Division of Developmental Disabilities

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Quality Improvement

The Division of Developmental Disabilities is responsible to ensure maximum quality of services are provided to people with developmental disabilities throughout the state.
 
The Division has implemented standards to ensure quality services through Title 404 of the Nebraska Administrative Code, and it is also responsible to comply with the stringent terms and assurances required by the Centers for Medicare and Medicaid in Nebraska’s Home and Community Based Services, Developmental Disability Waivers.
 
This is primarily accomplished through the Division’s Quality Assurance/Quality Improvement (QI) unit.
 
The Division’s QI Section is comprised of three areas: Waiver Management, Survey and Certification, and Technical Assistance. In addition, the QI unit employs the Division Contract Coordinator, the DD Psychologist, and two Program Specialists whom are Registered Nurses (RN's)

Waiver Management

The Division’s Waiver Manager and team consists of two staff assistants, a contract coordinator, and fifteen disability services specialists (DSS) that are physically located in local offices throughout the state.

With minimal technical assistance provided by the Centers for Medicare and Medicaid Services, the Manager was able to craft Nebraska’s current HCBS Waivers that meet, and in many ways exceed, national standards for person-centered practices and that emphasize true community integration and employment opportunities.
 
In the past years, the Manager has also taken over management of the DSS staff (which were historically managed as DD Service Coordination Districts, and prior to 2009 were under the Division of Children and Family Services), and provided them with significant training and oversight to equip them with the skills necessary to ensure compliance with CMS’s increasing quality assurance requirements.
 
The Waiver Management team has responsibility for developmental disability eligibility determinations. 
 
The DSS staff have received enhanced training on eligibility requirements and processes, and they have access to a DD Division staff psychologist when such expertise is required.
 
Eligibility determinations are significant for the Division, because our federal funding is contingent on valid and well-documented eligibility determinations.
 
Ensuring waiver compliance is crucial to the Division’s success, as over 50% of our funding for developmental disability services is reliant on this compliance.
 
As part of state planning process,  the Division meets routinely with individuals, families and community stakeholders to ensure that the service array provided by our current waivers continues to meet the needs of the people we support.

Survey and Certification
 
In October 2010, the Division assumed all certification activities for Specialized Providers. The 6 surveyor positions funded by the Legislature for increased community oversight were then transferred to the Division of Developmental Disabilities from the Division of Public Health.

The Surveyors focus on certification activities which include: on-site certification reviews, complaint review and investigations, analysis of reported incidents, and service reviews of provider services.
 
When medical or nursing issues are revealed during a review, the survey team can consult with one of the two DD Specialist RN's located at the DD central office.
 
The Survey and Certification team has been provided with significant training to equip them to address the needs of the people served in the DD system.
 
Labor Relations Alternatives, Inc. has provided them with training in “Conducting Serious Incident Investigations” and every surveyor is required to be certified as a Level I Investigator.
 
The Division has worked hard to address these concerns and to ensure that individuals, families, and community stakeholders can be confident in the quality of services being provided by the Division. Much progress has been accomplished in this area, but the Division will remain diligent to ensure consistency in the survey and certification activities.
 
If you would like to report a complaint related to a DD Service Provider, please use the complaint form or the phone number, FAX or email listed above. To report any allegation of abuse/neglect related to an individual, call 1-800-652-1999.
 
Technical Assistance

With the assumption of certification activities by the Survey and Certification team, the development of new waiver services, and revision of the Division's regulations, we recognized the importance of providing technical assistance to community providers separate and apart from the survey process; thus, the Technical Assistance team was created in 2009.
 
The technical assistance team includes a manager and a program specialist. 
 
Technical assistance services occur by phone, email, in-person, or via formal meetings or training opportunities.
 
In addition to general technical assistance, the Technical Assistance team processes and assists with the referrals for Team Behavioral Consultation (TBC), which is a service available to teams working with individuals who are experiencing challenging behaviors.
 
The Division currently contracts with OMNI Behavioral Health to provide TBC.
 
The Technical Assistance (TA) team also prepares, conducts, and/or organizes DDD sponsored projects and trainings statewide.
 
The TA team support waiver compliance efforts by coordinating training for DSS staff; objective assessment process training; service coordination supervisor IPP review; planning with personal outcomes; eligibility determination training; and Scales of Independent Behavior – Revised (SIB-R).
 
The Technical Assistance (TA) team participates in training alongside other Division staff, so that they are equipped to share information and skills gained with providers, individuals in services and their families and other stakeholders.
 
They also make a diligent effort to provide competency tools, record Division training sessions and retain training documentation, so that training materials can be shared with others.
 
The Technical Assistance team is a key component of ensuring the continuity of quality services across Nebraska.
 
It is not challenging for local providers to have independent access to all areas of expertise in the developmental disability field, and the TA team helps bridge this gap for community providers.
 
Being independent from the Survey and Certification team is also helpful, as providers are sometimes hesitant to seek advice from staff that are responsible for regulatory activities.

To contact the DDD QI Office call: 1-877-667-6266 (statewide or (402) 471-8786 (Lincoln); FAX to (402)471-8792 or email at: dhhs.ddcbsqi@nebraska.gov
 

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