3 The State demonstrates Service it plans address all Percent of participants Data source: Record reviews, has designed and participants’ assessed reviewed with a POC that was onsite or through Utilization implemented an effective needs (including health and adequate and appropriate to Review Unit. system for reviewing the safety risk factors) and their needs and goals Data collection responsible adequacy of service plans personal goals, either by (including health goals) as party: MCO. for waiver participants. the provision of waiver indicated in assessment(s) Frequency of data collection: services or through other Continuously and ongoing. means. Sampling: Representative Percent of participants sample, 95% CI reviewed with a POC that had Data aggregation responsible adequate and appropriate party: MCO and DOH. strategies to address their Frequency of data aggregation health and safety risks as and analysis: Monthly. indicated in the assessment(s). Percent of participants reviewed with a POC that addressed the participant's goals/needs as indicated in the assessment(s). Service plans are Percent of participants whose Data source: MCO database. updated/revised at least POC was updated within 365 Data collection responsible annually or when warranted days of the last evaluation. party: MCO. by changes in participant’s Frequency of data collection: needs. Ongoing. Percent of participants whose Sampling: 100% review. POC was updated as Data aggregation responsible warranted by changes in the party: MCO. participant's needs. Frequency of data aggregation and analysis: Quarterly.
3 The State demonstrates it has designed and implemented an effective system for reviewing the adequacy of service plans for waiver participants. Service plans address all participants’ assessed needs (including health and safety risk factors) and personal goals, either by the provision of waiver services or through other means. Percent of participants reviewed with a POC that was adequate and appropriate to their needs and goals (including health goals) as indicated in assessment(s) Percent of participants reviewed with a POC that had adequate and appropriate strategies to address their health and safety risks as indicated in the assessment(s). Percent of participants reviewed with a POC that addressed the participant's goals/needs as indicated in the assessment(s). Data source: Record reviews, onsite or through Utilization Review Unit. Data collection responsible party: MCO. Frequency of data collection: Continuously and ongoing. Sampling: Representative sample, 95% CI Data aggregation responsible party: MCO and DOH. Frequency of data aggregation and analysis: Monthly. Service plans are updated/revised at least annually or when warranted by changes in participant’s needs. Percent of participants whose POC was updated within 365 days of the last evaluation. Percent of participants whose POC was updated as warranted by changes in the participant's needs. Data source: MCO database. Data collection responsible party: MCO. Frequency of data collection: Ongoing. Sampling: 100% review. Data aggregation responsible party: MCO. Frequency of data aggregation and analysis: Quarterly.
nyc-final-rfq.docx