1. The Medicaid (NYS Department of Health) agency retains ultimate authority and responsibility for the operation of the waiver by exercising oversight over the performance of waiver functions by other state and local/regional non-state agencies (if appropriate) and contracted entities.
DOH WMS maintains overall authority and responsibility for the operation of the waiver by exercising oversight of the performance of waiver functions by contractors, such as the QMS and RRDC staff.
DOH WMS manages and oversees the performance of the contractors (QMS and RRDC) through annual random retrospective reviews of the SPs, NHTD Complaint Line calls, quarterly and annual reports, complaints/grievances, and annual on-site visits with the QMS, RRDC staff. If DOH WMS determines a decision by the QMS or the RRDC staff does not reflect established policy, corrective actions must be initiated.
DOH WMS has the final authority regarding acceptance/denial of an applicant and discontinuance of a waiver participant from the.
DOH WMS has the final authority regarding approval and termination of waiver providers.
DOH WMS maintains open discussion with waiver participants, QMS, RRDC's staff, waiver providers, Local Department of Social Services (LDSS), advocates and other community based organizations serving people with disabilities and seniors to understand and evaluate the functioning of contractor's staff.
DOH WMS will maintain a database to gather, evaluate and monitor data collected from reports and survey results including Plan of Correction information for trend analysis and identification of the need for program changes or improvements.
DOH WMS attends annual Regional Forums with waiver participants, families, advocates and waiver providers to gather information pertinent to contract or performance.
DOH WMS maintains a NHTD Complaint Line for use by waiver participants and others.
DOH WMS chairs RRDS and QMS Quarterly Meetings to review policies, network, present new policies/procedures, discuss regional trends and address waiver issues.
Any data gathered regarding this assurance must be included in the RRDS and/or QMS quarterly reports for review by DOH WMS. That staff, in consultation with QMS and RRDS evaluates the need to change policies/procedures.