7. Distribution of Waiver Operational and Administrative Functions. In the following table, specify the entity or entities that have responsibility for conducting each of the waiver operational and administrative functions listed (check each that applies): In accordance with 42 CFR §431.10, when the Medicaid agency does not directly conduct a function, it supervises the performance of the function and establishes and/or approves policies that affect the function. All functions not performed directly by the Medicaid agency must be delegated in writing and monitored by the Medicaid Agency. Note: More than one box may be checked per item. Ensure that Medicaid is checked when the Single State Medicaid Agency (1) conducts the function directly; (2) supervises the delegated function; and/or (3) establishes and/or approves policies related to the function. Other State Local Medicaid Operating Contracted Non-State Function Agency Agency Entity Entity Participant waiver enrollment x x Waiver enrollment managed against approved x x limits Waiver expenditures managed against approved x x levels Level of care evaluation x x Review of Participant service plans x x Prior authorization of waiver services x x Utilization management x x Qualified provider enrollment x x Execution of Medicaid provider agreements x Establishment of a statewide rate methodology x x Rules, policies, procedures and information x x development governing the waiver program Quality assurance and quality improvement x x activities Quality Improvement: Administrative Authority of the Single State Medicaid Agency As a distinct component of the quality improvement strategy, provide information in State’s the following fields to detail the methods for discovery and remediation. State’s a. Methods for Discovery: Administrative Authority
7. Distribution of Waiver Operational and Administrative Functions. In the following table, specify the entity or entities that have responsibility for conducting each of the waiver operational and administrative functions listed (check each that applies): In accordance with 42 CFR §431.10, when the Medicaid agency does not directly conduct a function, it supervises the performance of the function and establishes and/or approves policies that affect the function. All functions not performed directly by the Medicaid agency must be delegated in writing and monitored by the Medicaid Agency. Note: More than one box may be checked per item. Ensure that Medicaid is checked when the Single State Medicaid Agency (1) conducts the function directly; (2) supervises the delegated function; and/or (3) establishes and/or approves policies related to the function. Function Medicaid Agency Other State Operating Agency Contracted Entity Local Non-State Entity Participant waiver enrollment x x Waiver enrollment managed against approved limits x x Waiver expenditures managed against approved levels x x Level of care evaluation x x Review of Participant service plans x x Prior authorization of waiver services x x Utilization management x x Qualified provider enrollment x x Execution of Medicaid provider agreements x Establishment of a statewide rate methodology x x Rules, policies, procedures and information development governing the waiver program x x Quality assurance and quality improvement activities x x Quality Improvement: Administrative Authority of the Single State Medicaid Agency As a distinct component of the State’s quality improvement strategy, provide information in the following fields to detail the State’s methods for discovery and remediation. a. Methods for Discovery: Administrative Authority
ABI_Amendment_11.3.17.docx