Exhibit 8 - Medical Audit Tool.xlsx

XLSX spreadsheet 433 KB Posted Jul 13, 2026

Attached to: Medical and Mental Health Services
Solicitation number: 1301
Issued by: Idaho

About this file

Written by GovTribe AI · Aug 31, 2026

This file is a Medical Audit Tool spreadsheet developed by the Idaho Department of Correction for evaluating Value Based Care Performance across IDOC facilities. The document establishes a comprehensive quarterly audit framework with 25 distinct audit categories designed to assess medical service delivery quality and compliance. The audit tool encompasses credentialing and training standards, discharge planning procedures, receiving and diagnostic unit screening protocols, sick call services across general population and restrictive housing units, off-site care management, periodic health assessments for aging residents, chronic disease programs for diabetes, chronic kidney disease, HIV, and cirrhosis, dental and oral care, tuberculosis screening and treatment, vaccination programs, hepatitis C monitoring, infection control, peer review, and resident education. Each audit category specifies detailed performance thresholds ranging from 90% to 100% compliance, with weighted scoring allocations and specific clinical quality indicators that medical vendors must satisfy.

The audit tool functions as a performance measurement mechanism to hold contracted medical service vendors accountable to IDOC standards. Each audit includes specific populations sampled, clinical criteria to be evaluated, documentation requirements, and templated data collection sheets for recording individual resident encounters. The framework requires chart review documentation, vendor reporting, and IDOC dashboard tracking of compliance metrics. The tool demonstrates IDOC's emphasis on clinical outcomes, patient safety, continuity of care, medication management, specialty referral processes, and preventive health services. Several audit categories specifically target vulnerable populations including pregnant residents, individuals in long-term care settings, those receiving infirmary services, and residents undergoing observation protocols. The audit thresholds and weighted scoring structure indicate that IDOC will use this tool to evaluate vendor performance during contract execution and potentially tie payment or contract renewal to achievement of these quality standards.

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Summary Idaho Department of Correction Value Based Care Performance Audits

Summary of Audit Information

		Audit
Number	Audit Period
			Quarter 1 20XX
			Overall Score	ERROR:#DIV/0!
				Threshold	Audit Results
		1	Credentialing and Training	100%	ERROR:#DIV/0!
		2	Discharge Planning	90%	ERROR:#DIV/0!
		3	RDU Screening	95%	ERROR:#DIV/0!
		4	Sick Call GP	95%	ERROR:#DIV/0!
		5	Sick Call Segregation	95%	ERROR:#DIV/0!
		6	Sick Call RDU	95%	ERROR:#DIV/0!
		7	Off-Site Care	90%	ERROR:#DIV/0!
		8	Periodic Health Assessment	90%	ERROR:#DIV/0!
		9	CDP - Diabetes	95%	ERROR:#DIV/0!
		10	CDP - CKD	95%	ERROR:#DIV/0!
		11	CDP - HIV	95%	ERROR:#DIV/0!
		12	CDP - Cirrhosis	95%	ERROR:#DIV/0!
		13	Oral Care	90%	ERROR:#DIV/0!
		14	TB Screening and Treatment	98%	ERROR:#DIV/0!
		15	Vaccination Program	98%	ERROR:#DIV/0!
		16	Pregnant Resident	95%	ERROR:#DIV/0!
		17	Long Term Care	95%	ERROR:#DIV/0!
		18	Infirmary	95%	ERROR:#DIV/0!
		19	23-Hour Observation	95%	ERROR:#DIV/0!
		20	Hepatitis C Monitoring	95%	ERROR:#DIV/0!
		21	Transfer Screening	90%	ERROR:#DIV/0!
		22	Diagnostics	90%	ERROR:#DIV/0!
		23	Infection Control & CQI	95%	ERROR:#DIV/0!
		24	Peer Review	95%	ERROR:#DIV/0!
		25	Resident Education	98%	ERROR:#DIV/0!

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

01 Credentialing Training

Idaho Department of Correction Value Based Care Audit
Audit No:	1	Credentialing and Training	Audit Date:
Threshold:	100%		Audit Type:	MED QTR (X)
Weight:	2%		Auditor:
Medical vendor shall supply IDOC with a full roster of all vendor staff employed at each site during the audit period.

The term "vendor staff" includes any person providing services on behalf of the vendor to include vendor employees, agency staff, telehealth staff, and all on-site specialty contract staff.

	Q1	All staff completed IDOC contractor training (first available training after hire, including agency staff)
	Q2	All staff are CPR/AED certified; The CPR course must have a verified hands-on component
	Q3	All staff have documented Naloxone rescue administration training
	Q4	A current license, certification, or registration is on file for all RNs, LPNs, dental hygienists and any other healthcare professionals who are required to obtain or maintain a professional licensure, certification, or registration (Includes Correctional Medical Specialists and Unlicensed Assistive Personnel who administer medications)
	All Practitioners to include Medical Doctors, Doctors of Osteopathy, Psychiatrists, Nurse Practitioners, Physician Assistants, Dentists, Optometrists, and/or other applicable licensed practitioners must have documentation of current:
	Q5	All Medical vendor providers (physician, NP, PA) are registered as Idaho Medicaid providers within 90 days of hire
	Q6	Board of Pharmacy Licensure
	Q7	Unrestricted DEA/Controlled Substance Registration
		Chart Review:		No							Total	0
		Report (Vendor):		Yes							Denom	0
		Dashboard (IDOC):		No							%	ERROR:#DIV/0!
						Q1	Q2	Q3	Q4	Q5	Q6	Q7
		SITE	NAME	TITLE	DATE OF
HIRE	DATE OF
TERM	IDOC
TRAIN	CPR/AED
TRAIN	NARCAN
TRAIN	LICENSE
CERTIF	MEDICAID
REGIST	BOP
LICENSE	DEA/CS
REGIST		NOTES
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_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

02 Discharge Planning

Idaho Department of Correction Value Based Care Audit

Audit No:

Discharge Planning

Audit Date:

Threshold:

90%

Audit Type:

MED - QTR X

Weight:

Auditor:

Population Sampled: The IDOC DIG will provide the names of 100 residents released over the relevant audit period.

Residents discharged to the community are provided with:

30 day supply of all current oral medications (7 day supply for narcotic medication)

30 day script for all current oral medications (7 day script for narcotic medication) - Script not required for OTC medications

Current Medication List to include medication name, dosage, administration instructions, and reason for use (i.e. associated diagnosis)

Updated Problem List - Reflects all current medical, mental health, dental and substance use disorder diagnosis

Medical supply and equipment needs (diabetic supplies, mobility devices, wound care supplies, C-Pap, etc.) eyeglass prescription and naloxone (intranasal device and script) are documented and provided. Note: Naloxone is required only for residents diagnosed with a substance use disorder.

Summary of vaccines received (to include dates received) over the last 5 years of incarceration

Need for appointments: Follow-up type and time frame is included

Contact information (phone number) for appropriate clinics, based on reported district and/or city of discharge, is provided to resident

Medicaid application completed: Application submitted, or if previously active, is now in suspended mode. If ineligible, documentation of plan for health insurance at release is provided.

Chart Review:

Yes

Num

Report (Vendor):

Denom

Dashboard (IDOC):

ERROR:#DIV/0!

SITE

NAME

IDOC #

DISCH

DATE

30 DAY SUPPLY

7-NARC

30 DAY SCRIPT

7-NARC

CURRENT

MED

LIST UPDATED

PROB

LIST EQUIP

NARCAN

EYEGLASS VACCINES

ADMIN

5 YRS	F/U APPT TYPE
TIME	CMTY

CONTACT

INFO	MEDICAID INSUR
PLAN		Notes
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&8This material is property of the IDOC and is not to be reproduced without expressed permission Last revised on 11/15/10

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

03 RDU Screen

Idaho Department of Correction Value Based Care Audit

Audit No:

Receiving and Diagnostic Unit (RDU) Screen

Date of Audit:

Threshold:

95%

Type of Audit:

MED QTR (X)

Weight:

Auditor:

Population Sampled: The IDOC DIG will provide the names of 100 residents who processed through RDU (ISCI, PWCC, SBWCC) in the relevant audit period.

Initial medical history and screen (includes vital signs and actual weight)

Laboratory testing: CMP, CBC, HIV, RPR, HCV, A1C and Quantiferon Gold are drawn within 72 hours of arrival (Excl wknd & hol)

Laboratory results are reviewed by a provider prior to discharge from the intake facility

Positive HIV ab and/or positive T-PAL are reviewed with resident (FTF) within 72 hours of result (Excl wknd & hol, Known HIV = NA)

Initial Health Assessment completed by provider within 7 days of arrival

Identified Problems (diagnosis) are documented on the Problem List

Referrals are made to the appropriate modality (i.e., Chronic Disease Program, Mental Health, Off-site Specialty services, etc.)

Initial dental screen is performed by a dentist within 7 calendar days of arrival

MOUD are continued within 24 hours of arrival

Q10

MOUD: COWS scoring is ordered and completed (if not ordered, clinical justification is present)

Chart Review:

Yes

Total

Report (Vendor):

Denom

Dashboard (IDOC):

ERROR:#DIV/0!

Q10

SITE

NAME

IDOC#

RDU

ADMIT

DATE MEDICAL SCREEN LABS 72 HOURS LABS REVWD HIV

T-PAL

72 HRS	INITIAL PHA	PROB LIST	REFER
PRN	DENTAL SCREEN	MOUD CONT
24 HRS	COWS ORDERED & DONE		Notes
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_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

04 Sick Call GP

	Idaho Department of Correction Value Based Care Audit
	Audit No:	4	Non-Emergency Healthcare Services
General Population			Date of Audit:
	Threshold:	95%		Type of Audit:	MED QTR (X)
	Weight:	6%		Auditor:
	Population Sampled: The IDOC Health Services will review facility specific GP sick call logs reporting any resident who submitted a Health Service Request (HSR) detailing a clinical sign or symptom, in the relevant audit period, as obtained from the electronic health record.

Based on the above list, The IDOC DIG will provide the names of 135 residents housed in GP who submitted a Health Service Request (HSR) detailing a clinical sign or symptom over the relevant audit period.

KPI	1. Face-to-face encounter within 24 hours							Percentage Based Score
	Percentage of Health Service Request's (HSR's) received and addressed within 24 hours of HSR triage						ERROR:#DIV/0!	Indicator	Score	Weight
	Total number of Health Service Requests received that detailed a clinical sign or symptom							1	ERROR:#DIV/0!	15%
	Total number of Health Service Requests received that detailed a clinical sign or symptom and were subsequently addressed via a face-to-face encounter within 24 hours of triage							2	ERROR:#DIV/0!	85%
Residents who submit a Health Service Request detailing a clinical sign, symptom, or complaint are evaluated in Nurse Sick Call within 24 hours of triage and their medical record reflects the following:								Weighted Average		ERROR:#DIV/0!
Q1	Vital Signs (T, R, P, BP, O2 Sat) completed and documented on NET or in Provider Sick Call Encounter
Q2	Assessment is conducted and is specific to the presenting complaint
Q3	Appropriate Plan and intervention occurs according to the NET Guidelines (Actions & Referral: emergent, urgent, routine, none)
Q4	Provider visit (when referred from NSC) occurs timely, according to NET guidelines (Emerg/Urg = contact provider, rout = 14d)
Q5	If resident did not attend their provider referral appointment, a Medical Response Disposition form (MRD) is sent to the resident notifying them of their missed appointment with instructions regarding next steps (ex: resubmit HSR, rescheduled, etc.)
				Weighted Average	ERROR:#DIV/0!
	Chart Review:		Yes			Total	0
	Report (Vendor):		No			Denom	0
	Dashboard (IDOC):		No			%	ERROR:#DIV/0!
SITE		NAME	IDOC#	DATE

HSR #	Q1	Q2	Q3	Q4	Q5
						VS	ASSESS	PLAN
REFERRAL	PROVIDER
VISIT	NO VISIT
DOC		Notes
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05 Sick Call Seg

	Idaho Department of Correction Value Based Care Audit
	Audit No:	5	Non-Emergency Healthcare Services
Restrictive Housing Unit (RHU)		Date of Audit:
	Threshold:	95%		Type of Audit:	MED QTR (X)
	Weight:	3%		Auditor:
	Population Sampled: The IDOC Health Services will review facility specific RHU sick call logs reporting any resident who submitted a Health Service Request (HSR) detailing a clinical sign or symptom, in the relevant audit period, as obtained from the electronic health record.

Based on the above list, The IDOC DIG will provide the names of 40 residents housed in RHU who submitted a Health Service Request (HSR) detailing a clinical sign or symptom over the relevant audit period.

KPI	1. Face-to-face encounter within 24 hours
	Percentage of Health Service Request's (HSR's) received and addressed within 24 hours of HSR triage						95%	Indicator	Score	Weight
	Total number of Health Service Requests received that detailed a clinical sign or symptom						100	1	95%	15%
	Total number of Health Service Requests received that detailed a clinical sign or symptom and were subsequently addressed via a face-to-face encounter within 24 hours of triage						95	2	ERROR:#DIV/0!	85%
Residents who submit a Health Service Request detailing a clinical sign, symptom, or complaint are evaluated in Nurse Sick Call within 24 hours of triage and their medical record reflects the following:								Weighted Average:		ERROR:#DIV/0!
Q1	Vital Signs (T, R, P, BP, O2 Sat) completed and documented on NET or in Provider Sick Call Encounter
Q2	Assessment specific to the presenting complaint
Q3	Appropriate Plan/intervention according to sick call encounter guidelines (referral - emergent, urgent, routine, none)
Q4	Provider visit (when applicable) is conducted according to sick call encounter guidelines (Emerg/Urg = contact provider, rout = 14d)
Q5	If resident did not attend their provider referral appointment, a Medical Response Disposition form (MRD) is sent to the resident notifying them of their missed appointment with instructions regarding next steps (ex: resubmit HSR, rescheduled, etc.)
				Weighted Average:	ERROR:#DIV/0!
	Chart Review:		Yes			Total	0
	Report (Vendor):		No			Denom	0
	Dashboard (IDOC):		No			%	ERROR:#DIV/0!
SITE		NAME	IDOC#	DATE

HSR #	Q1	Q2	Q3	Q4	Q5
						VS	ASSESS	PLAN
REFERRAL	PROVIDER
VISIT	NO VISIT
DOC		Notes
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06 Sick Call RDU

	Idaho Department of Correction Value Based Care Audit
	Audit No:	6	Non-Emergency Healthcare Services
Reception and Diagnostic unit			Date of Audit:
	Threshold:	95%		Type of Audit:	MED QTR (X)
	Weight:	1%		Auditor:
	Population Sampled: The IDOC Health Services will review facility specific RDU sick call logs reporting any resident who submitted a Health Service Request (HSR) detailing a clinical sign or symptom, in the relevant audit period, as obtained from the electronic health record.

Based on the above list, The IDOC DIG will provide the names of 25 residents housed in RDU who submitted a Health Service Request (HSR) detailing a clinical sign or symptom over the relevant audit period.

KPI	1. Face-to-face encounter within 24 hours							Percentage Based Score
	Percentage of Health Service Request's (HSR's) received and addressed within 24 hours of HSR triage						95%	Indicator	Score	Weight
	Total number of Health Service Requests received that detailed a clinical sign or symptom						100	1	95%	15%
	Total number of Health Service Requests received that detailed a clinical sign or symptom and were subsequently addressed via a face-to-face encounter within 24 hours of triage						95	2	ERROR:#DIV/0!	85%
Residents who submit a Health Service Request detailing a clinical sign, symptom, or complaint are evaluated in Nurse Sick Call within 24 hours of triage and their medical record reflects the following:								Weighted Score:		ERROR:#DIV/0!
Q1	Vital Signs (T, R, P, BP, O2 Sat) completed and documented on NET or in Provider Sick Call Encounter
Q2	Assessment specific to the presenting complaint
Q3	Appropriate Plan/intervention according to sick call encounter guidelines (referral - emergent, urgent, routine, none)
Q4	Provider visit (when applicable) is conducted according to sick call encounter guidelines (Emerg/Urg = contact provider, rout = 14d)
Q5	If resident did not attend their provider referral appointment, a Medical Response Disposition form (MRD) is sent to the resident notifying them of their missed appointment with instructions regarding next steps (ex: resubmit HSR, rescheduled, etc.)
				Weighted Average:	ERROR:#DIV/0!
	Chart Review:		Yes			Total	0
	Report (Vendor):		No			Denom	0
	Dashboard (IDOC):		No			%	ERROR:#DIV/0!
SITE		NAME	IDOC#	DATE

HSR #	Q1	Q2	Q3	Q4	Q5
						VS	ASSESS	PLAN
REFERRAL	PROVIDER
VISIT	NO VISIT
DOC		Notes
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07 Off-Site Care

Idaho Department of Correction Value Based Care Audit
Audit No:		7	Off-Site Care		Date of Audit:
Threshold:		90%			Type of Audit:	MED QTR (X)
Weight:		5%			Auditor:
Population Sampled: Based on information provided from the previous quarter's consult request log, 100 resident charts with non-emergency room off-site consults will be randomly selected for review across the Idaho Department of Correction, with queries proportional to the number of residents in each facility.
Residents who require specialized healthcare needs that extend beyond the medical clinics provided on-site are referred to a community specialist and their medical record reflects the following:
Q1	Utilization Management decision is made within 5 business days of request (obtained from consult log)
Q2	ATP Determination: Provider must review ATP with patient, or send a MRD (with plan) within 14 days of ATP determination
Q3	Scheduling: Urgent appointments are secured and documented in the medical record within 7 days of UM approval AND routine appointments are secured and documented in the medical record within 30 days of UM approval.
Q4	Vital Signs (T, R, P, BP, O2 Sat, Wt) and Return from Offsite evaluation are completed by a Registered Nurse (If RN not avail, LPN can conduct - must notify provider)
Q5	Reason for offsite appointment is documented in the Return From Offsite encounter form
Q6	Offsite specialty consults, recommendations, and/or reports are filed in the medical record within 14 days of the offsite appointment
Q7	Specialist consult, recommendations, and/or report is reviewed with the patient in a face-to-face encounter within 14 calendar days of the offsite appointment
Q8	Deviation from offsite specialist consult recommendations: Clinical justification is required within 14 days
Q9	Informed refusal signed by the resident and licensed staff member (applicable if resident refused offsite consult)
	Chart Review:			Yes		Total	0
	Report (Vendor):			Yes		Denom	0
	Dashboard (IDOC):			No		%	ERROR:#DIV/0!
SITE		NAME	IDOC#	OFFSITE VISIT

ATP DATE	TYPE OF SERVICE	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9
							UM APPROV
OR ATP	ATP DISC OR MRD
14D	APPT SECURED 7D/30D	VS
RETURN EVAL	REASON OFFSITE
DOC	REPORT

FILED

14 DAYS	SPEC REC REV W/ PT 14D	DEV SPEC REC	REFUSAL	Notes
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

08 Periodic Health Assmt

Idaho Department of Correction Contract Performance Measure Audit
Audit No:	8	Periodic Health Assessment - Care of the Aging	Date of Audit:
Threshold:	90%		Type of Audit:	MED QTR X
Weight:	5%		Auditor:
Population Sampled:

IDOC DIG will provide the names of 100 residents aged 50 and older whose birth month occurred in the relevant audit period. Residents sentenced to a rider are exempt, regardless of age.

Periodic Health Appraisal (PHA) offered in the residents' birth month (age 50 and over)

Signed and Dated PHA Consent or Refusal is documented in the medical record.

PHA is completed by last day of the month following the residents birthday month. (i.e., Birthday is June, PHA must be completed by July 31st). Must contain narrative documentation of abnormal findings.

Periodic Health Appraisal Encounter must include the following:

Complete set of Vital Signs - Temp, Respirations, Pulse, Blood Pressure, O2 Saturation, and Weight (Actual/not stated)

Provider review of Vital Signs (last 12 months) - Document findings generally, if abnormal, the plan/intervention is documented.

Weight management review with recommendations for intervention if >5% weight loss or gain in the last twelve (12) months

Vaccine review is documented, recommended vaccines are offered as appropriate, including but not limited to Shingrix, RSV, Pneumococcal. (Vaccine administration will be captured on audit tool 15)

Vision Screen - Snellen (with or without glasses)

Hearing Screen (Whisper or other)

Q10

If FAIL Hearing Screen - referral to audiology

Q11

Review of systems conducted

Q12

Medication/Polypharmacy review conducted by a provider

Q13

Functional Activities of Daily Living Assessment Conducted

Q14

Cognitive Screen conducted/scored. Score of < 3 validated for dementia screening. If score <3 proceed to Q15

Q15

Cognitive Screen < 3 Patient enrolled <30d in CDP Special Needs/Cognitive Decline - Documented review for appropriateness of KOP medication

Q16

Fall Risk Assessment conducted, and documented. IF PASS - Continue to Q17 Timed Get Up and Go. If FAIL, SKIP Q17 Timed Get Up and Go, proceed to Q18.

Q17

Timed Get Up and Go test is conducted and results documented. If AT-RISK/FAIL, Continue to Q18 Fall Prevention Measures. If PASS, proceed to Q19.

Q18

Document fall prevention measures for FAILED Fall Risk Assessment or AT-RISK/FAILED Timed Get up and Go

Q19

POST form is discussed with patient, completed, and filed in medical chart. The resident EHR banner shall reflect the resident's current POST preferences. If resident elects not to complete a POST form, provider should note declination in the PHA; A signed refusal form is not required.

Chart Review:

Yes

Total

Report (Vendor):

Denom

Dashboard (IDOC):

ERROR:#DIV/0!

Q10

Q11

Q12

Q13

Q14

Q15

Q16

Q17

Q18

Q19

SITE

NAME

IDOC#

Date

of Birth

Date of PHA

Birth Offer

Con/ Ref

PHA Comp

Vitals Done

12 mo Vital Rev

Wt Mngt

Vacc

Vision

Hear

Aud

Ref

Rev of Syst

Poly Rx Rev

ADL

Mini Cog

Cog CDP if appl.

Fall Risk Asmt.

Get up Go

Failed Fall Risk TGUG

POST

NOTES:

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

09 CDP - DM CALC2

Idaho Department of Correction Value Based Care Audit

Audit No:

Chronic Disease Program

Diabetes Mellitus

Audit Date:

Threshold:

95%

Audit Type:

MED QTR (X)

Weight:

Auditor:

Population Sampled: The IDOC DIG will maintain an internal dashboard that identifies all residents with a history of a HbA1c of 6.5 or greater, or a diagnosis of diabetes. Key performance indicators will be measured based on residents who have a HbA1c of 6.5 or greater and individual chart reviews will be conducted on residents who have 2 HbA1c values 9.0 and above obtained at least 12 weeks apart.

KPI

1. HbA1c

Indicator

Score

Weight

Percentage of HbA1C completed in the six (6) months

100%

12.50%

Total number of residents with an A1C greater 6.5

100

100%

12.50%

Total number of residents with an A1c greater than 6.5 who had an A1C drawn in the last 6 months

100

100%

12.50%

KPI

2. Statin

100%

12.50%

Percentage of Statins prescribed for individuals between the ages of 40 and 75

100%

ERROR:#DIV/0!

50.00%

Total number of residents with an A1C greater 6.5

100

Weighted Average

ERROR:#DIV/0!

Total number of residents, between the ages of 40 and 75, with an A1C greater than 6.5 prescribed a statin

100

KPI

3. BP Average

Percentage of individuals whose BP average is less than 140/90 over the last 3 months

100%

Total number of residents with an A1C greater 6.5

100

Total number of residents with an A1C greater than 6.5 whose BP average is less than 140/90 over the last 3 months

100

KPI

4. Microalbumin

Percentage of Urine microalbumin completed in the last 12 months

100%

Total number of residents with an A1C greater 6.5

100

Total number of residents with an A1c greater than 6.5 who had a Urine Microalbumin completed in the last 12 months

100

For those with an A1C of 9.o and above, a chart review will be conducted to assess:

Active Insulin prescription (or signed, informed refusal by documenting provider)

Diabetic retinopathy screening within the last 12 months (dilated eye exam)

Time between CDP visits does not exceed 90 days

WEIGHTED AVERAGE:

ERROR:#DIV/0!

Chart Review:

Yes

Num

Report (Vendor):

Denom

Dashboard (IDOC):

Yes

ERROR:#DIV/0!

INFO

SITE

NAME

IDOC #

DATE

DX	MOST RECENT
A1C DATE	A1C
VALUE	INSULIN
RX	DEE
DATE	DEE
DONE	DATE

LAST

CDP	CDP 90D	Notes
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15

10 CDP - CKD

	Idaho Department of Correction Value Based Care Audit
	Audit No:	10	Chronic Disease Program
Chronic Kidney Disease			Audit Date:
	Threshold:	95%		Audit Type:	MED QTR (X)
	Weight:	2%		Auditor:
	Population Sampled: The IDOC DIG will maintain an internal dashboard that identifies all residents with a history of chronic kidney disease. Key Performance Indicators will be measured based on two glomerular filtration rate (GFR) values below 60, obtained at least twelve weeks apart.

Individual chart reviews will be conducted on residents who have 2 GFR values below 30, obtained at least twelve weeks apart.

KPI

1. Creatinine/eGFR:

Indicator

Score

Weight

Percentage of residents with a GFR rate <60 who had a Creatinine and GFR level drawn in the last 6 months.

100%

25.00%

Total number of residents with a GFR rate <60

100

100%

25.00%

Total number of residents with an eGFR rate below 60 who had a GFR and creatinine level drawn in the last 6 months

100

ERROR:#DIV/0!

50.00%

KPI

2. Urine Microalbumin

Weighted Average:

ERROR:#DIV/0!

Percentage of residents with a GFR rate <60 who had a Urine Microalbumin level drawn in the last 6 months.

100%

Total number of residents with a GFR rate < 60

100

Total number of residents with an eGFR rate <60 who had a Blood Microalbumin level drawn in the last 6 months

100

For those with an eGFR less than 30, a chart review will be done to assess:

Nephrology consult completed within the last 12 months (See exceptions for new DX and Dialysis)

No current nephrotoxic medications are prescribed (Absence = 1, Presence = 0)

Time between CDP visits does not exceed 90 days

WEIGHTED AVERAGE:

ERROR:#DIV/0!

Chart Review:

Yes

Num

Report (Vendor):

Denom

Dashboard (IDOC):

Yes

ERROR:#DIV/0!

INFO

SITE

NAME

IDOC #

NEPHRO CONSULT

DATE

NEPHRO

CONSULT

N-TOXIC MED

NSAIDS

NO = 1

YES = 0	DATE LAST CDP	CDP
90D		NOTES
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10

11 CDP - HIV

Idaho Department of Correction Value Based Care Audit

Audit No:

Chronic Disease Program

Human Immunodeficiency Virus

Audit Date:

Threshold:

95%

Audit Type:

MED QTR (X)

Weight:

Auditor:

Population Sampled: The IDOC DIG will maintain an internal dashboard that identifies all residents who have a diagnosis of Human Immunodeficiency Virus (HIV). Individual chart reviews will be conducted on all HIV positive residents.

Residents with an HIV or AIDS diagnosis are routinely monitored by on-site providers and specialists to monitor for progression of disease and their medical record reflects the following:

Viral Load Suppression: VL not detectable in the relevant audit period (ND= 1, det = 0)

HIV medications prescribed without lapse in the last 12 months

Pneumococcal vaccine up to date

Hepatitis B vaccine up to date

HIV specialist consult completed in the last 12 months

HIV Specialist consult recommendations are reviewed with the resident in a face-to-face encounter within 14 calendar days of the HIV Specialty appointment

HIV Specialist recommendations completed (Medication, diagnostic testing, and immunizations)

Dental assessment conducted in the last 12 months.

Baseline chest X-ray is completed and reviewed by a provider (within 30 days of arrival to intake facility)

Chart Review

Yes

Num

Report (Vendor):

Denom

Dashboard (IDOC):

Yes

ERROR:#DIV/0!

INFO

SITE

NAME

IDOC #

VIRAL

LOAD

DATE NEG

VIRAL

LOAD	HIV MED RX NO LAPSE	PNEUMO VAC	HBV
VAC	HIV/ID CONSULT
DATE	HIV CONSULT
Q 12 MOS	CONSULT
REV W/ PROVIDER	HIV SPEC

REC DIAG/

LAB	DENTAL ASSESS
DATE	DENTAL ASSMT
Q 12 MOS	CXR 30 D OF INTAKE	COMMENTS
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16

12 CDP - Cirrhosis

Idaho Department of Correction Value Based Care Audit

Audit No:

Chronic Disease Program

Cirrhosis

Audit Date:

Threshold:

95%

Audit Type:

MED QTR (X)

Weight:

Auditor:

Population Sampled: The IDOC DIG will maintain an internal dashboard, that identifies all residents who have a history of Cirrhosis, to include other qualifiers such as an F4 fibrotest score, hepatic encephalopathy, esophageal varices, alcoholic cirrhosis, and/or any other cirrhosis related diagnosis codes documented in the EMR. This audit includes residents housed in Community Release Centers but excludes residents participating in the expanded release CRC program.

Residents with Fibrotest score of F4, and/or cirrhosis, hepatic encephalopathy, or esophageal varices are routinely monitored by on-site providers and receive routine diagnostic testing to monitor for Hepatocellular Carcinoma and their medical record reflects the following:

Cirrhosis diagnosis documented on problem list (Current Health Status tab)

Ultrasound for HCC screening completed in last 6 months

No active prescriptions for NSAIDs (NO = 1, YES = 0)

Variceal screening by EGD completed (baseline) and per Hepatologist or Gastroenterologist recommendations thereafter

Chart Review:

Yes

Num

Report (Vendor):

Denom

Dashboard (IDOC):

Yes

ERROR:#DIV/0!

INFO

SITE

NAME

IDOC #

FIBRO

SCORE OR OTHER DX

CIRR

ON PL

COMP

DECOMP ULTRA

SOUND

DATE ULTRA

SOUND

Q 6MOS	NSAID
TYPE	NSAIDS

NO = 1

YES = 0	EGD
DATE	EGD
RECS	EGD
BASELINE & PER RECS		COMMENTS
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15

13 Oral Care

Idaho Department of Correction Value Based Care Audit
Audit No:	13	Oral Care	Date of Audit:
Threshold:	90%		Type of Audit:	MED QTR (X)
Weight:	3%		Auditor:
Population Sampled: The IDOC DIG will maintain an internal dashboard that identifies all residents who submitted a denture related health Service Request (HSR).

The IDOC Health Services will review facility specific dental sick call logs reporting any resident who submitted a Health Service Request (HSR) detailing the need for dental treatment, in the relevant audit period, as obtained from the electronic health record.

	KPI	1. Dentures:							Indicator	Score	Weight
		Percentage of dentures completed within 8 months of final extraction (6 mos if no extract)						100%	1	100%	25%
		Total number of residents who requested dentures						100	2	ERROR:#DIV/0!	75%
		Total number of residents who requested and received dentures within 8 months of final extraction (6 mos if no extract)						100	Weighted Average:		25%
	Residents who submit a Health Service Request detailing routine, urgent, or emergent needs, including dentures receive timely treatment and their medical record reflects the following:
	Q1	Routine (non-urgent/non-emergent) dental treatment is provided within 30 days of resident request
				Weighted Average:		0%
		Chart Review:		Yes			Total	0
		Report (Vendor):		Yes			Denom	0
		Dashboard (IDOC):		Yes			%	ERROR:#DIV/0!
	SITE		NAME	IDOC#	HSR #
OR TIME	DATE	DATE	Q1
						DENTAL
TREATMENT REQUESTED	DENTAL
TREATMENT PROVIDED	30 DAYS	TOTAL		Notes
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
	17
	18
	19
	20
	21
	22
	23
	24
	25
	26
	27
	28
	29
	30
	31
	32
	33
	34
	35
	36
	37
	38
	39
	40
	41
	42
	43
	44
	45
	46
	47
	48
	49
	50
	51
	52
	53
	54
	55
	56
	57
	58
	59
	60
	61
	62
	63
	64
	65
	66
	67
	68
	69
	70
	71
	72
	73
	74
	75
	76
	77
	78
	79
	80
	81
	82
	83
	84
	85
	86
	87
	88
	89
	90
	91
	92
	93
	94
	95
	96
	97
	98
	99
	100

&8This material is property of the IDOC and is not to be reproduced without expressed permission Last revised on 11/15/10

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

14 TB Screening & Tx

Idaho Department of Correction Value Based Care Audit
Audit No:	14	TB Screening and Treatment	Date of Audit:
Threshold:	98%		Type of Audit:	MED QTR (X)
Weight:	2%		Auditor:

Population Sampled: The IDOC DIG will provide the names of all residents whose birth month occurred in the relevant audit period excluding those who entered RDU in the last four (4) months. For every resident whose birthday occurred in the relevant audit period, the report shall include the results of their most recent PPD skin test, or Quantiferon blood test results.

	The vendor will provide a facility level Latent Tuberculosis Infection Treatment log relevant to the reporting period.											Percentage Based Score
	KPI	1. Annual TB test										Indicator	Score	Weight
		Percentage of annual TB tests conducted in the residents birth month.									93%	1	93%	35%
		Total number of residents whose birthday month occurred in the relevant audit period (by quarter)									600	2	100%	15%
		Total number of residents whose birthday month occurred in the relevant audit period who received an annual TB test in their birthday month.									556	3	ERROR:#DIV/0!	50%
	KPI	2. Annual TB Screening Form (Past positive, in lieu of annual TB test)										Weighted Average:		ERROR:#DIV/0!
		Percentage of annual TB symptom screenings conducted in the residents birth month.									100%
		Total number of residents whose birthday month occurred in the relevant audit period (by quarter)									20
		Total number of residents whose birthday month occurred in the relevant audit period who received an annual TB symptom screen in their birthday month.									20
	For those with an initial positive PPD, conversion, or Quantiferon Gold test, a chart review will be conducted to assess for the following:
	Q1	Chest X-Ray is completed within seventy two (72) hours of initial positive PPD or Quantiferon Gold test
	Q2	LTBI treatment is administered per provider order
	Q3	Monthly LTBI visit conducted by RN, mid-level practitioner, or physician.
						Weighted Average:		ERROR:#DIV/0!
		Chart Review:		Yes						Total	0
		Report (Vendor):		Yes						Denom	0
		Dashboard (IDOC):		Yes						%	ERROR:#DIV/0!
	SITE		NAME	IDOC#	INFO	INFO	Q1	INFO	INFO	Q2	Q3
					DATE OF
POS RESULT	DATE
OF CXR	CXR 72 HOURS	START DATE
LTBI TX	END DATE
LTBI TX	LTBI TX COMPLETE	LTBI VISIT
Q MONTH		Notes
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
	17
	18
	19
	20
	21
	22
	23
	24
	25
	26
	27
	28
	29
	30
	31
	32
	33
	34
	35
	36
	37
	38
	39
	40
	41
	42
	43
	44
	45
	46
	47
	48
	49
	50
	51
	52
	53
	54
	55
	56
	57
	58
	59
	60
	61
	62
	63
	64
	65
	66
	67
	68
	69
	70
	71
	72
	73
	74
	75
	76
	77
	78
	79
	80
	81
	82
	83
	84
	85
	86
	87
	88
	89
	90
	91
	92
	93
	94
	95
	96
	97
	98
	99
	100

15 Vaccination Prog

Idaho Department of Correction Value Based Care Audit
Audit No:		15	Vaccination Program		Date of Audit:
Threshold:		98%			Type of Audit:	MED QTR (X)
Weight:		3%			Auditor:
The medical vendor shall maintain a facility specific Influenza Clinic binder which shall include the dates influenza clinics were held and copies of each completed vaccine consent form. Consent forms shall be maintained on-site until reviewed by an IDOC Healthservices team member in the first quarter.
KPI	1. Influenza vaccine Clinics: (scored in Q1 only)
	Percentage of facilities that completed at least two annual flu vaccine clinics between October 1st and December 31st						100%
	Total number of facilities						10
	Total number of facilities that completed both required clinics (credit will not be given for partial compliance)						10
FACILITY			DATE #1 FLU VACC CLINIC	DATE #2 FLU VACC CLINIC			FLU

CLINIC

	ICIO									1
	NICI									1
	PWCC									1
	SAWC									1
	MVTC									1
	ISCC									1
	SBWCC									1
	IMSI									1
	ISCI									1
	SICI									1
	TOTAL:									10
	Residents identified as needing a Shingrix or RSV vaccine are offered the relevant vaccine(s) in the quarter in which their birthday falls.
			WEIGHTED AVERAGE:
		Chart Review:		Yes					Num	0
		Report (Vendor):		Yes					Denom	0
		Dashboard (IDOC):		No					%	ERROR:#DIV/0!
	SITE		NAME	IDOC #	INFO	DATE	Q1	DATE	Q2	INFO
					VACCINE
DUE	SHINGRIX

ADMIN OR

REFUSED	SHINGRIX	RSV
ADMIN OR REFUSED	RSV	ADMIN

REFUSED

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60

16 Preg Resident

Idaho Department of Correction Value Based Care Audit

Audit No:

Pregnant Residents

Date of Audit:

Threshold:

95%

Type of Audit:

MED QTR (X)

Weight:

Auditor:

Population Sampled: The medical vendor shall maintain a current registry of pregnant residents and submit a facility level pregnancy log, to IDOC on or before the 15th day of each month following the close of the relevant reporting quarter. For any pregnant resident who delivers, they will be kept on the registry for 90 days to ensure that post-partum depression screening is completed and that no other urgent pregnancy related needs are identified. Chart reviews will be conducted on all pregnant and post-partum residents up to 90 days after delivery.

Pregnant and postpartum residents receive timely and appropriate prenatal and post-partum care and their record reflects the following:

Problem List accurately reflects pregnancy related diagnosis

STI testing is conducted within 7 days of intake: HIV, HCV, Syphilis, Gonorrhea, Chlamydia

OUD screening is completed at intake using a validated screening tool

If OUD diagnosis at intake, MOUD agonist is offered or resident is referred to a local OTP

Prenatal vitamins prescribed - Initial Health Appraisal

Bottom bunk order in place

Snack order in place

Pillow order in place

Seen by OB within 30 days of intake

Q10

Evaluated by mid-level provider or physician at least once per month while pregnant

Q11

All pregnancy encounters contain a full set of vital signs (T,R,P,BP,O2 Sat) and actual weight

Q12

First postpartum visit occurred 1-14 days post delivery

Q13

Second postpartum visit occurred between 5 and 7 weeks post delivery

IDOC

Counseling provided and documented in accordance with her expressed desires regarding her pregnancy, whether she elects to keep the child or use adoptive services

IDOC

Depression screening is conducted at least once during pregnancy (validated tool)

IDOC

Depression screening is conducted at least once during the post partum period (validated tool)

Chart Review:

Yes

Total

Report (Vendor):

Yes

Denom

Dashboard (IDOC):

ERROR:#DIV/0!

INFO

Q10

Q11

Q12

Q13

IDOC

SITE

NAME

IDOC #

DUE DATE

PROB

LIST

STI TESTING 7 DAYS

OUD SCREEN

MOUD

VITA-

MINS

BOTTOM BUNK

SNACK

EXTRA PILLOW

OB 30 DAYS

MONTHLY PROVIDER EVAL

ENCOUNT VITALS

PP #1 VISIT

1-14D

PP #2

VISIT

5-7 WKS COUNS DESIRES PREG

DEPR

SCREEN POST -P

DEPR

SCREEN		Notes
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

17 Long-Term Care

Idaho Department of Correction Value Based Care Audit

Audit No:

Long-Term Resident Care

Date of Audit:

Threshold:

95%

Type of Audit:

MED QTR (X)

Weight:

Auditor:

Population Sampled: IDOC Health Services auditors will review the records of all residents housed in and admitted to long-term care in the relevant audit period. All assessments must be face-to-face and conducted once every seven (7) days, documentation in absentia does not meet this standard.

Admission assessment conducted by a physician or mid-level provider on day of admission to LTC

Weekly physical assessment conducted by a physician or mid-level provider

Weekly skin assessment conducted by a physician or mid-level provider (discussion - diabetic/wounds, impaired mobility, bed sores, etc.)?

Weekly mental status evaluation is documented, including orientation to person, place, and time. If significantly different from baseline, plan must be documented (baseline is progressive week-to-week, not retroactive to baseline at admission).

Weekly review of vital signs, including weight (actual), is conducted by a physician or mid-level provider. If abnormal, plan is documented.

Daily vital signs and weekly weights are conducted

Discuss

If > or < 5lb weight change in the previous 7 days, physician or mid-level provider documented a plan to address weight change

If > of < 5% weight change over the previous month, physician or mid-level provider documented a plan to address weight change

Chart Review:

Yes

Total

Report (Vendor):

Yes

Denom

Dashboard (IDOC):

ERROR:#DIV/0!

SITE

INFO

NAME

IDOC#

ADMIT

DATE

DIS

POSITION DATE

DIS

POSITION

ADMIT

ASSMT

WKLY

ASSMT

WKLY SKIN ASSMT

WKLY MENTAL STAT

WKLY

VS REVIEW

NURSE VS(D), WT (WK)

>5LB WT CHANGE 7 D

>5% WT CHANGE 1 MO

NOTES

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

18 Acute Infirmary Care

Idaho Department of Correction Value Based Care Audit

Audit No:

Infirmary

Date of Audit:

Threshold:

95%

Type of Audit:

MED QTR (X)

Weight:

Auditor:

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