Appendix C Case Management Agency Administrative Review Tool.pdf
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- Attached to
- SEP Services: Chaffee and Lake Counties
- Solicitation number
- RFP UHAA 2015000076 2
- Issued by
- Chaffee County, Denver City, Colorado
About this file
This is an Administrative Review Tool document issued by the Colorado Department of Health Care Policy and Financing for Solicitation RFP UHAA 2015000076, used to monitor case management agencies operating under a Medicaid waiver program. The tool serves as a compliance assessment instrument that evaluates whether contracted case management agencies meet state administrative requirements and operational standards. The review covers 26 key performance areas assessed on a yes/no/N/A basis, with each item worth 2.78 points toward a total possible score, and is conducted by designated reviewers on specified review dates.
The administrative monitoring tool evaluates critical operational functions including staff qualifications and screening, personnel management systems, client record maintenance, use of required information management systems, and client service accessibility. Additionally, the tool assesses contractor compliance with insurance requirements (including worker's compensation, general liability, and automobile liability coverage), HIPAA regulations, federal funding requirements under OMB Circular A-133, conflict of interest standards, and debarment certifications. The assessment framework ensures that case management agencies maintain proper administrative authority oversight, verify monthly service delivery to clients, protect client rights, maintain appropriate business office operations with accessible telecommunications, and submit required documentation to the Department in accordance with contractual obligations.
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Text version
Colorado Department of
Health Care Policy and Financing
SOLICITATION #:
RFP UHAA 2015000076
Appendix C
CASE MANAGEMENT AGENCY ADMINISTRATIVE
REVIEW TOOL
APPENDIX C Page 1 of 3
APPENDIX C, CASE MANAGEMENT AGENCY ADMINISTRATIVE REVIEW TOOL
ADMINISTRATIVE MONITORING TOOL
Agency Name:
Reviewed By:
Review Date:
Assurance: Administrative Authority
The Medicaid Agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local non-state agencies (if appropriate) and contracted entities.
Yes/No/ N/A PTS
1. Case Managers meet the qualifications as outlined in State regulation 0
2. Case Managers have been screened (e.g. drug screening, background checks) and are appropriate for employment as defined by the agency 0
3. Agency administers a personnel system for recruiting, hiring, evaluating, and terminating employees 0
4. If required by the contract, agency staffs a licensed medical professional 0
5. If required by the contract, the agency follows standards as set forth by the Department through DALs and written documents from Department sanctioned trainings 0
6. Agency completed QIS-mandated sample review of cases within required timeframes (Program Tool) 0
7. If required by the contract, agency has identified provider resource gaps and taken action to address 0
8. If required by the contract, agency has an established resource development committee and has a summary of activities available 0
9. Agency has a method of verifying that clients have received at least one waiver service each month 0
10. Agency maintains client records in accordance with program requirements, including documentation of all case activities, the monitoring of service delivery, and service effectiveness 0
APPENDIX C Page 2 of 3
11. The contractor uses the BUS for the purpose of client information management 0
12. Clients rights are protected as it pertains to the terms of the contract 0
13. Clients have access to the office during regular business office hours 0
14. Agency provides a telephone system and trained staff to:
a. Timely respond to messages 0
b. Provide access to telecommunication devices and/or interpreters for the hearing and/or vocally impaired 0
c. Provide access to foreign language interpreters as needed 0
15. Case management functions are performed according to the contract or provider agreement 0
16. The agency assisted in the administration of the most recent annual client satisfaction survey 0
17. Contractor submits Department-required information electronically as scheduled or upon Department's request 0
18. If required by the contract:
a. Insurance is maintained in the correct amounts 0
b. Worker's compensation coverage is available as required by state statute 0
c. Employer's liability insurance as required by state statute 0
d. Commercial general liability with minimum limits as specified in the contract and with the state as an additional insured 0
e. Automobile liability insurance with minimum limits as specified in the contract with the State as an additional insured 0
f. Insurance policies include language preventing the cancellation or nonrenewal without at least 45 days prior notice to the Department 0
g. Insurance policies include clauses stating that each carrier will waive all rights of recovery, under subrogation or otherwise, against the State of Colorado, its agencies, institutions, organizations, officers, agents, employees, and volunteers 0
h. The issuing insurance companies have a satisfactory standing with the State 0
i. Certificates showing insurance coverage were submitted to the Department within 7 business days of the effective date of the contract 0
APPENDIX C Page 3 of 3
19. In the event that the contractor subcontracts with other entities or organizations to perform duties outlined in the contract, that contractor has secured express written consent of the Department 0
20. Contractor complied with the Reporting requirements as specified in the contract 0
21. Contractor complies with HIPAA 0
22. If the Contractor received $500,000 or more of Federal Funds from all sources, the contractor has complied with the provisions of OMB Circular No. A- 133 0
23. During the term of this contract, the Contractor did not engage in any business or personal activities or practices or maintain any relationships which conflict in any way with the Contractor fully performing his/her obligations under this contract 0
24. The Contractor refrained from any practices, activities or relationships which could reasonably be considered to be in conflict with the Contractor's ability to fully perform the obligations to the Department under the terms of this contract 0
25. The Contractor (and subcontractors or subgrantees permitted under the terms of this contract) maintained a written code of standards governing the performance of its employees engaged in the award and administration of contracts 0
26. If this is a covered transaction as defined by the State Controller or the contract amount exceeds $100,000, the Contractor certified to the best of its knowledge and belief that it and its principals and subcontractors are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or agency 0
Grading: Each question is worth 2.78 pts. "Yes" or "N/A" (when applicable) is worth 2.78 pts, "No" is worth 0 pts. Total Score: 0
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