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.
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 and Aim
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.
Goal
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.
View the accessible PDF version of the 2024 Quality Initiatives
Liberty Presentations and Reports
Introduction to implementing a quality management framework for your organization to better the outcomes of everyone you serve.
- Critical Incident Annual Report FY 2023 - July 2023
- Targeted Analysis Training: Explains the Critical Incident Management Process (CIMP) and what is expected of waiver providers when Liberty Healthcare reaches out to a provider - November 1, 2022
- Liberty presentation regarding October 1, 2022 changes to Incident Reporting and GER Guide for all DD providers.
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.
- HLRAC flyer - A quick overview.
- HLRAC Stakeholder Training - January/February 2024
- HLRAC Provider Training - February 2024 - For DD Agency Providers. Includes the necessary information to be submitted to agency HLRCs in accordance with DDD policies and regulations; the new agency provider Therap reporting requirements for HLRC information; and an overview of the HLRAC role and functions and the referral process.
Resources to Mitigate Risk
Frequently Asked Questions (FAQs)
The Nebraska Quality Project aims to improve the quality of services provided to participants and families and improve their quality of life.
There are a few ways you can find out information and be involved:
- Attend meetings (for example the Monthly Home and Community Based Services Stakeholder Meeting).
- Email questions or concerns to Nebraska.Quality.Help@LibertyHealth.com.
- Subscribe to this webpage to receive notifications when information is posted.
No. The Nebraska Quality Project is targeted at improving the quality of services. Services will continue to be determined using person-centered planning to meet the participants needs.
Participants and their families are encouraged to identify and describe what is important to them to build a good life, and what supports and services they want to help them achieve a good life. Liberty and DDD strive to improve the quality of services with an emphasis on person-centered planning and utilizing the Charting the LifeCourse framework.
Providers will have more technical support. They will be expected to engage in continuous quality improvement to build provider capacity and the capability to provide higher-quality services to participants.
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.
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).
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.
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.
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.
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.
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.
Participant rights and guidelines on rights restrictions are outlined in the DD Policy Manual in Chapter 3.
Liberty Feedback Process
An important part of continuous quality improvement (CQI) is eliciting and responding to feedback from a variety of stakeholders. As a part of our commitment to CQI, Liberty initiated a new feedback process. Stakeholders are encouraged to deliver feedback directly to those it relates to; however, when a more formal process is needed, you can complete the Liberty Nebraska Feedback Survey. This information is collected daily and responded to promptly by Liberty Management. For assistance with this process call (402) 500-6525. You can also send us an email at Nebraska.Quality.Help@LibertyHealth.com.
Complete Liberty Nebraska Feedback Survey