Nebraska VR will conduct an intensive in-house and provider monitoring system that will ensure the delivery of quality services for clients. The system will include monitoring for compliance of agency regulations and for quality assurance. Monitoring will include the review of VR service delivery & a program review of all providers with contracts of $50,000 or more. VR will conduct a fiscal review on all contracts with the exception of “outcome based” agreements.

The Nebraska VR monitoring and quality assurance process outlines the internal staff responsibilities and the provider responsibilities. The responsibilities of the Program Director, the Office Director, the VR Specialist & the Fiscal Team apply to contracts & agreements as appropriate. The provider responsibilities apply to all programs as appropriate.

Training on Monitoring Policies for internal participating staff & providers will be conducted by the Program Director for Community Services and other designated staff.

VR Specialist (program liaison) role and responsibilities for Quality Service Delivery:

• Ensure all client participants meet eligibility criteria
• Ensure all participants in a supported employment (SE) program are a priority one (1), have a VR supported employment plan and enter the supported employment service in QE 2 plan services
• All Individual Plans for Employment (IPE), other than SE plans must include the appropriate goal, service for the program and enter service in QE 2
• Coordinate & monitor all referrals into the program
• Meet with the provider a minimum of once a month for client progress staffing(s)
• Ensure all QE2 data is up to date & accurate including all provider updates, progress, problems, employment information
• Approve stabilization based upon client, provider & employer information if in a Supported Employment Program
• Approve VR outcome based upon Client agreement (VR Client contact required), provider & employer information
• Ensure VR personal contact with client a minimum of every 90 days to review progress towards goal and to address issues
• Participate in a quarterly meeting and/or updates to review & to assess progress towards goal(s) with office director, provider administrator & direct service staff if appropriate.

Office Director responsibilities for Quality Service Delivery

• Review, approve and submit the quarterly provider outcomes report to the Fiscal Administrative Specialist and the Program Director for Community Services
• Attend the scheduled meetings of each provider if required
• Attend quarterly meetings to review and to assess progress towards goal(s) with liaison, provider administrator & provider direct service staff
• Submit a quarterly joint report with the liaison (VR specialist) outlining the number of client progress meetings, joint provider meetings and related activities to the Program Director of Community Services
• Perform case reviews on a 25% of successful client outcomes and 10% of unsuccessful clients in supported employment programs on a quarterly basis. Use Case Review Sheet for Supported Employment. Send copies of case review sheets to Program Director of Community Services no later than 60 days after the end of each quarter
• Case reviews will be conducted on all clients participating in other contracted skill training at the completion of program. Copies of case reviews will be sent to Program Director of Community Services no later than 60 days after the completion of the Program.

Program Director for Community Services responsibilities for Quality Service Delivery

• Review & monitor quarterly outcomes & submitted reports
• Attend quarterly provider meetings and/or meet with providers quarterly.
• Conduct random case reviews on consumers receiving services from non-supported employment vendors.
• Conduct annual Provider Program Review on all contracts over $50,000 to ensure outlined services provided to consumers. Use Provider Program Review sheet.
• Develop & conduct a quality improvement survey for VR specialists (liaisons) and provider staff
• Synthesize and analyze all collected information and data
• Develop a Provider Report on an annual basis
• Collaborate with Fiscal Administrator to develop the annual contracts with providers and/or develop any necessary corrective actions.

Fiscal Team

• Conducts fiscal program reviews
• Coordinates all contracts and agreements
• Ensures all contracts and agreements meet all VR rules & regulations
• Monitors and initiates all contract and agreement payments
• Collaborates with Program Director of Community Services on implementation of monitoring process and development of the provider reports.

Providers

• Providers will adhere to the Terms and Conditions of the contract.
• Providers will submit a quarterly performance report due 30 days after the end of each quarter.
• The report must be submitted to the designated VR representative (Office Director) for review and signature
• Providers (contractors) will submit a report on Program Effectiveness (Due 30 days after the end of the third (3rd) quarter to the Program Director for Community Services. Report includes consumer satisfaction survey, changes in the program as a result of consumer, partner and/or staff input and changes in process services or results over the last year that impacted services.
• Ensure staff communication with VR
• Ensure monthly progress meetings conducted
• Participate in a quarterly progress review meeting
• Participate in a program review if required
• Participate in a fiscal review if required

On Site Program Review

An onsite program review will be conducted on all providers with agreements over $50,000. A schedule and the quality assurance review will be communicated to the providers and to the VR participants during the first (1st) fiscal quarter of each contract year. The purpose of the onsite visit is to assess the progress of the programs in implementing grant activities and to verify the program activities are being implemented as reported. Client records will be examined using appropriate tools pertinent to the program. Outcome based contracts will not receive a fiscal review. Upon the completion of the onsite record review, an exit meeting will be held with providers and reviewers. Any finding that the provider does not agree with can be addressed. Provider staff and VR staff will participate in an online survey on service delivery prior to the onsite visit. A written report of the visit will be submitted to the provider within ten(10) days of the onsite visit.

Annual Provider Report

An annual provider report will be prepared for all contracts and agreements. The report will be based on information gathered from case reviews, fiscal reviews, onsite reviews and provider reports. The report will be submitted to the designated provider representative. The evaluation criteria may include:

Output/Workload

• Number of individuals served
• Number achieving successful outcome
• Number of hours working per week
• Wage
• Number of consumers who did not achieve a successful outcome
• Number of staff hours per service if applicable

Efficiency

• Cost per outcome (VR funded amount divided by the number of unduplicated successful outcomes)
• Cost per outcomes (based on the combination of all collaborating partner resources-the overall cost of the program divided by the number of the unduplicated successful outcomes)
• Timeliness of service (date of referral to date of completion of successful outcome)

Outcome/Effectiveness

• Percentage of individuals achieving a successful outcome compared to the number of closure, both successful and unsuccessful
• Percentage of earning equivalent to at least minimum wage
• Percentage of individuals earning at or above minimum wage
• Percentage of individuals earning at or above minimum wage as a ratio to the state's average hourly earnings
• Difference in percentage at application and at closure of those who said their wages were their primary source of support
• Consumer satisfaction
• Changes as a result of partner, staff or consumer input (include any report of consumer complaints and how they were resolved)
• Other changes in the process, services or results over the last year that have impacted on services

Corrective Action Plan:

If a corrective action plan is warranted, the report will identify issues to be remediated. The provider will have 30 days to develop a corrective action plan, submit to VR Management. VR will approve/disapprove within 30 days. The provider may ask for technical assistance from VR. VR Program Director & VR Office Director will monitor the progress of the plan. If provider does not make timely progress in resolving issues, VR management may terminate the provider’s contract and allocated funds may be returned to the state.

Termination of Contract/Service Agreement:

Nebraska VR will give a written notice of at least 30 days before terminating any contract with a provider, except where there is imminent danger to the health and the safety of consumers. The notice will contain grounds for the termination and allow for a reasonable time to remedy the problem.