CD10 Medicaid Status - Total Total Count of Consumers by Yes All registered services unduplicated • – Medicaid beneficiary Medicaid beneficiary status that Registered services w/ ADLs and IADLs • • Not Medicaid beneficiary received service. - unduplicated • Medicaid beneficiary Status Each registered service separately • • Missing Confidential service: Legal Assistance • CD11 ADL Score - Total Total Count of Consumers by Yes Registered services with ADL/IADL - • 0 ADL score that received service. unduplicated • 1-2 Each registered service separately for • • 3+ this is required (Personal Care, • ADL Missing Homemaker, Chore, Home-delivered • Nutrition, Adult Day Care, Case Mgmt) CD12 IADL Score - Total Total Count of Consumers by Yes Registered services with ADL/IADL - • 0 IADL score that received service. unduplicated • 1-2 Each registered service separately for • • 3+ which this is required (Personal Care, • IADL Missing Homemaker, Chore, Home-delivered • Nutrition, Adult Day Care, Case Mgmt) CD13 Nutrition Risk - Total Total Count of Consumers by Yes Registered services with Nutrition Risk • 0-5 Nutrition Risk Score that - unduplicated • 6+ received service. Each registered service separately that • Missing requires Risk Score (Home-delivered • nutrition, congregate nutrition, nutrition counseling) CD14 Age - At or Poverty of Consumers at or below Yes All registered services - unduplicated • <60 poverty by age group that Registered services with ADL/IADL - • • 60-64 received service. unduplicated • 65-74 Each registered service separately • • 75-84 Confidential service: Legal Assistance • 85+ • Age Missing •
CD10 Medicaid Status - Total • Medicaid beneficiary • Not Medicaid beneficiary • Medicaid beneficiary Status Missing Total Count of Consumers by Medicaid beneficiary status that received service. Yes • All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Confidential service: Legal Assistance CD11 ADL Score - Total • 0 • 1-2 • 3+ • ADL Missing Total Count of Consumers by ADL score that received service. Yes • Registered services with ADL/IADL - unduplicated • Each registered service separately for this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD12 IADL Score - Total • 0 • 1-2 • 3+ • IADL Missing Total Count of Consumers by IADL score that received service. Yes • Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD13 Nutrition Risk - Total • 0-5 • 6+ • Missing Total Count of Consumers by Nutrition Risk Score that received service. Yes • Registered services with Nutrition Risk - unduplicated Each registered service separately that requires Risk Score (Home-delivered nutrition, congregate nutrition, nutrition counseling) CD14 Age - At or Poverty • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing of Consumers at or below poverty by age group that received service. Yes • All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Confidential service: Legal Assistance
State_Program_Performance_Report_Requirements_Draft.docx