, 3 by Hospital: Class Members 1st Quarter of Fiscal Year 2013. The report displaying data by hospital for community hospitals accepting emergency involuntary clients is shared quarterly by posting reports on the CSN section of the Offices website. Standard 18.2 met for the past 4 quarters. Standard met for obtaining ISPs and creating treatment and discharge plans consistent with ISP; involving CWs in treatment and discharge planning was at 100% in FY13. IV.35No more than 20-25% of face-to-face crisis contacts result in hospitalization must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 19-1 and Adult Mental Health Quarterly Crisis Report Second Quarter, State Fiscal Year 2013 Summary Report. In FY10, standard met for the 1st quarter: slightly above for the 2nd (25.7%), 3rd (25.7%) and 4th (26.1%) quarters. In FY11, standard met for the 1st quarter, with the 2nd (25.6%), 3rd (26.2%) and 4th (26.4%) quarters results being slightly above the standard. In FY12, standard met all 4 quarters. In FY 13, standard met all 4 quarters. IV.3690% of crisis phone calls requiring face-to-face assessments are responded to within an average of 30 minutes from the end of the phone call must be met for 3 out of 4 quarters See attached Adult Mental Health Quarterly Crisis Report Second Quarter, State Fiscal Year 2013 Summary Report. Starting with July 2008 reporting from providers, SAMHS collects data on the total number of minutes for the response time (calculated from the determination of need for face to face contact or when the individual is ready and able to be seen to when the individual is actually seen) and figures an average. Average statewide calls requiring face to face assessments are responded to within an average of 30 minutes from the end of the phone call was met for all 4 Quarters in FY12 and 4 quarters in FY13. IV.3790% of all face-to-face assessments result in resolution for the consumer within 8 hours of initiation of the face-to-face assessment must be met for 3 out of 4 quarters See attached Adult Mental Health Quarterly Crisis Report Second Quarter, State Fiscal Year 2013 Summary Report. Standard has been met since the 2nd quarter of FY08. IV.3890% of all face-to-face contacts in which the client has a CI worker, the worker is notified of the crisis must be met for 3 out of 4 quartersSee attached Performance and Quality Improvement Standards: August 2013, Standard 19-4 and Adult Mental Health Quarterly Crisis Report Second Quarter, State Fiscal Year 2013 Summary Report. Standard has been met since the 1st quarter of FY08. IV.39Compliance Standard deleted 1/19/2011. IV.40Department has implemented the components of the CD plan related to vocational servicesAs of quarter 3 FY10, the Department has implemented all components of the CD Plan related to Vocational Services. IV.41QM system shows that the Department conducts further review and takes appropriate corrective action if PS 26.3 data shows that the number of consumers under age 62 and employed in supportive or competitive employment falls below 10%. (Amended language 1/19/11) 2011 Adult Health and Well-Being Survey: 13.8% of consumers in supported and competitive employment (full or part time). The Director of the Office of Quality Improvement and staff from Office of Adult Mental Health quality management presented the findings at a Health Forum on July 18, 2013. The Department has requested feedback on recommendations from the Consumer Council on how they would like to see the data utilized. IV.425% or fewer class members have unmet needs for mental health treatment services must be met for 3 out of 4 quarters and See attached Performance and Quality Improvement Standards: August 2013, Standard 21-1 This standard has not been met for the prior 4 quarters. IV.43EITHER quarterly unmet mental health treatment needs for one year for qualified non-class members do not exceed by 15 percentage points those of class members OR if exceeded for one or more quarters, SAMHS produces documentation sufficient to explain cause and to show that cause is not related to class status Unmet mental health treatment needs do not exceed 15 percentage points of Class Members. Reporting for this standard will be included in the October report. See attached report Consent Decree Compliance Standards IV.23 and IV.43IV.44QM documentation shows that the Department conducts further review and takes appropriate corrective action if results from the DIG survey fall below the levels identified in Standard # 22-1 (the domain average of positive responses to the statements in the Perception of Access Domain is at or above 85%) (Amended language 1/19/11) and2011 Adult Health and Well-Being Survey: 77% domain average of positive responses. The Director of the Office of Quality Improvement and staff from Office of Adult Mental Health quality management will present the results of the 2012 survey will be presented at an APS Forum in the fall of 2013. The Department has requested feedback on recommendations from the Consumer Counsel on how they would like to see the data utilized. IV.45Meet RPC discharge standards (below); if not met, document that failure to meet is not due to lack of mental health treatment services in the community 70% RPC clients who remained ready for discharge were transitioned out within 7 days of determination 80% within 30 days 90% within 45 days (with certain exceptions by agreement of parties and court master)See attached Performance and Quality Improvement Standards: August 2013, Standards 21-2, 21-3 and 21-4 Standard met since the beginning of FY08 IV.46SAMHS lists in quarterly reports the programs sponsored that are designed to improve quality of life and community inclusion, including support of peer centers, social clubs, community connections training, wellness programs and leadership and advocacy training programs list must cover prescribed topics and audiences that fit parameters of 105. See attached Performance and Quality Improvement Standards: August 2013, Standard 30 IV.4710% or fewer class members have ISP-identified unmet needs for transportation to access mental health services must be met for 3 out of 4 quarters See attached Performance and Quality Improvement Standards: August 2013, Standard 28 This standard has been consistently met since FY08. IV.48Provide documentation in quarterly reports of funding, developing, recruiting, and supporting an array of family support services that include specific services listed on page 16 of the Compliance Plan See attached Performance and Quality Improvement Standards: August 2013, Standard 23-1 and 23-2. NAMI fb88 is the provider of the family support services. IV.49Certify that all contracts with providers include a requirement to refer family members to family support services, and produce documentation that contract reviews include evaluation of compliance with this requirement.100% of contracts include this requirement. Documentation is maintained by the regional offices. IV.50Lists in quarterly reports the number and types of mental health informational workshops, forums and presentations geared to general public that are designed to reduce myths/stigma and foster community integration (cover prescribed list and fit audience parameters) See attached Performance and Quality Improvement Standards: August 2013, Standard 34.1 and attached Public Education Report for the past quarter.      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