are followed. Frequency of data collection: Monthly. Sampling: 100% review. Data aggregation responsible party: MCO. Frequency of data aggregation and analysis: Monthly. Number and percent of HCBS The State establishes Data source: MCO encounter participants who received overall health care data database physical exams consistent standards and monitors Data collection responsible with state 1915(i)-like policy. those standards based on party: MCO. the responsibility of the Frequency of data collection: service provider as stated Monthly. in the approved waiver. Sampling: 100% review. Data aggregation responsible party: MCO. Frequency of data aggregation and analysis: Monthly. 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 was onsite or through Utilization participants’ 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
are followed. Frequency of data collection: Monthly. Sampling: 100% review. Data aggregation responsible party: MCO. Frequency of data aggregation and analysis: Monthly. The State establishes overall health care standards and monitors those standards based on the responsibility of the service provider as stated in the approved waiver. Number and percent of HCBS participants who received physical exams consistent with state 1915(i)-like policy. Data source: MCO encounter data database Data collection responsible party: MCO. Frequency of data collection: Monthly. Sampling: 100% review. Data aggregation responsible party: MCO. Frequency of data aggregation and analysis: Monthly. 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 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
final-rfq.docx