triggered 60 days prior to the date it is due. Through the use of management reports registered nurses are provided with the data needed to ensure timely completion of reevaluation. The nurse documents the results of the re-evaluation using the MDS-HC, additional assessment questions and case notes. Level of Care entity reports to MRC include the date each Level of Care (LOC) re-evaluation is completed and the results of the level of care determination. State monitoring is conducted on a sample of records to ensure that re-evaluations have been conducted in accordance with all requirements. In addition, MRC, in collaboration with DDS, will conduct periodic site visits and annual assessments of the Level of Care entity. j. Maintenance of Evaluation/Reevaluation Records. Per 42 CFR §441.303(c)(3), the State assures that written and/or electronically retrievable documentation of all evaluations and reevaluations are maintained for a minimum period of 3 years as required in 45 CFR §92.42. Specify the location(s) where records of evaluations and reevaluations of level of care are maintained: Determinations of level of care are maintained by the Level of Care entity. Records are maintained for each waiver participant in accordance with 808 CMR 1.00 (the State’s Division of Purchased Services regulations that describe the contract compliance, financial reporting, and auditing requirements applicable to state procurements of human and social services). Quality Improvement: Level of Care 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.
Other Specify: Annually Continuously and Ongoing Other Specify: Add another Performance measure (button to prompt another performance measure) Performance Measure: % of clinical determinations of "denial" that have been reviewed for appropriateness of denial. (Number of denials reviewed/ Number of denials) Data Source (Select one) (Several options are listed in the on-line application): Other If ‘Other’ is selected, specify: Level of Care Entity reports 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) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually Level of Care Entity 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 State Medicaid Agency Weekly Operating Agency Monthly Sub-State Entity Quarterly
Appendix B-8: Access to Services by Limited English Proficient Persons Access to Services by Limited English Proficient Persons. Specify the methods that the State uses to provide meaningful access to the waiver by Limited English Proficient persons in accordance with the Department of Health and Human Services “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons” (68 FR 47311 - August 8, 2003): MassHealth eligibility notices and information regarding appeal rights are available in English and Spanish. In addition, these notices include a card instructing individuals in multiple languages that the information affects their health benefit, and to contact MassHealth Customer Service for assistance with translation. MassHealth and the Massachusetts Rehabilitation Commission (MRC) have developed multiple approaches to promote and ensure access to the waiver by Limited English Proficient persons. MassHealth has made waiver documents, such as eligibility notices and information regarding appeal rights, available in a number of languages. MRC also creates documents for participants in cognitively accessible formats. Case Managers are required to ensure the provision of services that are accessible to current and potential consumers. Accessible services are defined as those that address geographic, physical, and communication barriers so that consumers can be served according to their needs. Case Managers conduct outreach with materials in languages appropriate to their populations residing in the geographic service area. Case Managers also work collaboratively with minority community organizations that provide social services to identify individuals and families who may be eligible for waiver program services. MRC also has qualified Cultural Facilitators that may be accessed to assist in this process. MRC attempts to ensure that employees are capable of speaking directly with consumers in their primary language and in cognitively accessible formats. When this is not possible, they arrange for interpreting services by either a paid interpreting service, a cultural facilitator or through an individual, such as a family member, designated by the consumer. MRC also provides access to TTY services for persons calling the agency.
Service Delivery Method (check each that applies): Participant-directed as specified in Appendix E Provider managed Specify whether the service may be provided by (check each that applies): Legally Responsible Person Relative Legal Guardian Provider Specifications Provider Category(s) (check one or both): Individual. List types: Agency. List the types of agencies: Individual Personal Care Worker Personal Care Agencies Provider Qualifications Provider Type: License (specify) Certificate (specify) Other Standard (specify) Individual Personal Care Worker Individuals providing personal care services must have one of the following: - Certificate of Home Health Aide Training - Certificate of Nurse’s Aide Training - Certificate of Personal Care Training Individuals who provide Personal Care services must have responded satisfactorily to the Waiver provider enrollment process and must meet requirements for individuals in such roles, including, but not limited to must: have been CORI checked, have life or work experience providing services to individuals with disabilities; can handle emergency situations; can set limits, and communicate effectively with participants, families, other providers and agencies; have ability to meet legal requirements in protecting confidential information; and certification in CPR is required. Personal Care Agencies Individuals employed by the agency providing personal care services must have one of the following: - Certificate of Home Health Aide Training - Certificate of Nurse’s Aide Training - Certificate of Personal Care Training Any not-for-profit or proprietary organization that responds satisfactorily to the Waiver provider enrollment process and as such, has successfully demonstrated, at a minimum, the following - Education, Training, Supervision: Providers must ensure effective training of staff members in all aspects of their job duties, including handling emergency situations. Providers are responsible for ensuring staff are trained on applicable regulations and policies governing waiver service delivery and the principles of participant centered care. Agencies must have established procedures for appraising staff performance and for effectively modifying poor performance where it exists.
applies) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually Administrative Service Organization 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 State Medicaid Agency Weekly Operating Agency Monthly Sub-State Entity Quarterly Other Specify: Annually Continuously and Ongoing Other Specify: Add another Performance measure (button to prompt another performance measure) Performance Measure: % of providers licensed by DDS that continue to meet applicable licensure or certification standards. (Number of providers that continue to meet applicable licensure or certification standards/ Number of providers subject to licensure/certification) Data Source (Select one) (Several options are listed in the on-line application): Provider performance monitoring If ‘Other’ is selected, specify: Responsible Party for data collection/generation (check each that Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies)
b.Sub-assurance: The State monitors service plan development in accordance with its policies and procedures. i. Performance Measures For each performance measure the State will use to assess compliance with the statutory assurance complete the following. Where possible, include numerator/denominator. For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate. Performance Measure: No longer needed in new QM system Data Source (Select one) (Several options are listed in the on-line application): If ‘Other’ is selected, specify: No longer needed 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) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually No longer needed Continuously and Ongoing Stratified: Describe Group: Other Specify: No longer needed Other Specify: No longer needed 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
Specify: 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 State Medicaid Agency Weekly Operating Agency Monthly Sub-State Entity Quarterly Other Specify: Annually Continuously and Ongoing Other Specify: Add another Performance measure (button to prompt another performance measure) Performance Measure: % of service plans updated when warranted by changes in participants’ needs. (Number of service plans updated when needs change/ Number of participants reviewed with changing needs) Data Source (Select one) (Several options are listed in the on-line application): If ‘Other’ is selected, specify: SC Supervisor Tool 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) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually 95% Continuously and Stratified: Describe
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) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually 95% 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 State Medicaid Agency Weekly Operating Agency Monthly Sub-State Entity Quarterly Other Specify: Annually Continuously and Ongoing Other Specify: Add another Performance measure (button to prompt another performance measure) e. Sub-assurance: Participants are afforded choice between/among waiver services and providers. i. Performance Measures
For each performance measure the State will use to assess compliance with the statutory assurance (or sub-assurance), complete the following. Where possible, include numerator/denominator. For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate. Performance Measure: % of incident “trigger” reports that have had follow up action taken. (Number of incidents that reach the "trigger" threshold for which action has been taken/ Total number of incidents that reach the "trigger" threshold) Data Source (Select one) (Several options are listed in the on-line application): Critical events and incident reports If ‘Other’ is selected, specify: 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) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually 90% 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 State Medicaid Agency Weekly Operating Agency Monthly
assure that claims are coded and paid for in accordance with the reimbursement methodology specified in the approved waiver.”) i. Sub-assurances: a Sub-assurance: The State provides evidence that claims are coded and paid for in accordance with the reimbursement methodology specified in the approved waiver and only for services rendered. (Performance measures in this sub-assurance include all Appendix I performance measures for waiver actions submitted before June 1, 2014.) a.i. Performance Measures For each performance measure the State will use to assess compliance with the statutory assurance complete the following. Where possible, include numerator/denominator. For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate. Performance Measure: Services are billed in accordance with the plan of care. % of claims submitted to and paid by MMIS will be monitored and reported by MRC using remittance advices. (Approved and paid MMIS claims/ Total service claims submitted) Data Source (Select one) (Several options are listed in the on-line application): Financial records (including expenditures) If ‘Other’ is selected, specify: 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) State Medicaid Agency Weekly 100% Review Operating Agency Monthly Less than 100% Review Sub-State Entity Quarterly Representative Sample; Confidence Interval = Other Specify: Annually Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: