FY2014 RISK FACTOR ANALYSIS STANDARD WORKSHEET RISK FACTOR DETERMINATION: ______________________SERVICE PROVIDER Use this form to make a risk factor determination on your service providers. MAXIMUM MAXIMUM RISK FACTOR WEIGHT X = POINTS SCORE 5.00 1 X Annual Dollars Available = 5.00 2 X Number of Services Provided = Number of Clients Served 5.00 3 X = (unduplicated) 5.00 4 Results of AAA On Site Reviews X = – 5.00 5 Questioned Cost X = 6 5.00 X Independent Audit findings = 7 5.00 X Personnel Turnover = 8 3.00 X Policies and Procedures = 9 5.00 X Training = 10 5.00 X Reports Submissions = 3.00 11 X Complaints and Official Inquiries = 3.00 12 Appeals X = 3.00 13 Multiple Contacts X = 3.00 14 Home Delivered Routes X = 3.00 15 In-Home Contacts X = Totals RISK FACTORS ARE MULTIPLIED BY THE POINTS ASSIGNED TO THAT RISK FACTOR TO SHOW HOW THE WEIGHTED SCORE IS CALCULATED. COMPLETION OF THE ENTER RISK FACTOR WEIGHTING CALCULATIONS WILL RESULT IN A MAXMUM SCORE FOR THAT SERVICE PROVIDER. THIS SCORE IS ENTERED ON THE CONTRACT SCORE SHEET. AFTER ALL SCORES ARE ENTERED ON THE SERVICE PROVIDER SHEET, SERVICE PROVIDERS ARE ARRANGED IN THE RISK CLASSIFICATION TABLE BASED ON THEIR SCORED. THIS SCORE MAY BECOME THE BASIS FOR A NUMBER OF MANAGEMENT ACTIONS BY THE AREA AGENCY.
FY2014 RISK FACTOR ANALYSIS STANDARD WORKSHEET RISK FACTOR DETERMINATION: ______________________SERVICE PROVIDER Use this form to make a risk factor determination on your service providers. RISK FACTOR WEIGHT X MAXIMUM POINTS = MAXIMUM SCORE 1 Annual Dollars Available 5.00 X = 2 Number of Services Provided 5.00 X = 3 Number of Clients Served (unduplicated) 5.00 X = 4 Results of AAA On – Site Reviews 5.00 X = 5 Questioned Cost 5.00 X = 6 Independent Audit findings 5.00 X = 7 Personnel Turnover 5.00 X = 8 Policies and Procedures 3.00 X = 9 Training 5.00 X = 10 Reports Submissions 5.00 X = 11 Complaints and Official Inquiries 3.00 X = 12 Appeals 3.00 X = 13 Multiple Contacts 3.00 X = 14 Home Delivered Routes 3.00 X = 15 In-Home Contacts 3.00 X = Totals RISK FACTORS ARE MULTIPLIED BY THE POINTS ASSIGNED TO THAT RISK FACTOR TO SHOW HOW THE WEIGHTED SCORE IS CALCULATED. COMPLETION OF THE ENTER RISK FACTOR WEIGHTING CALCULATIONS WILL RESULT IN A MAXMUM SCORE FOR THAT SERVICE PROVIDER. THIS SCORE IS ENTERED ON THE CONTRACT SCORE SHEET. AFTER ALL SCORES ARE ENTERED ON THE SERVICE PROVIDER SHEET, SERVICE PROVIDERS ARE ARRANGED IN THE RISK CLASSIFICATION TABLE BASED ON THEIR SCORED. THIS SCORE MAY BECOME THE BASIS FOR A NUMBER OF MANAGEMENT ACTIONS BY THE AREA AGENCY.
AAA%20RISK%20ASSESSMENT%20FORM%20(2).docx