Common use of Task Description Clause in Contracts

Task Description. The requirements in Task 1 of this SOW are designed to improve quality of care with respect to preventing clinical disorders and directing the treatment of clinical disorders. Any facts, opinions, or other types of information obtained initially or in follow-up requests from individuals or other entities within the care delivery system are in connection with these improvements in quality of care. In accordance with 5 CFR 1320.3(h)(5), these information collection activities are not subject to the Paperwork Reduction Act and, therefore, do not have to be submitted to the Office of Management and Budget (OMB) for clearance. Note that this does not exempt QIO information collection activities from the Quality Improvement Program’s internal policies and procedures related to information collection, which are described in Sections 12600-12670 of the QIO Manual. This also means that, as described in the QIO Manual, a ▇▇▇'s proposed information collection activities continue to require timely submission to the QIO's Project Officer/Division of Quality Improvement for review and approval. The QIO shall update on a quarterly basis the documentation of PARTner activity codes as defined by CMS for its work in meeting the requirements of Task 1a in this SOW. The clinical performance measures will be based on the publicly reported enhanced quality measures available on Nursing Home Compare (▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/nhcompare/home.asp). The baseline rate for high-risk pressure ulcers, physical restraints, and management of pain in chronic (long stay) residents will be based on data from the second quarter of calendar year 2004. For the management of depressive symptoms measure, the baseline rate will be the highest rate achieved from the second quarter of calendar year 2004 through the second quarter of calendar year 2006. Remeasurement data for all clinical performance measures will be the most recently reported quarterly data available at approximately November 2007. Detailed specifications for the calculation of the Publicly Reported Nursing Home Quality Measures are available at ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇▇▇/▇▇▇▇.▇▇▇. In addition to the general requirements for Task 1, the QIO shall conduct the following activities consistent with Exhibit 1a: Nursing Home: a) At the statewide level, the QIO shall: i. Work with nursing homes and stakeholders to promote quality improvement on the clinical measures. The QIO shall, if requested, provide assistance to nursing homes on clinical measures as necessary and/or appropriate. ii. Set statewide targets for (at a minimum) high-risk pressure ulcers and physical restraints. The QIO shall document the targets set by submitting them via the STAR interactive website, which will then transmit this information via the appropriate SDPS application according to Section F – QIO Schedule of Deliverables. iii. Assist nursing homes throughout the state/jurisdiction to help them set targets at least annually for (at a minimum) pressure ulcers among high-risk residents and physical restraints. The QIO shall document the targets set by assisting the nursing homes in submitting this information via the STAR interactive website, which will then transmit this information via the appropriate SDPS application according to Section F – QIO Schedule of Deliverables. Nursing homes participating with the QIO as identified participants are expected to set targets at least annually for high risk pressure ulcers and physical restraints. The Nursing Home QIOSC will make available an interactive website that allows the QIO and nursing homes to set targets as well as providing resources for setting targets. Nursing homes may set any target (including below, above, or at the nursing home’s current rate) for the publicly reported quality measures. iv. (Optionally) Assist a subset of nursing homes in the state/jurisdiction (can overlap in whole or in part with the identified participant group) to document their processes of care for 50% of new admissions (up to a maximum of 25 admissions per month) related to: • skin inspection and pressure ulcer risk assessment; • depression screening and treatment; • evaluation of the necessity for and alternatives to the use of physical restraints; and • pain assessment and treatment. The minimum numbers of nursing homes that must transmit process improvement data in order for the QIO to receive credit for this optional activity are defined by the number of nursing homes in the state/jurisdiction: Number of Nursing Homes in State/Jurisdiction Minimum Number of Nursing Homes Transmitting Process of Care Data for QIO To Receive Credit up to 30 5 31–150 8 151–300 15 301–500 25 more than 500 40 This information shall be transmitted monthly for at least 10 (not necessarily consecutive) months between January 2006 and September 2007 to the QIO Clinical Data Warehouse. The data transmitted to the QIO Clinical Data Warehouse will be available only to the QIO community. These data will be collected using the Nursing Home Improvement Feedback Tool (NHIFT) or a private tool that conforms to the same data specifications. NHIFT will be made available free of cost to all nursing homes beginning in October 2005. Training for the QIOs will begin in October 2005. Monthly reporting will begin in January 2006. b) With the IPGs (IPG1 and IPG2), the QIO shall help its identified participants: i. (IPG1 only) Significantly improve the clinical quality of the care provided to their nursing home residents in the areas of pressure ulcers among high-risk residents, physical restraints, management of depressive symptoms, and management of pain. (IPG2 only) Significantly improve the clinical quality of the care provided to their nursing home residents in the areas of physical restraints and pressure ulcers among high risk residents. ii. (IPG1 and IPG2) Collect and monitor resident and staff experience of care/satisfaction. Resident and staff experience of care/ satisfaction surveys must be conducted at least annually. Resident experience of care shall be collected only for persons capable of responding on their own behalf. The Nursing Home QIOSC will provide a list of acceptable resident and staff experience of care/satisfaction tools. For the QIO to successfully meet this requirement, at least 90% of all identified participants must complete three annual resident and staff surveys during the course of the SOW. The QIO shall submit each nursing home’s baseline, interim, and final remeasurement rates as well as indicate which tool the nursing home has selected for use according to Section F – QIO Schedule of Deliverables; and iii. (IPG1 and IPG2) Collect and monitor employee turnover. The turnover rate for a given facility will be based on Certified Nursing Assistants/Aides (CNAs) no longer employed by the facility over the course of a 12 month period. For the QIO to successfully meet this requirement, at least 90% of all identified participants must report the CNA turnover rate at baseline, interim, and remeasurement. For the baseline, this 12 month period will be from January 1, 2005 – December 31, 2005. For the interim (second reporting period), the 12 month period will be from December 1, 2005 – November 30, 2006. For the final (remeasurement) reporting period, this 12 month period will be from September 1, 2006 – August 31, 2007. The QIO shall submit the information needed to calculate CNA turnover rate according to Section F – QIO Schedule of Deliverables. The information needed to calculate CNA turnover rate will be calculated in accordance with CMS instructions. c) In selecting IPG1, the QIO shall meet the following criteria: i. The QIO shall select IPG1 identified participants based on the number of nursing homes in the state/jurisdiction, as indicated in the following chart. >300 10% of nursing homes in the state/jurisdiction 15% of nursing homes in the state/jurisdiction ii. CMS will utilize SAS mapping software to ensure that IPG1 identified participants are distributed across the state/jurisdiction, including any rural areas in which nursing homes are located. Feedback will be provided to the QIO prior to the date that the QIO must submit its list of IPG1 identified participants. The QIO’s list of IPG1 identified participants must be approved by its Project Officer and the Task 1a GTL. iii. The QIO shall work with its state/jurisdiction partners, specifically the State Survey Agency and local stakeholder organization(s), in its selection of IPG1 identified participants. However, the confidentiality of IPG1 identified participants will remain preserved unless the provider chooses to disclose its work with the QIO. d) In selecting IPG2, the QIO shall meet the following criteria: The QIO shall work with the State Survey Agency to identify persistently poor performing nursing homes in the state/jurisdiction. CMS encourages the QIO to work with as many of these poor performing nursing homes as possible. The QIO must select its IPG2 to meet the minimum number of IPG2 identified participants indicated in the following chart. IPG2 identified participants shall not overlap with IPG1 identified participants. e) The QIO shall submit the following in accordance with Section F – QIO Schedule of Deliverables: • a list of IPG1 and IPG2 identified participants; • notification as to whether the QIO elects to have a subset of the nursing homes in the state/jurisdiction submit process of care data on a monthly basis and which nursing homes have committed to doing so. Clinical Performance Measure Results (based on publicly reported nursing home quality measures) Pressure Ulcers among High- Risk Residents The Project Officer will evaluate performance based on the activity to promote statewide clinical quality. If baseline is <10.5%: achieve a relative improvement rate >15% If baseline is 10.5% to 15%: achieve a relative improvement rate >25% If baseline is >15%: achieve a relative improvement rate >35% 10% relative improvement from baseline to remeasurement Physical Restraints If baseline is <4%: achieve a relative improvement rate >15% 10% relative improvement from baseline to remeasurement If baseline is 4% to 10%: achieve a relative improvement rate >35% If baseline is >10%: achieve a relative improvement rate >60% Management of Depressive Symptoms If baseline is <10%: achieve a relative improvement rate >30% If baseline is >10%: achieve a relative improvement rate >40% Management of Pain In If baseline is <5%: achieve a relative Chronic (Long Stay) Residents improvement rate >25% If baseline is 5% to 8%: achieve a relative improvement rate >35% If baseline is >8%: achieve a relative improvement rate >50% Process Improvement (Extra Credit) Process Change Implementati on A subset of nursing homes in the state/jurisdiction submit monthly data to the QIO Data Warehouse on at least one of the following topics for 50% of new admissions (up to a maximum of 25 admissions per month) for 10 out of 21 months: (1) skin inspection and pressure ulcer risk assessment; (2) depression screening and treatment; (3) evaluation of the necessity for and alternatives to the use of physical restraints; and (4) pain assessment and treatment Organization al Culture Change Target Setting At least 25% of nursing homes in the state/jurisdiction must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk All IPG1 identified participants must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk residents and physical restraints All IPG2 identified participants must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk residents and physical restraints The QIO sets statewide targets for (at a minimum) pressure ulcers among high-risk residents and physical restraints residents and physical restraints Data Collection on Experience of Care >90% of all identified participants collect data on and monitor resident satisfaction/experience of care annually for three years; and >90% of all identified participants collect data on and monitor staff satisfaction/experience of care annually for three years >90% of all identified participants collect and monitor total number of CNAs employed and total number of CNA terminations on an annual basis >90% of all identified participants collect data on and monitor resident satisfaction/experi ence of care annually for three years; and >90% of all identified participants collect data on and monitor staff satisfaction/experi ence of care annually for three years >90% of all identified participants collect and monitor total number of CNAs employed and total number of CNA terminations on an annual basis

Task Description. The requirements in Task 1 of this SOW are designed to improve quality of care with respect to preventing clinical disorders and directing the treatment of clinical disorders. Any facts, opinions, or other types of information obtained initially or in follow-up requests from individuals or other entities within the care delivery system are in connection with these improvements in quality of care. In accordance with 5 CFR 1320.3(h)(5), these information collection activities are not subject to the Paperwork Reduction Act and, therefore, do not have to be submitted to the Office of Management and Budget (OMB) for clearance. Note that this does not exempt QIO information collection activities from the Quality Improvement Program’s internal policies and procedures related to information collection, which are described in Sections 12600-12670 of the QIO Manual. This also means that, as described in the QIO Manual, a ▇▇▇'s proposed information collection activities continue to require timely submission to the QIO's Project Officer/Division of Quality Improvement for review and approval. The QIO shall update on a quarterly basis the documentation of PARTner activity codes as defined by CMS for its work in meeting the requirements of Task 1a 1b in this SOW. The clinical performance measures will be based on the publicly reported enhanced quality measures available on Nursing Home Compare (▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/nhcompare/home.asp). The baseline rate for high-risk pressure ulcers, physical restraints, and management of pain in chronic (long stay) residents will be based on data from the second quarter of calendar year 2004. For the management of depressive symptoms measure, the baseline rate will be the highest rate achieved from the second quarter of calendar year 2004 through the second quarter of calendar year 2006. Remeasurement data for all clinical performance measures will be the most recently reported quarterly data available at approximately November 2007. Detailed specifications for the calculation of the Publicly Reported Nursing Home Quality Measures are available at ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇▇▇/▇▇▇▇.▇▇▇. In addition to the general requirements for Task 1, the QIO shall conduct the following activities consistent with Exhibit 1a1b: Nursing HomeHome Health: a) At Both at the statewide levellevel and with a Clinical Performance IPG, the QIO shall: i. Work with nursing homes and stakeholders to promote quality improvement shall improve clinical performance measure results based on the target RFRs in the chart below. Improvement in Bathing 14% 34% Improvement in Transferring 8% 31% Improvement in Ambulation/Locomotion 9% 20% Improvement in Management of Oral 8% 18% Improvement in Pain Interfering with Activity 11% 41% Improvement in Status of Surgical Wounds 6% 38% Improvement in Dyspnea 17% 41% Improvement in Urinary Incontinence 9% 34% Any Emergent Care Provided This measure will not be used for the 8th SOW This measure will not be used for the 8th SOW Acute Care Hospitalization 30% 50% Discharge to Community 10% 35% The evaluation of clinical measuresperformance improvement will be based on baseline risk-adjusted rates computed from data available in OBQI roll- up reports. The baseline periods are as follows: -Round 1 QIOs – August 2003 – July 2004 -Round 2 QIOs – November 2003 – October 2004 -Round 3 QIOs – February 2004 – January 2005 Identified participants shall be selected based on the PRS database as of June 1, 2005. HHAs that first appear as open agencies in the PRS database after June 1, 2005, are not eligible to become identified participants. After determining open, non-pediatric agencies in the PRS database, the QIO shallwill use OBQI roll-up reports to determine agencies with 10 or more episodes of care on the acute care hospitalization measure in the 12-month baseline period. Identified participants must not be pediatric agencies, if requestedand must also have at least 10 episodes of care in the 12- month period from the OBQI roll-up reports covering the period March 1, provide assistance 2004–February 28, 2005. From this list, the QIO shall select identified participants according to nursing homes agency size, in order to fulfill CMS HHA size requirements regarding the IPG, as shown below. Also, an identified participant HHA shall not have an acute care hospitalization risk-adjusted rate of ≤23.9% for the baseline data period. However, in the event that a QIO is required to recruit >65% of HHAs that are eligible for the IPG to fulfill all IPG requirements (Clinical Performance IPG, Systems Improvement IPG, and substitute/extra insurance HHAs), the QIO shall be allowed to include a portion of HHAs with baseline acute care hospitalization risk-adjusted rates below 23.9%. The maximum portion allowable shall be equal to the minimum number necessary to bring the ratio of IP HHAs needed out of the number of HHAs eligible to ≤65%. If a QIO chooses to work with any of these HHAs, each HHA will be evaluated in a similar fashion as those HHAs considered high performers in the states required to submit a strategic plan for reducing acute care hospitalization. The remeasurement period will be approximately November 2007 (based on clinical measures September 2006 to August 2007 OBQI roll-up report data). The criteria for inclusion of HHAs in the statewide pool shall be equal to the criteria for IPG eligibility (open as necessary and/or appropriate. iiof June 1, 2005, non-pediatric, 10 episodes or greater at baseline and February 2005). Set HHAs that do not meet these criteria will not be included in the statewide targets pool at evaluation. For evaluation purposes, the Clinical IPG outcome results will be included in the statewide evaluation. If the performance through August 2005 for the QIO’s state/jurisdiction for statewide work or each individual HHA for IPG work is ≥90% for any OASIS publicly reported measure (at except for Improvement in Status of Surgical Wounds or Acute Care Hospitalization), the QIO shall select to work on a minimumdifferent measure. The statewide rates are the unweighted average of agency risk-adjusted rates. If the statewide rate for the acute care hospitalization measure is ≤25.0% through August 2005 (based on data from May 2004–April 2005 OBQI roll-up report), the QIO shall submit a strategic plan for the acute care hospitalization measure that details the QIO’s work statewide and with the Clinical Performance IPG. The QIO’s strategic plan shall describe: (1) high-risk pressure ulcers a strategy for decreasing both the statewide and physical restraintsIPG acute care hospitalization rates, and (2) the QIO’s statewide and IPG target RFRs. The QIO, its Project Officer, and the Task 1b GTL shall agree on the plan’s content and implementation by the deliverable due date. The QIO shall submit its CMS-approved strategic plan to its Project Officer and the Task 1b GTL in accordance with Section F – QIO Schedule of Deliverables. The QIO’s strategic plan will replace the contract requirements and evaluation criteria for the acute care hospitalization components of Task 1b. All other contract requirements and evaluation criteria shall apply as written in this SOW. For extra credit, the QIO may elect to work with HHAs in the state/jurisdiction to set quality improvement target rates for Acute Care Hospitalization and other OASIS publicly reported measures. If the QIO elects to pursue this extra credit, the QIO shall instruct HHAs on target setting to promote quality improvement. Although HHAs may set targets for any of the publicly reported measures, for purposes of QIO evaluation, targets must be set annually by the home health agency on both the Acute Care Hospitalization measure and one additional measure. The additional measure is the statewide measure for all non-Clinical IPG agencies. The additional measure is the HHA- selected measure for all Clinical IPG HHAs. Extra Insurance Clinical IPGs must set targets on Acute Care Hospitalization and either their agency-selected measure or the statewide measure. The QIO shall work to have the HHA document the its targets set by submitting them via the HH STAR interactive website, which will then transmit this information via the appropriate SDPS application according to Section F – QIO Schedule of Deliverables. iii. Assist nursing homes throughout the state/jurisdiction to help them set targets at least annually for (at a minimum) pressure ulcers among high-risk residents and physical restraints. The QIO shall document the targets set by assisting the nursing homes in submitting this information via the STAR interactive website, which will then transmit this information via the appropriate SDPS application according to Section F – QIO Schedule of Deliverables. Nursing homes participating with the QIO as identified participants are expected to set targets at least annually for high risk pressure ulcers and physical restraints. The Nursing Home QIOSC will make available an interactive website that allows the QIO and nursing homes to set targets as well as providing resources for setting targets. Nursing homes may set any target (including below, above, or at the nursing home’s current rate) for the publicly reported quality measures. iv. (Optionally) Assist a subset of nursing homes in the state/jurisdiction (can overlap in whole or in part with the identified participant group) to document their processes of care for 50% of new admissions (up to a maximum of 25 admissions per month) related to: • skin inspection and pressure ulcer risk assessment; • depression screening and treatment; • evaluation of the necessity for and alternatives to the use of physical restraints; and • pain assessment and treatment. The minimum numbers of nursing homes that must transmit process improvement data in order for the QIO to receive credit for this optional activity are defined by the number of nursing homes in the state/jurisdiction: Number of Nursing Homes in State/Jurisdiction Minimum Number of Nursing Homes Transmitting Process of Care Data for QIO To Receive Credit up to 30 5 31–150 8 151–300 15 301–500 25 more than 500 40 This information shall be transmitted monthly for at least 10 (not necessarily consecutive) months between January 2006 and September 2007 to the QIO Clinical Data Warehouse. The data transmitted to the QIO Clinical Data Warehouse will be available only to the QIO community. These data will be collected using the Nursing Home Improvement Feedback Tool (NHIFT) or a private tool that conforms to the same data specifications. NHIFT will be made available free of cost to all nursing homes beginning in October 2005. Training for the QIOs will begin in October 2005. Monthly reporting will begin in January 2006. b) With the IPGs (IPG1 and IPG2), the QIO shall help its identified participants: i. (IPG1 only) Significantly improve the clinical quality of the care provided to their nursing home residents in the areas of pressure ulcers among high-risk residents, physical restraints, management of depressive symptoms, and management of pain. (IPG2 only) Significantly improve the clinical quality of the care provided to their nursing home residents in the areas of physical restraints and pressure ulcers among high risk residents. ii. (IPG1 and IPG2) Collect and monitor resident and staff experience of care/satisfaction. Resident and staff experience of care/ satisfaction surveys must be conducted at least annually. Resident experience of care shall be collected only for persons capable of responding on their own behalf. The Nursing Home QIOSC will provide a list of acceptable resident and staff experience of care/satisfaction tools. For the QIO to successfully meet this requirement, at least 90% of all identified participants must complete three annual resident and staff surveys during the course of the SOW. The QIO shall submit each nursing home’s baseline, interim, and final remeasurement rates as well as indicate which tool the nursing home has selected for use according to Section F – QIO Schedule of Deliverables; and iii. (IPG1 and IPG2) Collect and monitor employee turnover. The turnover rate for a given facility will be based on Certified Nursing Assistants/Aides (CNAs) no longer employed by the facility over the course of a 12 month period. For the QIO to successfully meet this requirement, at least 90% of all identified participants must report the CNA turnover rate at baseline, interim, and remeasurement. For the baseline, this 12 month period will be from January 1, 2005 – December 31, 2005. For the interim (second reporting period), the 12 month period will be from December 1, 2005 – November 30, 2006. For the final (remeasurement) reporting period, this 12 month period will be from September 1, 2006 – August 31, 2007. The QIO shall submit the information needed to calculate CNA turnover rate according to Section F – QIO Schedule of Deliverables. The information needed to calculate CNA turnover rate will be calculated in accordance with CMS instructions. c) In selecting IPG1, the QIO shall meet the following criteria: i. The QIO shall select IPG1 identified participants based on the number of nursing homes in the state/jurisdiction, as indicated in the following chart. >300 10% of nursing homes in the state/jurisdiction 15% of nursing homes in the state/jurisdiction ii. CMS will utilize SAS mapping software to ensure that IPG1 identified participants are distributed across the state/jurisdiction, including any rural areas in which nursing homes are located. Feedback will be provided to the QIO prior to the date that the QIO must submit its list of IPG1 identified participants. The QIO’s list of IPG1 identified participants must be approved by its Project Officer and the Task 1a GTL. iii. The QIO shall work with its state/jurisdiction partners, specifically the State Survey Agency and local stakeholder organization(s), in its selection of IPG1 identified participants. However, the confidentiality of IPG1 identified participants will remain preserved unless the provider chooses to disclose its work with the QIO. d) In selecting IPG2, the QIO shall meet the following criteria: The QIO shall work with the State Survey Agency to identify persistently poor performing nursing homes in the state/jurisdiction. CMS encourages the QIO to work with as many of these poor performing nursing homes as possible. The QIO must select its IPG2 to meet the minimum number of IPG2 identified participants indicated in the following chart. IPG2 identified participants shall not overlap with IPG1 identified participants. e) The QIO shall submit the following in accordance with Section F – QIO Schedule of Deliverables: • . The QIO shall work with HHAs to set targets at least annually for the aforementioned OASIS measures. Targets are to be documented by HHAs via the HH STAR website twice during the SOW. The first annual target setting period ends October 31, 2006. The second annual target setting period begins November 1, 2006, and ends October 31, 2007. The Home Health QIOSC will make available the HH STAR interactive website that allows the QIO and HHAs to set targets as well as provide resources for setting targets. As the HH STAR website was not available at the beginning of the SOW contract, some HHAs have already set targets and submitted documented target information to the QIO. In these instances where HHAs have documented and submitted targets to the QIO before the HH STAR website was available, the QIO may enter HHA targets (those targets selected and documented by the HHA) into the HH STAR website for the first target setting period (ending October 31, 2006). For the second target setting period (November 1, 2006 – October 31, 2007) the QIO must work with the HHA to enter its own targets into the HH STAR website. The QIO may assist HHAs as needed to enter HH STAR targets. HHAs may set any target rate (including below, above, or at the HHA’s current rate) for the OASIS publicly reported measures. An HHA may choose to change their target rates. This will not affect the QIO evaluation as the QIO is evaluated on the act of setting by the HHA. Plans of Action are not required for target setting. The QIO is not required to work with the HHAs to set quality improvement target rates in this SOW. This is an extra credit activity. For target setting extra credit, 50 percent of the QIO’s total IPGs (Clinical Performance and Systems Improvement Organizational Culture Change) must set targets annually (twice during the SOW). It is not specified which percentage of targets are required from each IPG. The 50 percent will be measured as 50 percent of the total IPG during the first target setting period (ending October 31, 2006) and 50 percent of the total IPG during the second target setting period (November 1, 2006 – October 31, 2007). Different HHAs may set targets in each annual target setting period to count toward the 50 percent. The evaluation will be based upon 50 percent target setting in each of the annual target setting periods. In addition to the requirement that 50 percent of the IPGs set targets, 25 percent of non- IPG HHAs must set targets in each annual target setting period for a list of IPG1 and IPG2 QIO to receive extra credit points. Different HHAs may set targets in each annual target setting period to count toward the 25 percent. For target setting, non-IPG HHAs are defined as HHAs in the statewide pool at baseline that are not chosen as identified participants; • notification as to whether . HHAs not included in the statewide pool at baseline are not eligible for extra credit target setting, although the QIO elects is encouraged to have a subset work with these HHAs as resources permit. At the statewide level, the QIO shall work to incorporate influenza and pneumococcal immunization into the HHA comprehensive patient assessment. The QIO shall conduct baseline and remeasurement surveys, using the CMS survey tool, of the nursing homes all HHAs in the its state/jurisdiction submit process (excluding pediatric agencies and HHAs with fewer than 10 episodes of care) to determine their immunization practices. The QIO shall use the same CMS survey tool for baseline and remeasurement. HHAs that are non-pediatric agencies with 10 or more episodes of care data on a monthly basis and which nursing homes have committed to doing so. Clinical Performance Measure Results (based on publicly reported nursing home quality measures) Pressure Ulcers among High- Risk Residents data from March 2004–February 2005 OBQI roll-up report and that are open in PRS as of June 1, 2005, will be included in the baseline and remeasurement survey. The Project Officer will evaluate performance based on the activity to promote statewide clinical quality. If baseline is <10.5%: QIO shall achieve a relative improvement minimum 50% response rate >15% If (percent completing surveys) from the HHAs within its state/jurisdiction. The QIO shall submit the baseline is 10.5% to 15%: and remeasurement survey results in accordance with Section F – QIO Schedule of Deliverables. The QIO shall achieve a relative 50% improvement rate >25(i.e., a 50% If baseline is >15%: achieve a relative improvement rate >35% 10% relative improvement increase in the number of HHAs offering immunizations assessment) from baseline to remeasurement, or achieve 80% statewide performance. The remeasurement Physical Restraints If is based on all HHAs initially available to be surveyed, not just those completing the baseline is <4%: achieve survey. The surveys measure the percent of HHAs that have incorporated influenza and pneumococcal immunizations into their comprehensive patient assessment, including offering these vaccinations (or aligning themselves to a relative improvement rate >15% 10% relative improvement from baseline vaccination source such as a physician practice or health department) as well as providing follow-up activities that include verifying patients have received vaccinations. HHAs that are not able to remeasurement If baseline is 4% provide vaccinations shall demonstrate sufficient evidence of partnering. With the Clinical Performance IPG, the QIO shall work to 10%: achieve meet or exceed the targeted RFRs for Acute Care Hospitalization and one additional publicly reported measure selected by the HHA (excluding Emergent Care) by utilizing the OBQI process. The use of the OBQI process does require the creation of a relative improvement rate >35% If baseline is >10%: achieve Plan of Action (POA). The QIO may work with the HHA to document the POA on the POA Tool (on the ▇▇▇.▇▇▇▇▇▇.▇▇▇ website) or as a relative improvement rate >60% Management of Depressive Symptoms If baseline is <10%: achieve a relative improvement rate >30% If baseline is >10%: achieve a relative improvement rate >40% Management of Pain In If baseline is <5%: achieve a relative Chronic hardcopy (Long Staypaper) Residents improvement rate >25% If baseline is 5% POA. The QIO may work with the HHA to 8%: achieve a relative improvement rate >35% If baseline is >8%: achieve a relative improvement rate >50% Process Improvement (Extra Credit) Process Change Implementati on A subset of nursing homes in submit the state/jurisdiction submit monthly data POA to the QIO Data Warehouse on at least one in person, electronically, via fax, or via postal mail. The QIO shall have a copy (electronic or paper) of the following topics POA for 50% all Clinical Performance IPG HHAs. As the POA is an evolutionary document for an HHA, the POA does not need to be completed by the February 1, 2006, deliverable date for POA entry into PARTner. The QIO shall work to implement all POAs (Acute Care Hospitalization and the other publicly reported measure, excluding Emergent Care) with the HHA between May, 1, 2005, and February 1, 2006. The implementation date shall be documented in accordance with Section F – QIO Schedule of new admissions Deliverables. With a Systems Improvement and Organizational Culture Change IPG, the QIO shall: i. Implement and/or utilize telehealth as a tool to help reduce Acute Care Hospitalization. Telehealth as defined for this SOW in the home health setting will include both types: phone monitoring (up to a maximum planned telephone interactions with patients/caregivers) and telemonitoring (use of 25 admissions per month) for 10 out of 21 months: (1) skin inspection telemonitoring equipment and pressure ulcer risk assessment; (2) depression screening and treatment; (3) evaluation technology). It would be expected that QIOs would predominantly work with HHAs that have not previously implemented telehealth. However, some HHAs that have implemented telehealth may benefit from the assistance of the necessity QIO to assure that telehealth is used as an effective tool to reduce avoidable hospitalizations. Therefore, a QIO may work with HHAs that have previously implemented telehealth. All Systems Improvement Organizational Culture Change IPG HHAs must follow the Home Telehealth Guidelines. The HH QIOSC has supplied the QIO and Home Health Community with the Telehealth Reference Manual 2005 (found at ▇▇▇.▇▇▇▇▇▇.▇▇▇). This manual is a tool to assist HHAs and the QIO in understanding, implementing, and evaluating telehealth use at the individual HHA level. The QIO is encouraged to educate HHAs on Home Telehealth using the Home Telehealth Reference Manual 2005. The QIO shall be evaluated on the implementation and/or utilization of telehealth to reduce avoidable hospitalizations per the Home Health Guidelines. Home Telehealth Guidelines for and alternatives this SOW are as follows: An HHA must select to use phone monitoring and/or telemonitoring as the type of telehealth. The focus of home telehealth for this SOW will be to use telehealth as a practice tool to reduce avoidable hospitalizations. The use of physical restraints; and phone monitoring and/or telemonitoring will be documented on the individual patient care plan at the HHA level. Use of telehealth tools will also require that the HHA identify the patient population that will be targeted for home telehealth (4) pain assessment and treatment Organization al Culture Change Target Setting At least 25% e.g., a disease-specific group of nursing homes in the state/jurisdiction must set targets for the clinical measures for (at a minimum) pressure ulcers among patients, patients that are high-risk for re-hospitalization, patients that have a certain characteristic such as ≥9 medications, etc.). All IPG1 identified participants must set targets HHAs currently conduct teletriage activities by triaging incoming patient calls. The QIO shall work with Systems Improvement and Organizational Culture Change IPG to refine their teletriage processes (with phone monitoring or telemonitoring). Refinement of teletriage may include specific agency processes for triaging calls, both during business hours and after hours, and implementation of a monitoring system to monitor teletriage processes. An HHA may change the type of telehealth during this contract period. This would include changing from phone monitoring to telemonitoring, from telemonitoring to phone monitoring, or changing the patient population at risk. The QIO shall document the type of telehealth and patient population in accordance with Section F – Schedule of Deliverables, but will not be required to document any changes in the type of telehealth or patient population for changes made by the Systems Improvement and Organizational Culture Change IPG. Telehealth implementation and/or utilization by the Systems Improvement and Organizational Culture Change IPG in this SOW are for the clinical measures purpose of reducing avoidable hospitalizations. The Systems Improvement and Organizational Culture Change IPG will be included in the statewide evaluation for (at a minimum) pressure ulcers among high-risk residents and physical restraints All IPG2 identified participants must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk residents and physical restraints The QIO sets statewide targets for (at a minimum) pressure ulcers among high-risk residents and physical restraints residents and physical restraints Data Collection on Experience of Acute Care >90% of all identified participants collect data on and monitor resident satisfaction/experience of care annually for three years; and >90% of all identified participants collect data on and monitor staff satisfaction/experience of care annually for three years >90% of all identified participants collect and monitor total number of CNAs employed and total number of CNA terminations on an annual basis >90% of all identified participants collect data on and monitor resident satisfaction/experi ence of care annually for three years; and >90% of all identified participants collect data on and monitor staff satisfaction/experi ence of care annually for three years >90% of all identified participants collect and monitor total number of CNAs employed and total number of CNA terminations on an annual basisHos

Task Description. The requirements in Task 1 of this SOW are designed to improve quality of care with respect to preventing clinical disorders and directing the treatment of clinical disorders. Any facts, opinions, or other types of information obtained initially or in follow-up requests from individuals or other entities within the care delivery system are in connection with these improvements in quality of care. In accordance with 5 CFR 1320.3(h)(5), these information collection activities are not subject to the Paperwork Reduction Act and, therefore, do not have to be submitted to the Office of Management and Budget (OMB) for clearance. Note that this does not exempt QIO information collection activities from the Quality Improvement Program’s internal policies and procedures related to information collection, which are described in Sections 12600-12670 of the QIO Manual. This also means that, as described in the QIO Manual, a ▇▇▇'s proposed information collection activities continue to require timely submission to the QIO's Project Officer/Division of Quality Improvement for review and approval. The QIO shall update on a quarterly basis the documentation of PARTner activity codes as defined by CMS for its work in meeting the requirements of Task 1a 1c1 in this SOW. The clinical performance measures will be based on the publicly reported enhanced quality measures available on Nursing Home Compare (▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/nhcompare/home.asp). The baseline rate for high-risk pressure ulcers, physical restraints, and management of pain in chronic (long stay) residents will be based on data from the second quarter of calendar year 2004. For the management of depressive symptoms measure, the baseline rate will be the highest rate achieved from the second quarter of calendar year 2004 through the second quarter of calendar year 2006. Remeasurement data for all clinical performance measures will be the most recently reported quarterly data available at approximately November 2007. Detailed specifications for the calculation of the Publicly Reported Nursing Home Quality Measures are available at ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇▇▇/▇▇▇▇.▇▇▇. In addition to the general requirements for Task 1, the QIO shall conduct the following activities consistent with Exhibit 1a: Nursing Homeactivities: a) At Statewide i. Clinical Performance Measurement Reporting: The QIO shall work with PPS hospitals statewide to achieve a 25% participation rate for hospitals reporting data on the statewide levelexpanded set of measures shown in Table 1: Full Hospital Measure Set. In addition, the QIO shall provide assistance to all PPS and CAH hospitals to improve the validity, timeliness, and completeness of data submitted to the QIO Clinical Data Warehouse. The QIO shall work to achieve a 95% passing rate for chart validation for the full hospital measure set shown in Table 1 (i.e., 95% of hospitals submitting data to the QIO Clinical Data Warehouse, must achieve ≥80% match of data elements on the re-abstracted charts, or minus 1 if fewer than 20 hospitals in the state) for the last two quarters prior to approximately November 2007. This validation criterion only applies to PPS hospitals. The confidence interval applied to validation for the purposes of the Annual Payment Update will not be used in the evaluation of performance of this contract. The QIO shall:: • Facilitate hospitals’ use of the CMS Abstraction and Reporting Tool (CART) by providing technical support and assistance; • Encourage voluntary participation under the HQA in reporting on the additional measures; • Manage the interface between the hospitals and QualityNet Exchange through the Provider Reporting System (PRS) by keeping the data on the status of hospitals current; and • Under CMS direction, support hospitals in their efforts to comply with the Hospital Consumer Assessment of Health Plans Survey (HCAHPS) if it is incorporated into the HQA. i. Work ii. Clinical Performance Results: The QIO shall work with nursing homes hospitals and stakeholders to promote quality improvement on the clinical measuresAppropriate Care Measure (ACM) and SCIP measure. The QIO shall, if requested, provide assistance to nursing homes on clinical measures as necessary and/or appropriate. ii. Set statewide targets for (at If requested by a minimum) high-risk pressure ulcers and physical restraints. The QIO shall document the targets set by submitting them via the STAR interactive website, which will then transmit this information via the appropriate SDPS application according to Section F – QIO Schedule of Deliverables. iii. Assist nursing homes throughout the state/jurisdiction to help them set targets at least annually for (at a minimum) pressure ulcers among high-risk residents and physical restraints. The QIO shall document the targets set by assisting the nursing homes in submitting this information via the STAR interactive website, which will then transmit this information via the appropriate SDPS application according to Section F – QIO Schedule of Deliverables. Nursing homes participating with the QIO as identified participants are expected to set targets at least annually for high risk pressure ulcers and physical restraints. The Nursing Home QIOSC will make available an interactive website that allows the QIO and nursing homes to set targets as well as providing resources for setting targets. Nursing homes may set any target (including below, above, or at the nursing home’s current rate) for the publicly reported quality measures. iv. (Optionally) Assist a subset of nursing homes in the state/jurisdiction (can overlap in whole or in part with the identified participant group) to document their processes of care for 50% of new admissions (up to a maximum of 25 admissions per month) related to: • skin inspection and pressure ulcer risk assessment; • depression screening and treatment; • evaluation of the necessity for and alternatives to the use of physical restraints; and • pain assessment and treatment. The minimum numbers of nursing homes that must transmit process improvement data in order for the QIO to receive credit for this optional activity are defined by the number of nursing homes in the state/jurisdiction: Number of Nursing Homes in State/Jurisdiction Minimum Number of Nursing Homes Transmitting Process of Care Data for QIO To Receive Credit up to 30 5 31–150 8 151–300 15 301–500 25 more than 500 40 This information shall be transmitted monthly for at least 10 (not necessarily consecutive) months between January 2006 and September 2007 to the QIO Clinical Data Warehouse. The data transmitted to the QIO Clinical Data Warehouse will be available only to the QIO community. These data will be collected using the Nursing Home Improvement Feedback Tool (NHIFT) or a private tool that conforms to the same data specifications. NHIFT will be made available free of cost to all nursing homes beginning in October 2005. Training for the QIOs will begin in October 2005. Monthly reporting will begin in January 2006. b) With the IPGs (IPG1 and IPG2), the QIO shall help its identified participants: i. (IPG1 only) Significantly improve the clinical quality of the care provided to their nursing home residents in the areas of pressure ulcers among high-risk residents, physical restraints, management of depressive symptoms, and management of pain. (IPG2 only) Significantly improve the clinical quality of the care provided to their nursing home residents in the areas of physical restraints and pressure ulcers among high risk residents. ii. (IPG1 and IPG2) Collect and monitor resident and staff experience of care/satisfaction. Resident and staff experience of care/ satisfaction surveys must be conducted at least annually. Resident experience of care shall be collected only for persons capable of responding on their own behalf. The Nursing Home QIOSC will provide a list of acceptable resident and staff experience of care/satisfaction tools. For the QIO to successfully meet this requirement, at least 90% of all identified participants must complete three annual resident and staff surveys during the course of the SOW. The QIO shall submit each nursing home’s baseline, interim, and final remeasurement rates as well as indicate which tool the nursing home has selected for use according to Section F – QIO Schedule of Deliverables; and iii. (IPG1 and IPG2) Collect and monitor employee turnover. The turnover rate for a given facility will be based on Certified Nursing Assistants/Aides (CNAs) no longer employed by the facility over the course of a 12 month period. For the QIO to successfully meet this requirement, at least 90% of all identified participants must report the CNA turnover rate at baseline, interim, and remeasurement. For the baseline, this 12 month period will be from January 1, 2005 – December 31, 2005. For the interim (second reporting period), the 12 month period will be from December 1, 2005 – November 30, 2006. For the final (remeasurement) reporting period, this 12 month period will be from September 1, 2006 – August 31, 2007. The QIO shall submit the information needed to calculate CNA turnover rate according to Section F – QIO Schedule of Deliverables. The information needed to calculate CNA turnover rate will be calculated in accordance with CMS instructions. c) In selecting IPG1, the QIO shall meet the following criteria: i. The QIO shall select IPG1 identified participants based on the number of nursing homes hospital in the state/jurisdiction, as indicated in the following chart. >300 10% of nursing homes in the state/jurisdiction 15% of nursing homes in the state/jurisdiction ii. CMS will utilize SAS mapping software to ensure that IPG1 identified participants are distributed across the state/jurisdiction, including any rural areas in which nursing homes are located. Feedback will be provided to the QIO prior to the date that the QIO must submit its list of IPG1 identified participants. The QIO’s list of IPG1 identified participants must be approved by its Project Officer and the Task 1a GTL. iii. The QIO shall work with its state/jurisdiction partners, specifically the State Survey Agency and local stakeholder organization(s), in its selection of IPG1 identified participants. However, the confidentiality of IPG1 identified participants will remain preserved unless the provider chooses to disclose its work with the QIO. d) In selecting IPG2, the QIO shall meet provide assistance on improving the following criteria: The QIO shall work with the State Survey Agency to identify persistently poor performing nursing homes in the state/jurisdiction. CMS encourages the QIO to work with as many of these poor performing nursing homes as possible. The QIO must select its IPG2 to meet the minimum number of IPG2 identified participants indicated in the following chart. IPG2 identified participants shall not overlap with IPG1 identified participantsAppropriate Care Measure (ACM) and SCIP measures. eb) The QIO shall submit the following in accordance with Section F – QIO Schedule of Deliverables: • a list of IPG1 and IPG2 identified participants; • notification as to whether the QIO elects to have a subset of the nursing homes in the state/jurisdiction submit process of care data on a monthly basis and which nursing homes have committed to doing so. Clinical Performance Measure Results (based on publicly reported nursing home quality measures) Pressure Ulcers among High- Risk Residents The Project Officer will evaluate performance based on the activity to promote statewide clinical quality. If baseline is <10.5%: achieve a relative improvement rate >15% If baseline is 10.5% to 15%: achieve a relative improvement rate >25% If baseline is >15%: achieve a relative improvement rate >35% 10% relative improvement from baseline to remeasurement Physical Restraints If baseline is <4%: achieve a relative improvement rate >15% 10% relative improvement from baseline to remeasurement If baseline is 4% to 10%: achieve a relative improvement rate >35% If baseline is >10%: achieve a relative improvement rate >60% Management of Depressive Symptoms If baseline is <10%: achieve a relative improvement rate >30% If baseline is >10%: achieve a relative improvement rate >40% Management of Pain In If baseline is <5%: achieve a relative Chronic (Long Stay) Residents improvement rate >25% If baseline is 5% to 8%: achieve a relative improvement rate >35% If baseline is >8%: achieve a relative improvement rate >50% Process Improvement (Extra Credit) Process Change Implementati on A subset of nursing homes in the state/jurisdiction submit monthly data to the QIO Data Warehouse on at least one of the following topics for 50% of new admissions (up to a maximum of 25 admissions per month) for 10 out of 21 months: (1) skin inspection and pressure ulcer risk assessment; (2) depression screening and treatment; (3) evaluation of the necessity for and alternatives to the use of physical restraints; and (4) pain assessment and treatment Organization al Culture Change Target Setting At least 25% of nursing homes in the state/jurisdiction must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk All IPG1 identified participants must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk residents and physical restraints All IPG2 identified participants must set targets for the clinical measures for (at a minimum) pressure ulcers among high-risk residents and physical restraints The QIO sets statewide targets for (at a minimum) pressure ulcers among high-risk residents and physical restraints residents and physical restraints Data Collection on Experience of Care >90% of all identified participants collect data on and monitor resident satisfaction/experience of care annually for three years; and >90% of all identified participants collect data on and monitor staff satisfaction/experience of care annually for three years >90% of all identified participants collect and monitor total number of CNAs employed and total number of CNA terminations on an annual basis >90% of all identified participants collect data on and monitor resident satisfaction/experi ence of care annually for three years; and >90% of all identified participants collect data on and monitor staff satisfaction/experi ence of care annually for three years >90% of all identified participants collect and monitor total number of CNAs employed and total number of CNA terminations on an annual basisIdentified Participants