HEALTH CARE FINANCING ADMINISTRATION OFFICE OF ACQUISITION AND GRANTS, 2-21-15 CENTRAL BLDG. 7500 Security Blvd. Baltimore, MD 21244-1850

A -- QUALITY ASSURANCE FOR PHASE II OF THE HOME HEALTH AGENCY PR OSPECTIVE PAYMENT DEMONSTRATION SOL HCFA-95-035/DB POC Dave Barbato, Contract Specialist, 410-786-5145. SUMMARY OF WORK Description of Tasks A. General Requirements 1. The contractor shall furnish the necessary personnel, facilities, equipment, materials and supplies to perform the work set forth below. 2. All work under this contract shall be performed under the general guidance and monitoring of the HCFA project officer, and is subject to her/his approval. B. Specific Requirements 1. Develop Quality Assurance Work Plan (Task 1) The contractor shall prepare a work plan to govern the performance of work under this contract, and shall provide in the work plan a detailed allocation of contract resources and a time schedule for accomplishing the contract work. 2. Initial and Work Group Meetings, Quarterly Progress Reports (Task 2) Subtask 2.1 -- Attend Meetings The contractor shall meet with HCFA's project officer within 2 weeks of contract award to review the contractor's plan for conducting the quality assurance component of the Home Health Agency Prospective Payment Demonstration. The meeting will be held in Baltimore, Maryland. Subtask 2.2 -- Quarterly Reporting The contractor shall develop a reporting system and submit hard copy quarterly QA Activity Reports to HCFA no later than 30 days after the end of each project quarter. These reports shall summarize the results of all review activities in that quarter, including activity reports that summarize the status of data receipt from each of the treatment and control HHAs, the results of the Stage I outcome profiling, and the status and results of the Stage II reviews for each HHA. 3. Develop Software For Electronic Submission of QA Data from HHAs (Task 3) In order to facilitate data collection and receipt, HHAs will be encouraged to submit data electronically, either by modem or electronic mail. These data shall be submitted in a standard file format. The QA contractor will be responsible for designing an automated data collection system for the HHAs to use. 4. Train Demonstration Treatment and Control HHAs on QA Data Forms (Task 4) Each participating HHA will be trained on all of the demonstration procedures prior to implementation of the demonstration in their agency, that is, just prior to the beginning of the next Medicare cost report year. 5. Develop Data Receipt Control and Tracking System (Task 5) The QA contractor must establish a means by which all participating HHAs can submit QA data electronically. 6. Generate Agency Profiles for Stage I Review (Task 6) Stage I of the QA process involves multivariate analysis of the QUIG assessment data to measure the care outcomes of Medicare clients served by both the treatment and control HHAs. The QA contractor will generate agency-level reports on the results of the client outcomes on a semi- annual basis. To the extent possible, these outcome measures will be risk adjusted. 7. Identify Cases for Stage II Review (Task 7) Stage II of the QA process will involve the review of clinical records for those patients who are either included in specific outlier group(s) or who have experienced certain sentinel events while receiving treatment from the HHA. 8. Notify HHA of Cases for Stage II Reviews (Task 8) The QA contractor must identify those HHAs that are outliers for one or more outcome measures in a given quarter, based on the strategy developed in Task 7. These HHAs will be included in the Stage II review process. The QA contractor must identify the individual outlier cases that will be subject to the Stage II review. 9. Conduct Stage II Reviews (Task 9) For each HHA case selected for review, the QA contractor will complete the appropriate objective review criteria (ORCs), or conduct a focused medical review. This information will be used to assess the process of the care furnished by the HHAs. These reviews must be performed by RNs or individuals experienced in the provision of Medicare-covered home health services and knowledgeable of Medicare coverage criteria and policies. The QA contractor must also have a physician available (either on staff or on a consultative basis) to answer clinical questions that might arise during the course of the case review. 10. Notify HHA of Results of Stage II Reviews (Task 10) The QA contractor is required to inform the HHA of the results of the Stage II reviews performed within 45 days after receipt of the cases from the HHA. The QA contractor will develop a standardized reporting format that must be approved by HCFA. This report will include the number of cases reviewed, the number of problems identified, the number of cases pending, and any other pertinent information. 11. Submit Stage I and Stage II Results to the Evaluation Contractor (Task 11) The QA contractor will submit periodically both raw data files and analytic files to the demonstration evaluation contractor, Mathematica Policy Research, Inc. The raw data files will contain the data as it was received by the HHAs, with any data errors corrected. These raw data will be part of a linked file that includes data from the UB-92s provided to the QA contractor by the FI. 12. Monitor Quality of Stage I Data and Stage II Reviews (Task 12) The QA contractor shall submit a plan: (1) to conduct data audits of agency outcome data, (2) to monitor the accuracy of the Stage II record reviews, and (3) to assess the inter-rater and intra-rater reliability of reviews. 13. Report on QA Process (Task 13) The contractor shall submit to HCFA annual reports summarizing the results from agency profiles, and analyzing any differences between treatment and control agencies. This report will also provide information about any problems encountered during implementation of the QA process. (0132)

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