In order to assure Georgians of the state's commitment to protect consumers and preserve fiscal accountability of public funds by contractors in the provision of services, the following recommendations are made for consideration:

1. Consumer Safety and Protection

1. The Department will set forth standards for inspection of all residential sites paid for by providers contracted through the regional boards, and the Office of Regulatory Services will implement inspections and certification provision.
2. All providers of services receiving $250,000 or more in contracts from the regional boards are required to obtain accreditation by a national accrediting bodies which include the Joint Commission on Accreditation of Healthcare Organizations, Commission on Accreditation of Rehabilitation Facilities, Council on Quality and Leadership in Supports for People with Disabilities and Council on Accreditation of Services for Families and Children by July 1, 1999. Providers who receive less than $250,000 will be certified by the Department.
3. By February 1, 1999, a statewide policy requirement for reporting of all deaths to regional boards and Division will be implemented and questionable or unusual deaths will be reviewed.
4. Redirected mental health, mental retardation and substance abuse funds will be used to establish a statewide investigation capacity within the division and in each region. This will permit prompt review of questionable deaths and serious or unusual incidents. Training in conducting investigations and risk management for contracted providers will be created and delivered in order to develop and strengthen agency internal review processes. Some funds for this initiative have been requested as a part of the FY 2000 Budget. Additional funds will need to be identified.

1. Consumer Quality of Care

1. An external utilization management system will be implemented that will sample clinical records to:

1. Validate an appropriate match of consumer to the services provided;
2. Validate services provided are in compliance with standards; and
3. Validate that services provided match service billing and provide for a mechanism for payback to the Department of Medical Assistance of identified exceptions will be implemented beginning July 1, 1999.

1. A Consumer Quality Services Unit will be established within the Division to implement a system-wide continuous quality improvement policy by July 1, 1999. The unit in partnership with the regions will:

1. Conduct on a random basis a provider performance evaluation review that focuses on consumer outcomes, the quality of clinical processes and adequacy of the clinical record;
2. Assist regions in designing performance measures to be included in provider contracts and in analyzing the performance data; and,
3. Working in partnership with the regions, conduct focus management and system reviews to identify problems and resolution.

1. A consumer/family approach to monitoring to assure quality of care and consumer satisfaction will be required by the Division of each region by July 1, 1999.
2. To improve the quality of services and to assure professional standards are maintained, the Department's contract with providers will require licensed professional staff to conduct diagnostic assessments, grant agency service authorizations and provide clinical/programmatic supervision beginning July 1, 1999.
3. The Division will implement the collection and tracking of statewide performance measures for each disability that have been established to measure consumers service outcome, consumers' access to care, the acceptability of services delivered and the value of the services provided.
4. The Department will include in FY 2000 provider contracts a requirement that calls for the development and implementation of corrective action plans as a result of any Department reviews, inspections, evaluations or monitoring activities. If upon reinspection it is found that the provider is still out of compliance, the Department will impose financial and/or contract sanctions.

1. Fiscal Accountability

1. The Division will establish a cap on administrative cost within its contracts with all providers and will limit the amount of state and federal funds that may be used toward the compensation of directors of provider organizations.
2. The Department has sought the Attorney General's opinion and, upon receipt of the advice, if appropriate the Division will place contractual restrictions that clearly state that public funds will not be used to compete with private providers in the provision of services not otherwise purchased by the state through the regional boards; contracts with the provider.
3. By July 1, 1999, begin to phase in the implementation of performance-based contracts and payment systems as opposed to the current expense reimbursement contracting system.
4. Proceed in working with DMA in order for DHR to manage all public funds expended by community service boards (state funds and Medicaid funds) by July 1, 1999. This action also removes the current community service board monopoly under the clinic option for Medicaid funds.
5. To initiate greater competition and contingent on the two previous items, the Division will take the necessary steps to begin to include more private providers under contract to gain greater efficiency and effectiveness of programs.