Performance Number and percentage of timely notice of appeal rights provided to Measure: waiver applicants/participants who make one of the following claims: a) denied access to Medicaid Waiver Program, b) denied access to needed services while enrolled in the waiver, c) denied choice of provider if more than one qualified provider was available to render the service Data Source (Select one) (Several options are listed in the on-line application): If is selected, specify: ‘Other’ 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) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval =5 Other Annually Specify: X Continuously and Stratified: Describe Ongoing Group: Other Specify: Other Specify: Data Source (Select one) (Several options are listed in the on-line application): If is selected, specify: ‘Other’ Responsible Party for Frequency of data Sampling Approach data collection/generation: (check each that collection/generation (check each that applies) (check each that applies)
Performance Measure: Number and percentage of timely notice of appeal rights provided to waiver applicants/participants who make one of the following claims: a) denied access to Medicaid Waiver Program, b) denied access to needed services while enrolled in the waiver, c) denied choice of provider if more than one qualified provider was available to render the service Data Source (Select one) (Several options are listed in the on-line application): If ‘Other’ is selected, specify: 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) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval =5 Other Specify: Annually X Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: Data Source (Select one) (Several options are listed in the on-line application): If ‘Other’ is selected, specify: Responsible Party for data collection/generation (check each that Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies)