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Office of Mental Health

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


ICC Agency to OMH Waiver Data Collection and Reports


ICC Agency Reports to OMH
Specific data is submitted by the ICC Agencies within prescribed timeframes to OMH to assist in assuring that the HCBS Waiver is being implemented effectively within approved guidelines and to assure timely provision of technical assistance by OMH. These include the following.

Annual Administrative Review
As the primary oversight agency for the HCBS Waiver Program, OMH plays a major role in quality management. For OMH to perform this function, ICC Agencies must complete and submit an Administrative Review Form each year. The Administrative Review Form provides information regarding- referrals, internal agency policies, procedures, sufficiency of providers, trends and quality management. The Administrative Review Form is required to be completed and submitted in accordance with directives issued by OMH, Central Office. ICC Agencies will be notified each year with an updated form and guidance to complete the document. OMH, Central Office and OMH Field Office will review the Administrative Review Form and provide technical assistance, as needed.

Outcome Measures Descriptive Data to be entered on CAIRS

Semi-Annual Program Report on CAIRS
This report is completed by each agency twice a year on CAIRS. A one month lag is figured into the reporting phases. January through June is due by July 31 and June through December is due January 31.

Semi-Annual Waiver Subcontractor Services Summary on CAIRS
This report provides OMH with data on total utilization and expenditures for the five waiver subcontracted services over a six month period including which subcontractors were used, frequency of services utilized and costs. OMH analyzes these for comparison across the regions as well as statewide. To assure that the information is complete, the Waiver Service Summary is entered on CAIRS in September for the previous January through June and in March of the following year for July through December.

Quarterly Program Specific Fiscal Report on CAIRS
This data entry module in CAIRS has four sections which provide the ability to enter the following information:

OMH HCBS Waiver Reports

OMH Central Office routinely offers a number of reports which agencies may access through CAIRS. These include:

Reports based on agency:

Reports based on region:

Reports based on county:

Client Reports: