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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

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The Division of Developmental Disabilities (DDD) works to improve the quality and delivery of services to people receiving home and community-based services.  ​

Sections on this page

    ​In 2020 DDD contracted with Liberty Healthcare Corporation to 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). Liberty provides technical assistance to guide decision-making using data insights that align goals, objectives, and initiatives each year to ensure participants are at the center of their services and expectations around safety and compliance are being met.

    Nebraska's Quality Initiatives

    The Quality Management Strategy (QMS) uses person-centered review to enrich 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. ​​

    Goals

    Enrich people's interactions and ensure they 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 greater integration of services and settings.
    • Increasing the focus on what's important to the person so services are shaped around the person instead of the person fitting into a service model.
    • 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 to better the outcomes of participants.

    Read More 

    2024 Quality IInitiatives Chart
    View the accessible PDF version of the 2025 Quality Initiatives
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    Mortality Reviews ​

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    Includes triage, determining if other participants are at risk, and initial/comprehensive reviews. Reviews identify factors that may have influenced the participant's health leading to their death, gather information indicating whether the death was potentially preventable, and determine any concerns with quality of care, service level, and emergent care delays.

    Frequently Asked Questions about Mortality Reviews

    Why do Mortality Reviews?

    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.



    Critical Incident Management Process​ (CIMP) and Root Cause Analysis (RCA)

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    Reviews General Event Reports (GERs) and assists in preventing incident recurrence while maintaining the safety of involved participants.

    Critical Incident Management - July 2023

    Resources to Mitigate Risk

    Calling 9-1-1

    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 to review General Event Reports (GERs) and complete Root Cause Analysis (RCA) activities to assist in preventing incident recurrence dent 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 participant's team will be assigned an Incident Review Specialist who will complete discovery activities. The specialist will request documents and complete interviews. Providers will provide documents and facilitate interviews with employees, participants, or other parties. Occasionally, an onsite review will be conducted, requiring approximately two hours of the participant's 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. DHHS began leading this in April 2025.

    HLRC Requirements for DD Agency Providers - September 2024 

    DD agency providers enter HLRC information in Therap. 

    HLRAC Training - February 2024

    HLRAC helps 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. 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 participants' rights and rights restrictions?

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



    Resources from the Technical Assistance Program (TAP) 

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    Training: Communicable Disease - December 2024

    Communicable Disease - November and December 2024

    Training: Incident Follow-Up and GER Resolution - September 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. 



    ​​Liberty Feedback Process 

    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.​