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Quality
Developmental Disabilities
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What would you like to do?

What would you like to do?

What you need to know

What would you like to do?

What you need to know

What you need to know

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Nebraska Department of Health and Human Services (DHHS) Division of Developmental Disabilities (DDD) is working to improve both the quality and delivery of services to people receiving home and community-based services. This includes aged people and those who experience disabilities, including intellectual and developmental disabilities. 

Sections on this page
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    ​DDD contracted with Liberty Healthcare Corporation in 2020 to help plan and enact changes to improve services. Liberty is a Quality Improvement Organization Like Entity certified by the Centers for Medicare and Medicaid Services (CMS) that provides technical assistance to guide decision-making using data insights that align goals, objectives, and initiatives each year to ensure that participants are at the center of their services and expectations around safety and compliance are being met.

    Nebraska's Quality Initiatives

    The Nebraska Quality Management Strategy (QMS) uses person-centered review to enrich our understanding of how participants and families experience Home and Community-Based Services (HCBS). It uses compliance checks to ensure expectations around safety and standards are met. Ultimately it guides decision-making to align goals, objectives, and initiatives each year to make better decisions around HCBS. ​​

    The QMS starts by answering key questions we want to know. 

    Goals

    Enrich people's interactions with their services and ensure people are at the center of their services. This is done by:

    • Interviewing participants and their families to ensure their voice is heard.
    • Discovering if participants have a choice in the services they receive and how to get to greater integration of services and settings.
    • Increasing the focus on what's important to the person so HCBS services are shaped around the person instead of the person fitting into a service model; and
    • Exploring and implementing initiatives focused on quality enhancements to enrich each participant's experience with their service, ensuring their unique needs and preferences are at the heart of every decision and improved strategy in Nebraska.

    December 2023 Presentation

    Introduction to implementing a quality management framework for your organization to better the outcomes of everyone you serve.

    Read More ​

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    2024 Quality IInitiatives Chart
    View the accessible PDF version of the 2024-25 Quality Initiatives

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    Mortality Reviews ​

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    This process includes triage, other participants at risk determinations, and initial/comprehensive reviews. These reviews identify factors that may have influenced the participant's health leading to their death, information indicating the death was potentially preventable, and determine any concerns with quality of care, service level, and emergent care delays.

    Mortality Reports - July 2024

    Frequently Asked Questions about Mortality Reviews

    Why does Liberty do a Mortality Review?

    The goal of a mortality review is to determine if all necessary and reasonable measures were taken to provide for the health, safety, and welfare of the participant. Mortality reviews are completed for people receiving a Medicaid HCBS Waiver service or living at Beatrice State Developmental Center (BSDC).

    Where can I find the Notification of Death form? When is it completed?

    The Notification of Death Form is in the form section on the DD Provider page. DD providers are required to complete all available information. A yellow box at the bottom of the form will submit the form by sending an email to nebraska.quality.help@libertyhealth.com. The form must be completed and submitted within ten days of a participant's death.


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    CIMP and Root Cause Analysis


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    The Critical Incident Management Process (CIMP) is used to review General Event Reports (GERs) and complete Root Cause Analysis (RCA) activities to assist the provider or agency in preventing the recurrence of the incident while seeking to maintain the safety of involved participants.

    Critical Incident Management - July 2023

    Resources to Mitigate Risk

    Calling 9-1-1

    Constipation Prevention

    Fall Prevention

    Infection Risk Prevention

    Medical Emergency Preparedness

    Frequently Asked Questions about CIMP and Root Cause Analysis

    ​What is the Critical Incident Management Process?

    The Critical Incident Management Process (CIMP) is used by Liberty to review General Event Reports (GERs) and complete Root Cause Analysis (RCA) activities to assist the provider or agency in preventing the recurrence of the incident while seeking to maintain the safety of involved participants.

     

    What is a Root Cause Analysis?

    Root Cause Analysis (RCA) is one of the basic quality tools used for quality improvement. It is a systematic process to discover the root cause of issues to identify appropriate solutions and prevent recurrences of the issues or problems. It relies on data to inform the process of analysis, and it focuses on the HOW and WHY something happened rather than WHO is responsible.

     

    What is the purpose of the Root Cause Analysis?

    During a Root Cause Analysis (RCA), the Individual Service Plan (ISP) team will be assigned an Incident Review Specialist who will complete the discovery activities. The assigned specialist will request documents and interviews during this process, and providers will provide the documents and facilitate the interviews with employees, participants, or other parties. Occasionally, an onsite review will be conducted, requiring approximately 2 hours of the ISP team's time to develop a plan.



    Human and Legal Rights Advisory Committee​​ 

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    The Human and Legal Rights Advisory Committee (HLRAC) assesses and provides consultation regarding human and legal rights and restrictions imposed through approved person-centered plans, and ensures people are exercising their full rights.

    HLRC Requirements for DD Agency Providers - September 2024 

    As of March 15, 2024, DD agency providers are required to enter their HLRC information in Therap. 

    HLRAC Training - February 2024

    DDD and Liberty created a Human Legal Rights Advisory Committee (HLRAC) to help protect the rights of people receiving DD Waiver services, promote best practices for provider committees, and add a quality outcome focus. The HLRAC reviews cases, makes recommendations, and shares information with the providers and teams to achieve individually defined quality-of-life outcomes. 

    Frequently Asked Questions about HLRAC 

    What is the purpose of the HLRAC?

    The Human and Legal Rights Advisory Committee (HLRAC) helps protect and promote the rights of people receiving DD Waiver services. The overall goal of the HLRAC is to impact a reduction of rights restrictions for DD Waiver participants and increase positive outcomes.

    How is the HLRAC different from an agency provider's rights review committee?

    The HLRAC is advisory in capacity and does not approve or deny rights restrictions. The HLRAC members have diverse backgrounds and experiences that assist with making best practice recommendations for rights restrictions and agency rights review committee functions.

    Where can I find more information on DD Waiver participants' rights and rights restrictions?

    Participant rights and guidelines on rights restrictions are outlined in the DD Policy Manual in Chapter 3.



    ​Technical Assistance Program (TAP) 

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    The Technical Assistance Program (TAP) provides training and technical assistance (TA) to providers based on requests. The program will include onsite assistance and a library of tools, resources, and best practices.

    TAP Overview - July 2024

    The Technical Assistance Program (TAP) is available to provide training and hands-on support to individuals and providers upon request . This is available for all five HCBS Waivers. 

    • Introducing TAP - Includes an overview of the TAP program, who can request assistance, the Technical Assistance Plan, and any follow-up needed. Allows time for questions at the end. 
    • ​Live virtual overview of the new Technical Assistance Program - July 30 and July 31, 2024

    Quarterly Systemic Trainings - October 2024

    The Technical Assistance Program (TAP) offers one training each quarter, presented three separate times.​ 

    Recognizing and Preventing Abuse, Neglect, and Exploitation - August 2024 

    Incident Follow-Up and GER Resolution - September 2024 

    This training provides an in-depth look at the Incident Remediation process in the GER Resolution. It is intended to assist providers and other individuals who complete the Resolution by giving a detailed explanation of what is required in each section. 

    Communicable Disease - November 19, December 4, and December 7, 2024

    TAP Request Form


    Onsite Provider Review (OPR)

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    ​OPR is an organizational review of policies, procedures, and person-centered participant interviews to show the quality of services received by the participant.

    A performance report card will be generated Using key data from the provider reviews, incident information, and other performance measures.

    This initiative is expected to go-live February 2025.​​

    OPR Overview - December 2024

    Presentations for stakeholders in December 2024 and January 2025.




    Utilization Review 

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    The Utilization Review (UR) process reviews a sample of claims to validate service provision and utilization of authorized services. Aggregated data from utilization reviews will be collected and analyzed to reveal systemic issues with submitted claims.

    Expected development in February 2025.​


    ​​Liberty Feedback Process 

    An important part of continuous quality improvement (CQI) is eliciting and responding to feedback from a variety of stakeholders. Stakeholders are encouraged to deliver feedback directly to those it relates to; however, when a more formal process is needed, you can contact Liberty. For assistance call (402) 500-6525. You can also send an email to Nebraska.Quality.Help@LibertyHealth.com.​