CD33 Medicaid Status - ADL 3+ Total Count of Consumers with Yes Registered services with ADL/IADL • – Medicaid beneficiary ADL score of 3 and above by unduplicated • Not Medicaid beneficiary Medicaid beneficiary status that Each registered service separately for • • Medicaid beneficiary Status received service. which this is required (Personal Care, • Missing Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD34 Nutrition Risk Score - ADL 3+ Count of Consumers ADL score Yes Home Delivered Meals • 0-5 of 3 and above by Nutrition Risk • 6+ Score that received service. • Score Missing • CD35 Age - IADL 3+ Count of Consumers IADL score Yes Registered services with ADL/IADL • – <60 of 3 and above by age group unduplicated • 60-64 that received service. Each registered service separately for • • 65-74 which this is required (Personal Care, • 75-84 Homemaker, Chore, Home-delivered • 85+ Nutrition, Adult Day Care, Case Mgmt) • Age Missing • CD36 Gender Identity - IADL 3+ Total Count of Consumers with Yes Registered services with ADL/IADL • – Female IADL score 3 and above by unduplicated • Male gender identity that received Each registered service separately for • • service. which this is required (Personal Care, •Other Gender Missing Homemaker, Chore, Home-delivered • Nutrition, Adult Day Care, Case Mgmt) CD37 Rural Status - IADL 3+ Count of Consumers IADL score Yes Registered services with ADL/IADL • – Rural of 3 and above by rural status unduplicated • Non-rural that received service. Each registered service separately for • • Rural Status Missing which this is required (Personal Care, • Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt)
CD33 Medicaid Status - ADL 3+ • Medicaid beneficiary • Not Medicaid beneficiary • Medicaid beneficiary Status Missing Total Count of Consumers with ADL score of 3 and above by Medicaid beneficiary status 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) CD34 Nutrition Risk Score - ADL 3+ • 0-5 • 6+ • Score Missing Count of Consumers ADL score of 3 and above by Nutrition Risk Score that received service. Yes • Home Delivered Meals CD35 Age - IADL 3+ • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing Count of Consumers IADL score of 3 and above by age group 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) CD36 Gender Identity - IADL 3+ • Female • Male •Other • Gender Missing Total Count of Consumers with IADL score 3 and above by gender identity 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) CD37 Rural Status - IADL 3+ • Rural • Non-rural • Rural Status Missing Count of Consumers IADL score of 3 and above by rural status 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)
State_Program_Performance_Report_Requirements_Draft.docx