Continuously and Stratified: Describe Ongoing Group: Other Specify: Other Specify: Add another Data Source for this performance measure Data Aggregation and Analysis Responsible Party for Frequency of data data aggregation and aggregation and analysis analysis: (check each that (check each that applies applies X State Medicaid Agency Weekly X Operating Agency Monthly Sub-State Entity Quarterly Other Annually Specify: Continuously and Ongoing X Other Specify: Every two years Performance Number and percentage of providers in a representative sample receive Measure: and retain 100% of amounts claimed for Wavier services. The numerator is the total number of providers in the review sample which receive and retain 100% of amounts claimed for waiver services; the denominator is the total number of providers in the review sample. Data Source (Select one) (Several options are listed in the on-line application):Other If is selected, specify: ‘Other’ CAPS claims payment history report; MMIS claims payment history report; Provider Claims Responsible Party for Frequency of data Sampling Approach data collection/generation: (check each that collection/generation (check each that applies) (check each that applies) applies) X State Medicaid Weekly 100% Review Agency X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval = 95% Confidence Level, 5% Margin of Error
Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: Add another Data Source for this performance measure Data Aggregation and Analysis Responsible Party for data aggregation and analysis (check each that applies Frequency of data aggregation and analysis: (check each that applies X State Medicaid Agency Weekly X Operating Agency Monthly Sub-State Entity Quarterly Other Specify: Annually Continuously and Ongoing X Other Specify: Every two years Performance Measure: Number and percentage of providers in a representative sample receive and retain 100% of amounts claimed for Wavier services. The numerator is the total number of providers in the review sample which receive and retain 100% of amounts claimed for waiver services; the denominator is the total number of providers in the review sample. Data Source (Select one) (Several options are listed in the on-line application):Other If ‘Other’ is selected, specify: CAPS claims payment history report; MMIS claims payment history report; Provider Claims Responsible Party for data collection/generation (check each that applies) Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval = 95% Confidence Level, 5% Margin of Error
ABI_Amendment_11.3.17.docx