Number of provider trainings Data source: Training verification operated by the MCO. records. Data collection responsible party: MCO. Frequency of data collection: Quarterly. Sampling: 100% review. Data aggregation responsible party: DOH. Frequency of data aggregation and analysis: Quarterly. 5 Administration and Number and/or percent of Data source: Reports to DOH on operation: The State aggregated performance delegated administrative Medicaid Agency (SMA) measure reports generated by functions. retains ultimate authority the MCO and reviewed by the Data collection responsible and responsibility for the DOH that contain discovery, party: MCO. operation of the waiver remediation, and system Frequency of data collection: program by exercising improvement for ongoing Monthly. oversight of the performance compliance of the assurances. Sampling: 100% review. of waiver functions by Data aggregation responsible contracted entities. Number and/or percent of party: MCO. MCO administrative and Frequency of data aggregation quality assurance reports and analysis: Monthly. approved by DOH prior to implementation by the MCO. 6 Financial accountability: The The State provides Percent of providers who have Data source: Routine Medicaid DOH maintains financial evidence that claims are payment recouped for waiver claims verification audits. accountability through coded and paid for in services without supporting Data collection responsible payment of claims for accordance with the documentation. party: MCO. services that are authorized reimbursement Frequency of data collection: and furnished to 1915(i)-like methodology specified in Continuously and ongoing. participants by qualified the approved waiver and Sampling: 90% CI. providers. only for services rendered. Data aggregation responsible party: MCO. The State must demonstrate Frequency of data aggregation
Number of provider trainings operated by the MCO. Data source: Training verification records. Data collection responsible party: MCO. Frequency of data collection: Quarterly. Sampling: 100% review. Data aggregation responsible party: DOH. Frequency of data aggregation and analysis: Quarterly. 5 Administration and operation: The State Medicaid Agency (SMA) retains ultimate authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by contracted entities. Number and/or percent of aggregated performance measure reports generated by the MCO and reviewed by the DOH that contain discovery, remediation, and system improvement for ongoing compliance of the assurances. Number and/or percent of MCO administrative and quality assurance reports approved by DOH prior to implementation by the MCO. Data source: Reports to DOH on delegated administrative functions. 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. 6 Financial accountability: The DOH maintains financial accountability through payment of claims for services that are authorized and furnished to 1915(i)-like participants by qualified providers. The State must demonstrate The State provides evidence that claims are coded and paid for in accordance with the reimbursement methodology specified in the approved waiver and only for services rendered. Percent of providers who have payment recouped for waiver services without supporting documentation. Data source: Routine Medicaid claims verification audits. Data collection responsible party: MCO. Frequency of data collection: Continuously and ongoing. Sampling: 90% CI. Data aggregation responsible party: MCO. Frequency of data aggregation
final-rfq.docx