Medicaid Managed Care - U.S. Senate Special Committee on Aging

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of persons who can observe and identify problems in service quality and
notify appropriate officials when there are deficiencies.
Because program quality depends on the active participation of recipients,
families, and service providers, states are also providing substantial
trsin nr to these groups to encourage a-id s-trengther. their participation
Training can include informing recipients and families of available service
providers, procedures for providing feedback about services, and steps to
take if quality is not improved Training for service providers may focus on
reinforcing the fact that the recipient and family have the right to make
choices about services and that staff must be responsive to those choices
unless they are inappropriate for safety concerns or for other compelling
reasons, such as available financial resources.
States are also modifying how they monitor quality. Traditionally, they
emphasized compliance with certain criteria, such as maintaining a
minimum level of staff resources and implementing standard care
processes. Some states are focusing their quality monitoring more on
outcome measures for each individual while still assessing providers'
compliance with program standards. For example, states, including the
three we visited, are trying to determine whether the recipients are living
where and with whom they chose, whether they are safe in this
environment, and whether they are satisfied with their environment and
the services they receive.
States are also attempting to make their oversight less intrusive for the
recipients. For example, some states use trained volunteers to interview
recipients at their homes on a periodic basis to check the quality of
services received In other instances, although case managers are required
to meet recipients on a regular basis, meetings can be arranged at the
recipient's convenience, including in the evening or on weekends or at a
place the recipient likes to meet at, such as at his or her home or local
park or library. Case managers talk with the recipients and their families
about the quality of the services they receive and take any actions
necessary to correct deficiencies.
Some Recipients May Face While officials in the three states we visited and other experts agree that
Avoidable Risks Until many persons prefer services provided at home to services provided in
States More Fully Develop institutions or other group settings, they also note that providing services
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