The purpose of the proposed rule is to develop minimum standards to exempt Community Care for the Elderly (CCE) lead agencies from the required competitive bidding process.

DEPARTMENT OF ELDER AFFAIRS
Community Care for the Elderly

RULE NO: RULE TITLE
58C-1: COMMUNITY CARE FOR THE ELDERLY
58C-1.006: Standards for Lead Agency Exemption from the Competitive Bid Process
PURPOSE AND EFFECT: The purpose of the proposed rule is to develop minimum standards to exempt Community Care for the Elderly (CCE) lead agencies from the required competitive bidding process.
SUBJECT AREA TO BE ADDRESSED: The establishment of minimum standards for the exemption of CCE lead agency contracted providers from the competitive bid process.
SPECIFIC AUTHORITY: 430.08, 430.203(9)(b) FS.
LAW IMPLEMENTED: 430.203(9)(b) FS.
A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: October 25, 2006, 9:30 a.m. - 12:00 Noon
PLACE: Department of Elder Affairs, 4040 Esplanade Way, Conference Room 225F, Tallahassee, Florida 32399, [phone].
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399-7000, telephone number [phone], Email address [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399-7000, telephone number [phone], Email address [e-mail].

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

58C-1.006 Standards for Lead Agency Exemption from the Competitive Bid Process.

In order to achieve the maximum amount of services delivered to the greatest number of elders, achieve the highest quality of care provided, and achieve both results most cost-effectively, the competitive bid process is the preferred method for the selection of CCE lead agencies.  However, an area agency on aging may exempt a CCE lead agency (hereafter referred to as “lead agency”) from the competitive bid process for a subsequent contract cycle (a cycle consists of 3 years) if the AAA is able to demonstrate by written, verified documentation that the lead agency has met the conditions listed in the following subsections during its last two contract cycles.  As part of its monitoring process, the department shall include review of the verified documentation that led the AAA to make the determination to exempt a lead agency from the competitive bid process.

(1) SUBSTANTIAL COMPLIANCE.

The lead agency shall have demonstrated substantial compliance with all state, federal, and contractual  requirements.  Substantial compliance is defined as having no deficiencies, or deficiencies identified that result in no actual harm, or deficiencies identified with potential for only minimal harm to the health, safety, and welfare of clients or to the operations of the aging service programs.

(2) CONSUMER OUTCOME MEASURES.

The lead agency shall have developed written procedures to successfully implement measurable consumer outcomes directed at:

(a) Maintaining clients in the least restrictive settings;

(b) Targeting high-risk clients;

(c) Improving quality of life;

(d) Improving or maintaining functional status;

(e) Helping elders to live in a safe home environment;

(f) Improving nutritional status of elders; and

(g) Assisting caregivers to continue providing care.

(3) COST-EFFICIENCY.  The lead agency shall have demonstrated:

(a) Maximum efficiency in minimizing administrative costs and effectively budgeting case management costs, increasing funds available for core services, and actively seeking all community resources available;

(b) Capability of utilizing other funding sources available before utilizing CCE funds;

(c) Sound fiscal and management practices.  An independent, certified accounting firm may provide this documentation in writing; and

(d) Development and effective implementation of detailed written fiscal policies and procedures.

(4) PROVISION OF SERVICES.  The lead agency shall have:

(a) Developed detailed written procedures and demonstrated the capability to accept referrals, provide case management, and coordinate or provide core services throughout the entire designated community care services area;

(b) Developed detailed written procedures and demonstrated  the capability for intake, initial screening, eligibility determination, prioritization, and referral;

(c) Demonstrated the ability to provide optional service component(s) in addition to core services.

(d) Developed detailed written procedures and performed monitoring activities to ensure that all lead agency employees, volunteers, and service providers adhere to standards of confidentiality and disclosure of client information as required by federal and state laws and regulations.

(e) Developed detailed written procedures for and have demonstrated the ability to complete comprehensive client assessments through determination of risk level, functional status, and establishing service needs.

(f) Developed detailed written procedures for:

1. Emergency and disaster preparedness; and

2. Providing services during and after emergency and disaster situations and demonstration of the capability to provide these services (if applicable).

(g) Developed detailed written grievance and complaint procedures for clients and service providers, and demonstrated compliance with these procedures.

(h) Developed and implemented written procedures for voter registration and have demonstrated the ability to encourage elders to register to vote.

(5) TRAINING REQUIREMENTS.

In addition to any other training requirements, at a minimum, the lead agency shall have:

(a) Developed procedures for and ensured that all direct care staff and volunteers received pre-service, in-service, and annual continuing education training; and

(b) Ensured that in-service and continuing education training included topics related to Alzheimer’s disease and related disorders and at least two other topics related to the care of the elderly and the aging process that is appropriate to the service provided.

(6) PROVIDER SANCTIONS.  The lead agency shall have:

(a) Developed procedures for the implementation of provider sanctions for failure to comply with state, federal, or contractual requirements; and

(b) Demonstrated uniform and consistent application of its sanctioning procedures.

(7) CASE MANAGEMENT.  The lead agency shall have developed:

(a) Detailed written procedures for and have monitored case management activities to ensure that case managers:

1. Complete comprehensive client assessments that determine risk level, functional status, and establish service need;

2. Develop care plans to meet individual client needs;

3. Serve as client advocates by seeking services from all community resources in addition to traditional service providers; and

4. Monitor the quality, timeliness, appropriateness, and cost of client services.

(b) Detailed written procedures for monitoring the quality of service delivery and have demonstrated its case managers’ ability to manage client care plans.

(c) Detailed written procedures outlining the method for credentialing and re-credentialing case managers pursuant to subparagraph (10)(c)10. of this rule.

(8) ACCESSIBILITY.  The lead agency shall have demonstrated accessibility by:

(a) Ensuring on-call case management services are available on evenings, weekends, holidays, and emergencies;

(b) Responding within 72 hours to Adult Protective Services referrals classified as high risk and in need of services to prevent further harm;

(c) Responding to referrals for persons at imminent risk of institutional placement; and

(d) Serving targeted groups as established in the AAA’s area plan.

(9) CONTINUOUS QUALITY IMPROVEMENT.  The lead agency shall have demonstrated the ability for continuous quality improvement by effectively and efficiently:

(a) Practicing innovative approaches to program management, staff training, and service delivery that promote cost-avoidance, cost-effectiveness, and program efficiency;

(b) Providing access to a continuum of care encompassing a full range of preventive, maintenance, and restorative services for functionally impaired elderly persons; and

(c) Utilizing feed back from persons served, stakeholders, and its quality assurance measures referenced in subsection (10) of this rule.

(10) QUALITY ASSURANCE PROGRAM:  The AAA or a recognized entity specializing in the development of quality assurance programs shall document in writing that the current lead agency meets the provisions of this subsection.

(a) The lead agency shall have developed and demonstrated the operations of a quality assurance program that:

1. Enhances clients’ quality of life and care based on outcomes of the care plan and client satisfaction;

2. Emphasizes quality client outcomes, including preventing or delaying placement in an institutional setting;

3. Focuses on clients’ abilities to attain or maintain their highest practicable mental, physical, and psychosocial well being; and

4. Promotes coordinated services that best suit clients’ needs.

(b) The program shall have included a system to identify and prioritize problem areas for resolution and a process to design and implement strategies to resolve identified problems.  At a minimum, the system shall have a:

1. Process for changing the current quality assurance program as needed;

2. Protocol that requires the active involvement of the lead agency director, a designated quality assurance director, and staff;

3. Protocol that requires its subcontractors to participate in joint quality assurance program efforts; and

4. Description of the mechanism for measuring the success of quality assurance strategies, implementations, and for providing feedback to all involved in the program.

(c) The program shall have included at least the following elements:

1. An appointed quality assurance director;

2. An active quality assurance committee;

3. A written description of the program;

4. A continuity of care and services plan, including remedies for instances where the lead agency or subcontractor is unable to carry out it duties and responsibilities for client care and service provisions;

5. Written responsibilities for monitoring, evaluating, and improving care;

6. Written procedures for quality assurance program supervision;

7. Documentation of adequate resources to carry out the program’s specified activities effectively;

8. Written procedures for staff participation in the program;

9. Written procedures for delegation of quality assurance responsibilities to designated personnel;

10. Written procedures for credentialing and re-credentialing case managers that must include required training;

11.Wirtten procedures for informing clients about their rights and responsibilities;

12. Written procedures to ensure the availability of and the accessibility to services and care throughout the community care service area;

13. Written procedures to ensure the accessibility and availability of records, as well as proper record keeping, and a process for record review;

14. Written procedures for utilization review;

15. Written procedures for quality assurance program documentation; and

16. Written procedures for coordination of quality assurance activities with other lead agency management activities.

(d) The lead agency shall have demonstrated an active quality assurance committee.  The committee shall be responsible for at least the following tasks:

1. Overseeing the quality of life and care indicators such as the degree of personal autonomy, provision of services and support systems to assist clients in exercising medical and social choices, self-direction of care, and maximum use of natural support networks;

2. Reviewing grievances identified through formal and informal complaint procedures and through external oversight;

3. Reviewing case records and documentation of all internal complaint/grievance steps;

4. Reviewing quality assurance policies, standards, and written procedures to ensure that they adequately address the needs of clients;

5. Reviewing client utilization of services with adverse or unexpected outcomes;

6. Developing and periodically reviewing written policies and procedures on areas of concern;

7. Reviewing ethical issues and questions such as end-of-life decisions and advance directives; and

8. Developing a system of peer review.

(e) The lead agency shall have conducted  quality of care reviews to monitor the quality, appropriateness, and effectiveness of client care at least quarterly.  The reviews shall have included clients who received services in the previous quarter.

1. At a minimum, the reviews shall include:

a. Targeted specific conditions and health service delivery issues appropriate to clients for a focused monitoring and evaluation;

b. Generally accepted practice guidelines to objectively evaluate health services delivery issues and the care the case manager delivered or failed to deliver;

c. Quality indicators derived from the practice guidelines to screen and monitor care and services delivered; and

d. Selection of conditions and issues to study on client profile data.

2. The elements for review shall include the following:

a. Management of the client’s diagnosis as noted in the client assessment section of Form 701B;

b. Appropriateness and timeliness of care;

c. Comprehensiveness of and compliance with the plan of care; and

d. Evidence of special screening for, and monitoring of, high-risk persons and conditions.

Specific Authority 430.203(b) FS. Law Implemented 430.203(b) FS. History—New _________.