Meet Our Newest Team Member!

Please help us give a warm welcome to our newest team member, Dave Branding, PhD!

With more than 40 years of administrative, executive leadership and board governance experience in a variety of health and human service organizations, integrated delivery systems and health plans, Dave has served as a provider, purchaser and funder. He specializes in achieving and maintaining accreditation, improving risk management practices and creating supportive accountability systems.

Working at CARF International for more than 12 years, Dave has led more than 120 accreditation surveys across 40 states and provinces as an administrative and program surveyor, team leader and report-writer for the Behavioral Health, Opioid Treatment Program, Employment and Community Support and Business and Services Management Network standard manuals. He also serves on CARF’s appeal and review boards.

In addition to administering several million dollars in grant funding, he has delivered dozens of conference program presentations and participated in more than 20 statewide and national policy and practice improvement initiatives.

Dave earned a Doctorate in Education and Master of Arts degree, along with a certificate in transition planning, from Southern Illinois University. He received a Bachelor of Science in Psychology from Central Michigan University.

We are thrilled to have Dave on our team!

Team Member Highlight – Carol Smith

Carol started her accreditation career in 1980 when she implemented a substance abuse outpatient and prevention program for the State of Michigan Office of Substance Abuse Services. For more than a year,
Carol prepared the agency for its first national accreditation survey and began implementing policies and procedures during a time when the behavioral health field lacked clearly defined standards. After
achieving accreditation, she became a consultant and specialized in helping agencies navigate the CARF and The Joint Commission accreditation processes.

Carol has an extensive career in the field of accreditation, specifically with CARF. She has been a CARF surveyor for 28 years and has served on several ISAC’s (International Standards Advisory Committee) to help revise and develop new standards. She has provided training on accreditation topics both to an international audience and to new CARF surveyors and is a content editor of survey reports, and serves on the CARF accreditation appeal board.

Carol spends free time with her husband, her pug, and two cats in northern Michigan. She enjoys walking on the beach, traveling, gardening, reading and spending time at her winter home in southeastern Florida.

We are happy to have Carol on the Accreditation Guru team!

The Advantages of Accreditation

Some human service agencies view accreditation as a luxury. Others see it as a hassle. Yet the benefits are undeniable.

Achieving national accreditation announces to the world that your organization strives to be the best it can be. That’s hard work, but the process sets you on the course for long-term greatness.

Attempting to cultivate a culture of excellence and reach lofty goals enhances your reputation, but accreditation also offers more practical benefits: it’s a reliable way to increase revenue and decrease costs, objectives that are valued by almost every human service agency.

Accreditation Requirements

Due to the advent of the Family First Prevention Services Act (FFPSA), many child welfare organizations that provide residential, out-of-home care and seek federal government funds are required to be accredited, a mandate that takes effect beginning in October of this year (though states have the option to delay the process for up to two years).

Several states also require that various types of service providers become accredited as a qualifying step toward earning their license or receiving higher reimbursement rates.

Culture of Excellence

Without question, accreditation signals to potential funders and clients that your organization adheres to high standards, internal cohesion and exemplary service delivery.

Other benefits include improved internal and external stakeholder communication and enriched staff training programs that, in part, lead to enhanced services to clients.

The results of a questionnaire sponsored by the Council on Accreditation affirm these assertions:

* 94 percent of respondents agree that the process “improves transparency and accountability”

* 86 percent contend that it “improved outcomes for the people they serve”

* 90 percent acknowledge that it “improved their quality of services”

Gaining accreditation from a prominent agency also demonstrates your commitment to reach beyond the minimum licensing standards and maintain strong management, program consistency, financial controls, outcome measurements and continuous improvement.

Financial Incentives and Quality Improvement

Beyond the cultural benefits to earning accreditation, there are more practical reasons to seek this distinction. According to The Joint Commission, a prominent accrediting agency, the accomplishment beefs up your bottom line by increasing reimbursement rates, in part by reducing paperwork preparation time.

Accreditation forces organizations to focus on quality improvement and measure outputs and outcomes of deliverables, which both funders and stakeholders are increasingly demanding.

Planning service offerings and maintaining meticulous documentation can attract additional recognition and funding sources from governments, foundations, grant makers and individual donors.

It also boosts referral volume. The Joint Commission contends that other positive outcomes include an increased “ability to work with a broad array of clients” that improves “an organization’s ability to participate in referral networks, thus potentially increasing the value of referrals.”

The Joint Commission further found that “payers want to work with organizations that provide high quality services, which helps elevate their brand” and pay public relations and marketing dividends.

Accreditation decreases risk due to the development of management plans, which in turn lowers liability and insurance costs. Data collection, an increased effectiveness of care and improved intake billing also streamline costs.

A recent study sponsored by CARF International, another accrediting body, compiled startling statistics demonstrating that CARF-accredited programs experienced a 26 percent increase in persons served annually, a 37 percent increase in conformance to quality standards and a 37 percent increase in annual budget dollars programs from before their first survey as compared to their latest survey.

Accreditation in Action™

“The accreditation and re-accreditation process helped us raise the bar for our staff and the population that we serve,” said Hughes Johnson, managing director of compliance and performance improvement at Memphis-based Youth Villages, which operates in 14 states across the country, shared his organization’s experiences with accreditation.

“It’s a tough process with a large number of standards, but it helped us develop a defined policy that holds us accountable.”

According to Elizabeth Carey, president and CEO at Starr Commonwealth, which offers programs for children and families in Albion, Michigan, her organization is dedicated to “performing at the highest levels for the children, families and communities we serve.” Therefore, “achieving and maintaining accreditation is a critical factor to ensuring high quality.”

The Payoff

Many human services agencies claim that they adhere to upholding high ethical and client service standards.

Far from being a chore, achieving accreditation has become a necessity for all human service organizations participating in today’s competitive environment. In addition to sending a definitive sign that quality and consistent professionalism permeate your organization’s culture, it offers tangible benefits that pay dividends every day.

For more information or for assistance with becoming nationally accredited, contact us at info@AccreditationGuru.com.

Are You Measuring Your Service Outcomes? You Should Be!

According to a recent study in the International Journal for Quality in Health Care, “what cannot be measured, cannot be improved.”

With detailed digital data available just a few clicks away, non-profits are being held accountable for measuring their service outcomes. In fact, all organizations seeking to gain and maintain accreditation are required to record and report outcome statistics as part of their performance improvement programs.

For example, while The Joint Commission has always required organizations to assess outcomes of care, treatment or services, organizations are now required to accomplish this through the use of a standardized tool or instrument.  By utilizing “measurement-based care,” The Joint Commission “believes these standards enhancements will help accredited customers meet the growing demand to demonstrate the value of their services and increase the quality of the care, treatment, or services they provide.”

For health and behavioral service providers, the focus on process – or fee-for-service arrangements – is obsolete: the new priority centers on positive patient results, which must be documented.

This approach rejects fee-for-service reimbursement, where “individual providers are incentivized to order more tests and procedures and manage more patients in order to get paid more, regardless of patient outcomes,” according to the New England Journal of Medicine.

Value- and performance-based models aim to rein in ballooning costs. The outcome-based orientation is partially designed to help lower spending.

Another broad goal is to improve care and help patients efficiently navigate the health care system. Collaboration and customized services are replacing the top-down model, where experts determine the procedures and patients follow along.

Many major insurance companies are reorienting their reimbursement schedule to reflect this data-driven model. According to national accrediting body CARF, Cigna, Aetna and U. S. Healthcare plan to increase value-based payments to as much as 90 percent of all reimbursement spending in the next few years.

Beyond private insurance companies, state and federal mandates are also pushing patient care toward outcome-based services.

The Centers for Medicare & Medicaid Services (CMS) has begun implementing value-based changes, for example. Under Section 223 of the federal Protecting Access to Medicare Act, moreover, the Substance Abuse and Mental Health Services Administration initiated a pilot program in eight states to introduce value-based outcomes in certified community behavioral health clinics.

The program includes technical specifications and data-reporting templates requiring the collection of 21 measurable data points.

Participating states are mandated to “collect and report on encounter, clinical outcomes, and quality improvement data,” according to CMS. “The statute also requires annual reporting by the states that will entail collection of data which can be used to assess the impact of the demonstration program.”

In addition, fee-for-service reimbursement is being replaced by the prospective payment system (PPS), which is based on the quality of care rather than services provided.

Another new initiative implemented by CMS, Bundled Payments for Care Improvement, links “payments for the multiple services beneficiaries receive during an episode of care.” Acute care hospitals, skilled nursing facilities, home health care agencies and inpatient rehabilitation facilities, “enter into payment arrangements that include financial and performance accountability for episodes of care.”

CARF reports that state regulators are also spurring the shift toward performance-based models and criteria by promoting prevention and methods that consider social determinants of heath.

“The future is undoubtedly in favor of providers that can implement strong performance management practices,” according to CARF. Agencies that reorient their practices in this new direction will be well-positioned to achieve and maintain accreditation status.

Contact Accreditation Guru to help put your organization on course to thrive in this brave new world of outcome-based measurement.

Time is Tight: Seek Accreditation Now for QRTPs [as Mandated by the Family First Prevention Services Act]

The new Family First Prevention Services Act (FFPSA) has generated many questions about the timing of when each state will decide to implement the regulations and, in turn, when the new category of residential settings called Qualified Residential Treatment Programs (QRTPs) are required to become nationally accredited. Accreditation for qualified residential treatment programs has thus become a hot topic for such centers.

FFPSA is changing the face of child welfare by authorizing federal dollars to support prevention services for children identified as being in “imminent risk” of entering foster care. It also shifts the focus from relying on congregate or group care settings to keeping children in family-like atmospheres – specifically foster family homes.

Under FFPSA, with limited exceptions, states will be able to dedicate federal Title IV-E funding for children’s care maintenance payments in a residential setting after the first two weeks of placement. Approved settings, including the new QRTPs, must use a trauma-informed treatment model and employ registered or licensed nursing staff and other licensed clinical staff who are onsite according to the treatment model and  available 24 hours a day and seven days a week.

The law institutes other requirements related to formal assessments of children that ensure the appropriateness of the placement, family engagement and aftercare support for at least six months post-discharge. For additional information, visit: http://www.ncsl.org/research/human-services/family-first-prevention-services-act-ffpsa.aspx

States’ Decisions – To Delay or Not Delay?

FFPSA specifies that to be considered as an official QRTP, the program must be licensed and accredited by a Department of Health and Human Services-approved accreditation agency: Commission on Accreditation of Rehabilitation Facilities (CARF), Joint Commission on Accreditation of Healthcare Organizations or Council on Accreditation (COA) by October 1, 2019, unless a state requests a delay for up to two years.

States are presently weighing their options to request a delay or “opt-in” to comply with the new restrictions regarding reimbursement. States must submit their request to the HHS Children’s Bureau by November 9, 2018 if they intend to delay the effective dates of certain provisions in the Family First act. However, states may still change their decision after their plan has been submitted, so nothing is definitive at this point – except that QRTPs will need to become accredited.

A number of service providers are opting to wait and see if their state will delay the effective dates with the hope that this will provide additional time to become nationally accredited. However, a delay in accreditation for qualified residential treatment programs is a gamble on the service provider’s future.

“I recommend that non-family-based care providers like group homes or residential programs who wish to become a licensed QRTP, begin the process of accreditation now,” said Leslie Ellis-Lang, Managing Director, Child and Youth Services at CARF. “It is the safest action.”

Accreditation for Qualified Residential Treatment Programs

Most service providers require 12 to 18 months or more to become nationally accredited. With the initial effective date of October 1, 2019 one year away (unless a state delays enactment), there is still some time to complete the process.

To meet the FFPSA deadline, organizations must consider the time necessary to:

  • Select an accrediting body
  • Secure budgetary allotment and board approval
  • Develop accreditation-required plans, including an organization-wide strategic plan, among others
  • Prepare standards-compliant policies, procedures and protocols
  • Implement accreditation standards (both CARF and COA require six months of conformance with standards before an onsite survey may take place; Joint Commission does not require this “look back”)
  • Make operational, service delivery and facilities improvements, as necessary
  • Prepare staff and board members for the accrediting body’s onsite survey

Accreditors’ Efforts and Deadlines

Under such a sweeping federal mandate as FFPSA, thousands of organizations throughout the United States will apply for accreditation at the same time, which can strain the capacity of the accrediting bodies.

The good news is that each of the three (presently) approved agencies (CARF, COA, Joint Commission) have been proactively preparing for this onslaught of new applicants by increasing their operational staff and adding surveyors to conduct the onsite reviews.

Yet each accrediting body has its own timeline, based on when applications are due and the scheduling of onsite surveys. Regardless of which body is selected, an organization should generally estimate that it will take at least 12 months to achieve accreditation.

In order to complete the process and receive accreditation by October 1, 2019, organizations must submit their application and deposit by the following deadlines:

CARF:

CARF recommends that organizations choosing to use the 2018 Child and Youth standards for their survey and wanting to be notified of their outcome prior to October 1, 2019, should submit their application by December 31, 2018.

COA:

COA’s application deadline for organizations working toward the October 1, 2019 benchmark is November 19, 2018.

Also, in October 2018, COA will provide an application fee refund (in the form of a credit against future fees) for organizations that are mandated by FFPSA and are pursuing accreditation for the first time. An organization must complete its initial application by October 3 and fully execute an accreditation agreement by October 31, 2018 in order to receive this benefit.

The Joint Commission:

To complete the accreditation process and receive a Joint Commission accreditation award by October 1, 2019, organizations are “strongly encouraged” to submit an application and deposit by December 31, 2018 with a request for onsite survey (“ready date”) of no later than April 1, 2019.

Regardless if a state decides to opt-in or delay the FFPSA regulation and requirement for QRTPs, all service providers are strongly encouraged to begin the road to national accreditation as soon as possible. No matter what a particular state decides to do, the mandate is here to stay. Don’t gamble on your organization’s future!

 

Accreditation Guru is available to assist in the accreditation for qualified residential treatment programs, child welfare and behavioral healthcare organizations nationwide as they navigate the road to accreditation in an efficient and streamlined manner. For more information, contact us at Info@AccreditationGuru.com.

 

Addiction Treatment Centers Need Certification to Advertise on Facebook

Last year, Google barred advertisements from appearing in search results for addiction treatment centers in the United States. Starting last month, however, the company allowed centers with LegitScript Addiction Treatment Certification to run ads on its platform.

Now, Facebook recently announced that it will also require that addiction treatment centers achieve certification before they are approved to advertise on its properties, including Instagram and Messenger. LegitScript, a verification and monitoring service for online pharmacies, charges $995 for initial certification and $1,995 for annual vetting.

Google and Facebook’s advertising restrictions stemmed from complaints about addiction centers that targeted people suffering from addiction, offering sub-par clinical services to the highest bidder or making out-of-state recommendations solely to collect a referral fee. Other disreputable addiction treatment centers inflate staff qualifications and engage in improper billing.

Still, it is important to remember that certification represents a lower standard than accreditation. There is no need to rely on random internet searches to find reputable addiction treatment providers: just determine if a given organization is nationally accredited by an independent accrediting agency.

To earn national accreditation, an external panel of experts conducts thorough on-site scrutiny of addiction and human services organizations to ensure that they adhere to the rigorous guidelines and criteria set by the nationally recognized accrediting bodies. The initial process takes up to a year of preparation and organizations must reapply for accreditation every three or four years to maintain the designation.

National accreditation provides independent third-party validation of an organization’s quality of care. Addiction treatment centers and other human service organizations usually tout this status on their websites. Reputable treatment providers can also be found directly on the accrediting bodies’ websites, including The Joint Commission (formerly JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Council on Accreditation (COA).

LegitScript’s certification applies to “any website, application, or merchant that provides information about in-person drug or alcohol addiction treatment, or facilitates in-person or online drug or alcohol treatment, other than at a private residence or non-clinical setting.” Recovery residences that “do not provide clinical services or addiction treatment, provide or purport to provide a cooperative living environment in a non-commercial location (a private residence or similar setting), and are not part of a larger treatment program offered by an addiction treatment provider, are not eligible for certification.”

Read more about the crackdown on addiction treatment advertising online here

Celebrating Foster Parents During National Foster Care Month

As I reflect on over 20 years serving as a foster care worker, what comes to mind first are the foster parents. I’ve recruited, trained, licensed, counseled, laughed and cried with foster parents and enjoyed most every moment.

Whether you are reading this as a person interested in fostering, an agency with a foster care program, a professional in the field, a child advocate, or just found this blog searching the web, I assure you my comments come from experience not only as a foster care worker but also as a former foster parent.

Foster parents are one of the most undervalued commodities in our country and we need a continuous growing pool of them.  With over 437,000 children currently in foster care across the U.S., the need for foster parents is tremendous nationally. Foster parents are our safety net for abused and neglected children, and the system is challenged with recruiting, supporting and retaining them.

The experience of a foster parent can’t be measured by conventional methods. The emphasis our society puts on academic degrees and professional success leaves out the intangibles. A foster parent’s value is in their devotion, their emotional and physical commitment to the well-being of a vulnerable child.

Who makes a great foster parent? A kind and compassionate person who has the desire to parent, teach, and love someone else’s children. We all may know people who could fulfill those requirements, but then there’s the hard fact that these kids are part of a system and a challenging one at that. The bureaucracy that faces foster parents often discounts their input even if it’s clear that they are the ones who know best what will help the children in their care.

If you are interested in possibly becoming a foster parent, here are some important tips to keep in mind:

  • Check to see that the foster family agency holds a national accreditation by either CARF, Council on Accreditation (COA) or the Joint Commission – this tells you that the organization values best practice standards that are well above state minimum rules and regulations. I have worked for several agencies in my career, some nationally accredited and some not. The difference was notable in areas of support to foster parents, staff, and overall agency professionalism.
  • Accredited agencies provide outstanding support to foster parents and additional child-specific training.
  • Ask to speak with other foster parents, attend an orientation, and meet with the program director.
  • Ask to see the agency’s program goals and outcomes for foster care.
  • See how foster parents are included in organizational quality improvement process.
  • If you are looking at a nonprofit agency see what the composition of the board of directors is and if they are involved in activities to support foster parents.
  • Review a non-profit agency’s IRS form 990, which are available online at https://www.guidestar.org.
  • With a for-profit agency, you may want to research the leadership team.

May Is National Foster Care Month. With that, we should all take the time to recognize that we each can play a part in enhancing the lives of children and youth in foster care. Hats off to all of the foster parents out there!

Accreditation Mandate for QRTPs Under FFPSA: Start the Process Now!

When it passed the Family First Prevention Services Act (FFPSA) last February, Congress aimed to change the face of child welfare, in part by implementing a funding shift that restricts the use of Title IV-E financing for out-of-home “congregate care” placements. The goal is to increase assurances that children will be kept in family-like settings whenever possible.

One section of FFPSA defines a Qualified Residential Treatment Program (QRTP), which is one of the few settings that will be allowed to receive federal reimbursements after the first two weeks a child has been in care.

A key provision of the Act is that QRTPs must be accredited by a national organization. This is a long process that should be undertaken as soon as possible because time to comply with the act is running out. Do not underestimate the effort it takes to achieve national accreditation. The time to begin the process is now.

Congregate care providers must become QRTPs by October 1, 2019 if they want to be eligible for this designation. While states have the option to extend this deadline for up to two years, all providers should be working toward next year’s October 1 deadline.

What does it mean to become a QRTP? In summary, the service provider must:

  • Be licensed and be accredited by at least one of three federally approved accreditors: The Commission on Accreditation of Rehabilitation Facilities (CARF), Council on Accreditation (COA) or The Joint Commission (formerly JCAHO)
  • Use a trauma-informed treatment model
  • Have registered or licensed nursing staff and other licensed clinical staff, available 24/7, on-site according to the treatment model
  • Demonstrate family engagement and outreach, including siblings, in the child’s treatment
  • Provide discharge planning and family-based aftercare supports for at least six months post-discharge

The accreditation mandate sets a high bar, but one that helps ensure the delivery of high-quality care. Organizations that earn accreditation have reached beyond the minimum licensing standards and made a long-term commitment to strong governance, program consistency, outcome measurement and continuous improvement throughout their agencies.

Accreditation requires organizations to undergo an objective review by an independent accrediting body and signifies that they are effectively managing their resources and enhancing the quality of life for the population served.

Many organizations underestimate the time required to prepare for and become accredited. In general, it takes 12 to 18 months to prepare for national accreditation, sometimes more, sometimes less, depending on the original state of readiness.

The time needed to complete the accreditation process includes, but is not limited to, the following:

  • Selecting an accrediting body
  • Securing budgetary allotment and board approval
  • Preparing standards-compliant policies, procedures and protocols
  • Implementing accreditation standards
  • Making operational and service delivery improvements, as necessary
  • Participating in a mock survey

Because Family First represents a looming, national deadline for accreditation, there will be many hundreds (if not thousands) of organizations trying to become accredited at the same time. And the accrediting bodies only have a finite amount of capacity to accommodate all of these applicants.

Therefore, every organization should begin the accreditation process as soon as possible to get ahead of the rush. Once the process begins, effective project management and support from leadership will help ensure that accreditation activities are not derailed by other priorities that may crop up.

 

For information on how to effectively and pro-actively prepare for CARF, COA or Joint Commission accreditation, please contact Accreditation Guru, Inc. at Info@AccreditationGuru.com or 212.209.0240.