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Quality Services Review (QSR)

The Developmental Disability Services Division (DDSD) Quality Services Review (QSR) is intended to meet the Department of Disabilities, Aging, and Independent Living's (DAIL's) commitment to the State of Vermont and the Centers for Medicare and Medicaid Services (CMS) to monitor and review the quality of services provided using Federal and State home and community-based services (HCBS) funding.  The purpose of the QSR is to ascertain the quality of the services provided by the Designated Agencies and Specialized Services Agencies (DA/SSAs) and to ensure that minimum standards are met with the respect to DAIL and DDSD guidelines and policies for developmental disabilities services.  The QSR involves on-site reviews by DDSD Quality Management Reviewers to assess the quality of Medicaid-funded services.  Site visits are conducted every two years with follow-up as appropriate.

The QSR is based upon nine DDSD Outcomes.  These outcomes are evaluated based on the services provided to a sample of individual's receiving HCBS funding.  To the degree possible, the sample will be reflective of the spectrum of supports provided by the agency.

The QSR consists of a visit and conversation with each individual in the sample and their support team; a conversation with the person's guardian/family, where applicable; a review of the individual's agency file (including the individual's support plan), and a conversation with the individual's service coordinator.  The DDSD Nurse Surveyor also focuses specifically on how well the agency meets the medical requirements set out in the Health and Wellness Guidelines.

The QSR report is the formal mechanism for notifying the agency of the DDSD review team's findings.  The report consists of:

  • A summary of key service areas along with strengths and opportunities for improvement;
  • A table with specific "Examples of Positive Practice" and instances that do not meet the standard, thus requiring "Necessary Changes;"
  • Recommendations where applicable:
  • Areas in which the agency is expected to ensure some system improvements, identified as "Areas of Importance."

The agency has 45 days to respond with a plan of corrections to address any identified area of importance, necessary changes and opportunities for improvement.  The DDSD lead reviewer, nurse surveyor and other members of the team will review the plan and work with the agency to ensure all the identified areas are brought into compliance.

Quality Services Review Process from A to Z - a guide to coordinating a Review for Reviewers