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Did Agency Receive Letter? PowerPoint PPT Presentation


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Start Establish Annual Review Calendar. Sample 5% Random Sample. Upload State Sample Data into Review Database. Did Agency Receive Letter?. Send Review Notification Letter to Agency 2 weeks prior to review. Yes. No. First Health CSR calls Agency to confirm receipt of notification letter.

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Did Agency Receive Letter?

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Did agency receive letter

Start Establish Annual Review Calendar

Sample

5% Random Sample

Upload State Sample Data into Review Database

Did Agency Receive Letter?

Send Review Notification Letter to Agency 2 weeks prior to review

Yes

No

First Health CSR calls Agency to confirm receipt of notification letter

First Health CSR provides verbal notification and faxes letter to Agency

Entrance Conference

1. Review process explained

2. 1st day’s sample provided

3. NCI Agency surveys distributed

4. NCI Consumer Survey Pre-Surveys distributed

5. Agency administrative review initiated

Are any findings overturned?

No

Yes

Overturned indicators corrected in remote database

Administrative Review completed

Administrative Reconsideration Conference conducted

Concurrent Process

Agency provides service files and completed NCI Pre-Surveys

NCI Consumer Surveys initiated

First Health interviewer coordinates obtaining consents and appointments with agency staff, individuals, and legally responsible family/advocates

Review of services initiated

Are any findings overturned?

No

Services Reconsideration Conference conducted

Yes

Overturned indicators corrected in remote database

A

B


Did agency receive letter

B

A

Was review of 5% sample completed?

Did any events require mandated reporting?

No

No

Yes

Yes

Next review sample provided to agency

First Health makes mandated reports to all applicable agencies

Review of services continues

Services Reconsideration Conference conducted

Did individual or legal representative request direct communication to agency?

No

Are any findings overturned?

No

Yes

First Health provides immediate report to state agency

Yes

Exit Conference

1. Administrative findings/trends reviewed

2. Service findings/trends reviewed

3. Consumer Interview s trends reviewed

4. Follow-up procedures reviewed

Overturned indicators corrected in remote database

Report of Findings

Sent to provider agency and state agency 30 days following Exit Conference

1. Agency review findings

2. De-identified NCI Consumer Survey outcomes

3. Recommendations

4. Plan of Correction template for each recommendation

Does provider agency appeal findings?

Appeal

State agency, supported by First Health, conducts Appeal

Yes

No

C


Did agency receive letter

C

Plans of Correction

Provider agency develops action steps to address findings ... due to First Health within 30 days of receipt of Report of Findings

Agency resubmits Plans of Correction

Did First Health approve submitted Plans of Correction?

Technical Assistance

First Health provides technical assistance to enhance Plans of Correction

No

Yes

Follow-Up Review

First Health conducts onsite Follow-Up Review within 120 days of approval of Plans of Correction

Follow-Up Report

Sent to provider agency and state agency 30 days following Follow-Up Review

Was agency compliant implementing POCs?

Technical Assistance

First Health provides technical assistance

No

Yes

Quarterly Reports

First Health provides state agency with Quarterly Report that includes aggregate quarterly and year-to-date review findings, statewide trends, and conclusions

Annual Report

First Health provides state agency with Annual Report that includes:

1. Aggregate annual review findings

2. Statewide trends/analysis

3. NCI Consumer Survey data

4. NCI Provider Survey data

5. NCI Family Survey data

6. Data analysis

7. Crosswalk with CMS HCBS Quality Framework

Outcomes / Systemic Recommendations

Repeat Process


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