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Library: Policy

317:30-5-763.1. Medicaid agency monitoring of the ADvantage program

Revised 7-1-13

(a) The OHCA's monitoring of the ADvantage Program is a quality assurance activity.  The agency evaluates the ADvantage program on a continual basis to ensure quality, through the review of various performance measures set forth in the waiver document.  The areas evaluated include:

  • (1) Member eligibility determination;

  • (2) Member "freedom of choice";

  • (3) Member health and welfare;

  • (4) ADvantage certified and SoonerCare contracted providers on the plan;

  • (5) Member acceptance of the plan;

  • (6) Qualified case managers;

  • (7) Plan services are goal-oriented services; and,

  • (8) Plan of care costs are within cost cap guidelines.

(b) Deficiencies found by the OHCA are reported to the AA for correction and/or explanation. Additionally, a quality management report is submitted to the Centers for Medicare and Medicaid Services annually.

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