sample of working days participants of notice of who were program 3. Every enrolled deficiencies. 12 months during the The CSA will 3. 3. time period follow up with DHMH/MHA DHMH/MHA under the program 3 with CSAs with CSAs 4. Utilization review of services on POC in review months after conjunction with provider authorization and claims the final data Review of of the all POC performance during improvement identified plan. time period for a defensible sample of 4. Every participants 4. ASO 4. 12 months who were DHMH/MHA enrolled with ASO & during the CSAs time period under review Review of all POC during identified time period for a defensible sample of participants
4. Utilization review of services on POC in conjunction with provider authorization and claims data sample of participants who were enrolled during the time period under review Review of all POC during identified time period for a defensible sample of participants who were enrolled during the time period under review Review of all POC during identified time period for a defensible sample of participants 3. DHMH/MHA with CSAs 4. ASO 3. Every 12 months 4. Every 12 months 3. DHMH/MHA with CSAs 4. DHMH/MHA with ASO & CSAs working days of notice of program deficiencies. The CSA will follow up with the program 3 months after the final of the performance improvement plan.
1915_i_SPA_CMS_Submission.docx