Data Source (Select one) (Several options are listed in the on-line application): Other If is selected, specify: ‘Other’ SIMS data report Responsible Party for Frequency of data Sampling Approach data collection/generation: (check each that collection/generation (check each that applies) (check each that applies) applies) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Annually Specify: Continuously and Stratified: Describe Ongoing Group: Other Specify: Other Specify: Data Source (Select one) (Several options are listed in the on-line application): Reports to State Medicaid Agency on delegated Administrative functions If is selected, specify: ‘Other’ Analysis of SCO MDS submissions Responsible Party for Frequency of data Sampling Approach data collection/generation: (check each that collection/generation (check each that applies) (check each that applies) applies) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Annually Specify: Continuously and Stratified: Describe Ongoing Group: Other Specify: Other Specify:
Data Source (Select one) (Several options are listed in the on-line application): Other If ‘Other’ is selected, specify: SIMS data report Responsible Party for data collection/generation (check each that applies) Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: Data Source (Select one) (Several options are listed in the on-line application): Reports to State Medicaid Agency on delegated Administrative functions If ‘Other’ is selected, specify: Analysis of SCO MDS submissions Responsible Party for data collection/generation (check each that applies) Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: