Did Agency Receive Letter?

1. Start Establish Annual Review Calendar Sample 5% Random Sample Upload State Sample Data into Review Database Did Agency Receive Letter? Send Review Notification Letter to Agency 2 weeks prior to review Yes No First Health CSR calls Agency to confirm receipt of notification letter First Health CSR provides verbal notification and faxes letter to Agency Entrance Conference 1. Review process explained 2. 1st day’s sample provided 3. NCI Agency surveys distributed 4. NCI Consumer Survey Pre-Surveys distributed 5. Agency administrative review initiated Are any findings overturned? No Yes Overturned indicators corrected in remote database Administrative Review completed Administrative Reconsideration Conference conducted Concurrent Process Agency provides service files and completed NCI Pre-Surveys NCI Consumer Surveys initiated First Health interviewer coordinates obtaining consents and appointments with agency staff, individuals, and legally responsible family/advocates Review of services initiated Are any findings overturned? No Services Reconsideration Conference conducted Yes Overturned indicators corrected in remote database A B

2. B A Was review of 5% sample completed? Did any events require mandated reporting? No No Yes Yes Next review sample provided to agency First Health makes mandated reports to all applicable agencies Review of services continues Services Reconsideration Conference conducted Did individual or legal representative request direct communication to agency? No Are any findings overturned? No Yes First Health provides immediate report to state agency Yes Exit Conference 1. Administrative findings/trends reviewed 2. Service findings/trends reviewed 3. Consumer Interview s trends reviewed 4. Follow-up procedures reviewed Overturned indicators corrected in remote database Report of Findings Sent to provider agency and state agency 30 days following Exit Conference 1. Agency review findings 2. De-identified NCI Consumer Survey outcomes 3. Recommendations 4. Plan of Correction template for each recommendation Does provider agency appeal findings? Appeal State agency, supported by First Health, conducts Appeal Yes No C

3. C Plans of Correction Provider agency develops action steps to address findings ... due to First Health within 30 days of receipt of Report of Findings Agency resubmits Plans of Correction Did First Health approve submitted Plans of Correction? Technical Assistance First Health provides technical assistance to enhance Plans of Correction No Yes Follow-Up Review First Health conducts onsite Follow-Up Review within 120 days of approval of Plans of Correction Follow-Up Report Sent to provider agency and state agency 30 days following Follow-Up Review Was agency compliant implementing POCs? Technical Assistance First Health provides technical assistance No Yes Quarterly Reports First Health provides state agency with Quarterly Report that includes aggregate quarterly and year-to-date review findings, statewide trends, and conclusions Annual Report First Health provides state agency with Annual Report that includes: 1. Aggregate annual review findings 2. Statewide trends/analysis 3. NCI Consumer Survey data 4. NCI Provider Survey data 5. NCI Family Survey data 6. Data analysis 7. Crosswalk with CMS HCBS Quality Framework Outcomes / Systemic Recommendations Repeat Process