Analysis of States LicensingCertification Outcomes Processes

1
Analysis of States Licensing/Certification
Outcomes Processes

• Person-Centered Outcomes
• Respect and dignity
• Respectful interactions with staff
• Age appropriate dress
• Respect for the individuals culture and
  religion
• Rights and responsibilities
• Privacy
• Having personal possessions
• Receiving payment for work
• Voting
• Having ones own possessions
• Safeguards for the use of restrictive
• procedures
• Personal safety and risk
• Abuse neglect
• Environment

2
Person-Centered Outcomes (continued)

• Health and Medication
• Access to health care services
• Routine examinations,
• Management and administration
• Diet/nutrition
• Use of durable medical equipment
• Access to needed ancillary clinical supports such
  as
• Occupation therapy and physical therapy
• Community inclusion and integration
• Working in integrated settings
• Using local resources and amenities
• Independence and autonomy
• Prepare meals and do chores, perform work tasks
  and
• live ad work in accessible settings
• Choice and decision-making
• Everyday choices (e.g., meals, routines,
  activities)

3
Analysis of States Licensing/Certification
Outcomes Processes

• RELATIONSHIP OF PERSON-CENTERED OUTCOMES TO
  SERVICE PLANNING
• Individual involvement in planning
• Identifying people's preferences, choices (e.g.,
  services, housemates, work) and personal goals
• Assessing/evaluating peoples needs for support
• Developing strategies for implementing goals
• Monitoring peoples progress

4
Analysis of States Licensing/Certification
Outcomes Processes

• SURVEY METHODOLOGY
• All person centered survey process have the
  following in common
• A representative sample of individuals served
  by the agency
• Surveys are complete through
• Documentation Review
• Interviews with individuals, staff, family,
• case managers
• All Surveys include observation of individuals in
  the location where they receive services
• Most surveys also include a review of
  agency related documentation
• Examples
• Staff orientation/training
• Investigation reports
• Incidents reports

5
Analysis of States Licensing/Certification
Outcomes Processes

• SAFEGUARDING OUTCOMES AND REQUIREMENTS
• The most uniformly prescriptive set of
  requirements and outcomes
• Rights
• Informing individuals and family members about
• individual rights and responsibilities
• Abuse, neglect and exploitation
• Reporting allegations of abuse
• Investigate allegations, take action if the
• investigations are substantiated
• Protect individuals from harm
• Take action if investigation substantiated
• Restrictive procedures
• Psychotropic medications, behavior support
• plans, and restraints
• Require

6
Analysis of States Licensing/Certification
Outcomes Processes

• Medications Prescriptive requirements for
  management and
• administration of medications
• Health
• More prescriptive requirements for
• medications than health.
• Require
• Routine examinations
• Identification of health care needs
• Access to health care services
• Special diets nutritional meals
• Environmental
• Greatest requirements
• Larger residential living situations
• And/or residences that provided 24-hour
• staffing

7
Analysis of States Licensing/Certification
Outcomes Processes

• STAFFING AND STAFF TRAINING
• Less emphasis on staff educational level and
  degrees
• Staff ratios less prescriptive tied into
  individual needs
• Staff knowledge and competency seen as an
  essential safeguards!
• Some training required before staff can work
  alone with individuals
• Examples of orientation/training requirements
• Emergency procedures (e.g., evacuation)
• Abuse/neglect reporting
• Knowledge support strategies for the individual
• Administration of medications (if the state has a
  delegated staff giving medications)
• Human rights
• Incident reporting
• First aid and CPR
• Medication administration certification for
  states that

8
Analysis of States Licensing/Certification
Outcomes Processes

• Different Models of Licensing Certification
• ONLY LICENSING (MINNESOTA)
• COMBINED LICENSING AND CERTIFICATION PROCESS
  (MASSACHUSETTS)
• SOME SERVICES LICENSED, OTHERS CERTIFIED (UTAH)
• PROVIDER APPROVAL PROCESS (COLORADO)

9
STATE OF LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALSOFFICE FOR CITIZENS WITH DEVELOPMENTAL
DISABILITIES LICENSING AND CERTIFCATION REFORM
WORKGROUP TASKS

• OVERALL GOAL
• DEVELOP A FRAMEWORK FOR A REVISED SYSTEM FOR
  LICENSING AND CERTIFIYING SERVICES FOR PEOPLE
  WITH DEVELOPMENTAL DISABILITIES
• WORKGROUP TASKS
• Review results of 5 state analysis
• Develop a set of operating principles
• Develop a core outcomes would apply to all
  services (refer to what 5 states determined to be
  important)
• Decide what services are subject to a regulatory
  review process
• Decide if there will be separate process for
  licensing and certification. If yes,
• Decide what is the purpose of each process (e.g.,
  enforcement, enhancement, contracting decisions,
  people and family members making choices about
  services)
• Decide what services are subject to licensure and
  services subject to certification
• Decide what is the unit of service to be
  certified and/or licensed (e.g., by provide, by
  location be service type)

10
LICENSING AND CERTIFICATION REFORM WORKGROUP
TASK, (Continued)

• Decide what the relationship is between the two
  processes (refer to the different models among
  the 5 states)
• Decide who is involved in each process
• if no,
• Decide what will be enforced and what will be
  service enhancement.
• Decide what is the unit of service to be
  certified and/or licensed (e.g., by provider, by
  location, be service type)
• Decide who is involved in the process