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