1. Assurance: The State demonstrates that it implements the process and instrument(s) specified in the approved waiver for evaluating/reevaluating an applicant’s /waiver participants level of care consistent with care provided in a hospital, NF, or ICF/ID-DD Subassurance: An evaluation for LOC is provided to all applicants for whom there is a reasonable indication that services may be needed in the future

2. CountyCase Status LOC Evaluation Received LOC Evaluation Not Received Yazoo80%20% Montgomery39%61% Lawrence81.7%19.3%

3. Assurance: The State demonstrates that it has designed and implemented an effective system for reviewing the adequacy of service plans for waiver participants Subassurance: Service plans address all members’ assessed needs (including health and safety risk factors) and personal goals, either by the provision of waiver services or through other means.

4. CountyCase Status Existing Plans of Services and Supports No Plans of Services and Supports Yazoo72%28% Montgomery39%61% Lawrence81.7%19.3%

5. Assurance: The State demonstrates that it has designed and implemented an adequate system for assuring that all waiver services are provided by qualified providers Subassurance: The State verifies that providers initially and continually meet required licensure and/or certification standards and adhere to other standards prior to their furnishing waiver services.

6. CountyProvider Status Meets Certification Requirements Does Not Meet Certification Requirements Yazoo66%34% Montgomery39%61% Lawrence81.7%19.3%

7. Assurance: The State demonstrates it has designed and implemented an effective system for assuring waiver participant health and welfare Subassurance: The State demonstrates that an incident management system is in place that effectively resolves those incidents and prevents further similar incidents to the extent possible.

8. CountyIncident Reports Inquiry Received No Inquiry Yazoo61%39% Montgomery39%61% Lawrence81.7%19.3%

9. Assurance: The State must demonstrate that it has designed and implemented an adequate system for insuring financial accountability of the waiver program Subassurance: State financial oversight exists to assure that claims are coded and paid for in accordance with the reimbursement methodology specified in the approved waiver and only for services rendered.

10. CountyClaim Status Service on POS Service not on POS Yazoo50% Montgomery39%61% Lawrence81.7%19.3%

11. Assurance: The Medicaid Agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local/regional non-state agencies (if appropriate) and contracted entities.

12. CountyIndividuals Certified to Recieve Waiver Services Eligible for Medicaid Ineligible for Medicaid Yazoo50% Montgomery39%61% Lawrence81.7%19.3%

13. CategoryTotal Expenditures ($ Millions) Number of Users Average paid per user Case Management 34.0513,973$2433 Supported Employment 13.391727$7753 Day Services12438638$15,272 Home-based Services 15512,683$12,221 Caregiver Support 19.244666$4,123 Service Use and Expenditures- FY 2013