Medical Social Worker with a minimum of 1 year of relevant experience. Physical, Occupational, or Rehab Therapists with a minimum of 1 year Q13: Does the audit include NF LOC for waivers relevant experience. such as PACE or other home and community based Please refer the NM Medicaid NF LOC Criteria waiver services: Or is it just those members need and Instruction: Nursing Facility placement? Search: Providers/Manuals and Guides. Q14: Will the EQRO be responsible for reviewing the PASSR? R13: See R2 Q15: For NF LOC determinations that were denied, does a Physician attest to this and subsequently testify in a Fair Hearing? R14: No R15: The MCO is required to have a Medical director review denials, and would testify if requested to do so during a Fair Hearing. Specifications: A. 27-28 Q1: We believe there is a typo and this section R1: Yes, this should be 8, not 1. Please see Detailed Scope of Work, should be numbered 8. amendment 2. Deliverables 8. Communications and Q2: Is this section (1. Communications and R2: Yes Meetings Meetings) part of the deliverables section and thus subject to the 25-page limit? Q3: What is the anticipated frequency of on-site R3: At a minimum the EQRO should plan to meetings with HSD/MAD vs. telephone or video attend quarterly on-site meetings. conferences? Specifications: B. 28- 29 Q1: Would the State consider an EQRO without R1: No Mandatory CMS certification as a QIO (-like) entity, if the EQRO Specifications maintained a subcontractor relationship with a QIO
Q13: Does the audit include NF LOC for waivers such as PACE or other home and community based waiver services: Or is it just those members need Nursing Facility placement? Q14: Will the EQRO be responsible for reviewing the PASSR? Q15: For NF LOC determinations that were denied, does a Physician attest to this and subsequently testify in a Fair Hearing? Medical Social Worker with a minimum of 1 year of relevant experience. Physical, Occupational, or Rehab Therapists with a minimum of 1 year relevant experience. Please refer the NM Medicaid NF LOC Criteria and Instruction: Search: Providers/Manuals and Guides. R13: See R2 R14: No R15: The MCO is required to have a Medical director review denials, and would testify if requested to do so during a Fair Hearing. Specifications: A. Detailed Scope of Work, Deliverables 8. Communications and Meetings 27-28 Q1: We believe there is a typo and this section should be numbered 8. Q2: Is this section (1. Communications and Meetings) part of the deliverables section and thus subject to the 25-page limit? Q3: What is the anticipated frequency of on-site meetings with HSD/MAD vs. telephone or video conferences? R1: Yes, this should be 8, not 1. Please see amendment 2. R2: Yes R3: At a minimum the EQRO should plan to attend quarterly on-site meetings. Specifications: B. Mandatory Specifications 28- 29 Q1: Would the State consider an EQRO without CMS certification as a QIO (-like) entity, if the EQRO maintained a subcontractor relationship with a QIO R1: No
18-630-8000-0005%20Q%26A's.docx