that it has designed and and analysis: Continuously and implemented an adequate ongoing. system for insuring financial Percent of claims verified Data source: MCO's compliance accountability of the waiver through the MCO's report. program. compliance audit to have paid Data collection responsible in accordance with the party: MCO. participant's waiver treatment Frequency of data collection: Plan. Quarterly or Continuously and On-going. Sampling: 95% CI. Data aggregation responsible party: MCO and DOH. Frequency of data aggregation and analysis: Quarterly. The State provides The State pays the MCO N/A to MCO reporting. evidence that rates remain actuarially sound rates. consistent with the approved rate methodology throughout the five-year waiver cycle.
that it has designed and implemented an adequate system for insuring financial accountability of the waiver program. and analysis: Continuously and ongoing. Percent of claims verified through the MCO's compliance audit to have paid in accordance with the participant's waiver treatment Plan. Data source: MCO's compliance report. Data collection responsible party: MCO. Frequency of data collection: Quarterly or Continuously and On-going. Sampling: 95% CI. Data aggregation responsible party: MCO and DOH. Frequency of data aggregation and analysis: Quarterly. The State provides evidence that rates remain consistent with the approved rate methodology throughout the five-year waiver cycle. The State pays the MCO actuarially sound rates. N/A to MCO reporting.
final-rfq.docx