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Office of Mental Health

Home and Community Based Services Waiver
Guidance Document
Division of Children and Families


Monitoring and Evaluation Overview: ICC Agency Site Visits, Agency Corrective Actions Plans


ICC Agency HCBS Monitoring and Evaluation Overview

Evaluation and monitoring of the HCBS Waiver Program is mandated by the federal government and the NYS Legislature to examine the efficacy and cost effectiveness of the program. ICC Agencies are required to routinely submit data to the OMH for monitoring and evaluating purposes.

Systematic evaluations focusing on child and family outcomes are completed within prescribed timeframes. Various instruments are utilized for this purpose including annual family and youth satisfaction surveys, the Admission Record, Six-Month Follow-Up and Child Discharge forms.

Another measurement utilized is the CANS MH Level of Care Rating Form from which data is compiled to evaluate treatment outcomes. Additionally, specific agency reports are monitored and data maybe summarized by OMH to assist in evaluating financial efficiency as well as service utilization and effectiveness.

The wide range of reports and instruments used to evaluate the HCBS Waiver Program look at multiple aspects of the program.  The following represents a sampling of areas evaluated:

Child and Family Outcomes:

Family Satisfaction:

System Factors:

ICC Agency Site Visits

OMH ICC Agency Site Visits
Starting in 2015, the Office of Mental Health (OMH) and the Department of Health (DOH) combined their Individualized Service Plan (ISP) reviews into one. OMH provides DOH annually with a list of participants enrolled in the waiver for the respective waiver review year. DOH then runs a query through the NYS Medicaid Data Warehouse to identify all OMH HCBS Waiver participants during the sample time period who were enrolled in the SED Waiver for at least four consecutive months. DOH selects a random statewide sample number, using a random number generated table, based on the number of approved waiver slots at the beginning of the review year. The DOH sampling methodology generates a list that includes all waiver services and all waiver service providers and assures that the annual DOH-OMH service plan sample is both statistically valid and representative of all waiver participants. The selected sample is forwarded to OMH at the beginning of the next waiver year and OMH provides the sample list of individuals to the OMH Field Office Coordinators. These are the individuals that are reviewed during their site visits using the Site Visit Tool. Of these records identified by the statistically valid sampling, DOH will annually select a percentage of the ISP’s to conduct a desk review. DOH will compare OMH findings using OMH Site Visit tool with their finding.

A Medicaid billing validation review for a statistically valid sample is derived from the larger DOH statistically valid sample of ISPs. A list of the participants whose records will need to be copied and sent to OMH are distributed to the providers. DOH conducts this review by comparing the claims/billing detail report to ISP documentation for the specified waiver year. DOH identifies and tracks deficiencies and monitors to assure that appropriate remediation are completed by OMH and reported to DOH in the agreed upon timeframe. If DOH finds deficient practices, OMH is notified and then they contact the ICC agency requiring them to provide a Performance Improvement Plan (PIP) and proof of reimbursement, as appropriate. OMH reports all corrective actions and proof of reimbursement to DOH.

Corrective Action Plans
For problems and deficiencies discovered during the OMH annual site visits to each ICC Agency, the Field Coordinators forward copies of the Site Visit Summary Form, with any necessary corrective actions noted to the agency and to the OMH HCBS Waiver Program for review. The ICC Agencies must submit a performance improvement plan to the Regional Field Coordinator within 30 days of receipt of the Site Visit Summary, using the OMH approved Performance Improvement Plan form (PIP) for review. The Field Coordinator forwards a copy of the agency's improvement plan to Central Office HCBS Waiver Unit for review. After communication between the parties is completed, the final PIP along with a copy of the OMH Field Coordinator’s letter of approval of the plan is sent to the Central Office HCBS Waiver Unit. The OMH approved PIP is subject to request additional information (RAI) pending the findings of the DOH review. A PIP addendum may be required if the OMH approved PIP does not address all citations found during the DOH review. In such cases, OMH will request an addendum, or additional information, from the ICC Agency to satisfy all citations found during the OMH/DOH review year. The Field Coordinator monitors implementation of the improvement plan and provides technical assistance as needed.