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i.e. honesty, integrity, respect, trust, responsibility and to be helpful and courteous to ourcustomers at all times.Delmarva consistently strives to exhibit the following key customer service qualities: Timeliness of response; Accuracy of information; Thoroughness of approach; Respectfulness of interactions.If Delmarva falls short of meeting these requirements and a customer complains, we makeevery effort to resolve the complaint quickly and take the following steps to prevent thesource of dissatisfaction from recurring. The following protocol can be followed whenlodging a grievance: Contact our customer service representative at our toll free number 866-254-2075and explain your concern; If you are not satisfied with the explanation/resolution ask to speak with a RegionalManager; If you are still not satisfied with the resolution please ask to speak with the ProjectDirector; Calls are returned within 24 hours or by the next business day; Responses to written inquiries are within 30 days;Non-Compliance with the Discovery Review ProcessAccording to 2009 Florida Statutes (409.907 and 409.913) and 1915j, the provider isrequired to participate in quality improvement activities conducted by the state of Florida.This includes the release of Medicaid patient information when requested. According to1915j, "The State assures that there are necessary safeguards in place to protect the healthand welfare of individuals provided services under this State Plan Option, and to assurefinancial accountability for funds expended for self-directed personal assistance services".Non-Compliant providers are those: Who do not respond to at least two attempts to schedule reviews with them, Who do not make individual records available for review purposes, Who is a “no-show” after a review has been scheduled.Procedure for Providers who do not respond to scheduling efforts:Immediately after the second failed attempt to schedule an annual ProviderDiscovery Review or individual record review, the Delmarva QAR notifies RegionalAPD staff of the difficulty scheduling the review with the provider/CDC representative. This is in the form of a phone call followed up with an email. TheDFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 8 of 39

provider/CDC representative is given three business days to respond to APDRegional staff. If Regional staff succeeds in getting the provider/CDC representativeto comply, the review is scheduled and conducted accordingly. If there continues tobe non-compliance from the provider/CDC representative despite efforts from APDstaff, the provider/CDC representative is scored “Not Met” in all areas of thediscovery tool.Procedure for Providers who do not make individual records available for the reviewprocess:During the scheduling phase of the Discovery Review Process providers/CDC representatives are made aware of time frames for making records available. TheQAR informs each provider/CDC representative involved in the Person CenteredReview (PCR) and Provider Discovery Review (PDR) which records need to beavailable and when. If the provider/CDC representative does not make all recordsavailable for review within the designated time frame, the provider/CDC representative is scored “Not Met” for all elements pertaining to the record review.The QAR notifies Regional APD staff by phone.Procedure for providers who are a “no-show” after a review has been scheduled:Should a provider fail to appear at the scheduled time and location for a ProviderDiscovery Review or individual record review, the provider/CDC representative isscored “Not Met” for all elements pertaining to the record review. The QAR notifiesRegional APD staff by phone.Discovery Review ProceduresQuality FrameworkThe Quality Assurance System developed by Delmarva, in collaboration with the Agency forHealth Care Administration (AHCA) and the Agency for Persons with Disabilities (APD), isused to determine whether current systems to support individuals are efficient, effective,and rendered to their satisfaction. The Quality Assurance System Discovery Process has thegoal of discovery, with two key processes being the Person Centered Review (PCR) and theProvider Discovery Review (PDR).Person Centered Reviews (PCRs)The Person Centered Review process embodies the philosophy commonly characterized bymany self-advocates of “Nothing About Me, Without Me”. It is designed to determine theeffectiveness of the Waiver Support Coordinator in rendering services to individuals, asspecified by the individual. Is there a consistent person centered approach used that allowsDFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 9 of 39

individuals to direct their own lives, choose their own services and providers, participate inthe development of their own support plans, and determine their own goals andobjectives? Is the support plan deployed appropriately? The PCR sample is designed toallow results to be generalized to each APD Region and to the state system as a whole.The Discovery Process begins with PCRs to assess the efficiency and quality of supports,services, planning and delivery from the individual’s perspective. PCRs begin with a face toface interview with individuals receiving services and include a review of the supports andservices rendered by the Support Coordinators specific to that individual, including a reviewof the support plan. The following flow chart describes the PCR process.DFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 10 of 39

PCR ProcessPre-Interview ActivitiesInterview/On-site ActivitiesPost Interview/Activities WSC notificationIndividual selection and notificationSchedule interview and confirmPre-interview information gatheringAPD notification/critical informationgathering Schedule time with WSC/centralrecord review Claims data pull Face to Face interview with individualo NCIo PCR -Individual Interview Toolo Health Summary Observation (If Applicable)o Residential Facilityo Day Training Facility Family/Interview, if necessary Interview with WSC Record Review Ongoing Data Entry Claims Data Analysis Medical Peer Review Process Report Generation, Approval andDistribution NCI Validation**Alert Identification and Reporting occurs in any phase if indicated**DFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 11 of 39

Pre-Interview/Onsite ActivitiesNotification to WSCAll WSC’s and Consultants rendering services to individuals are included as part of the PCRprocess. A review schedule is submitted to AHCA and APD for approval. WSC’s are sent aletter describing the PCR and PDR processes and the expectations of their participation inthe process. The letter includes a web address for the FSQAP Web site where the PCRprocedures can be accessed online. The support coordinator and consultant are directed tothe Delmarva website to access the procedure manual explaining the PCR process. Theletter also includes a list of potential documents the support coordinator must makeavailable for the PCR process. These include but are not limited to individual’s centralrecord, service authorizations, progress notes, medical information, and providerinformation (implementation plans, quarterly summaries etc.).Selecting the Sample for PCRsSupport coordinators and consultants who rendered and billed for services over theprevious 6 month period, as identified through claims data, are eligible for a PCR/PDR. On aquarterly basis support coordinators and consultants rendering services receive a letternotifying them they are scheduled for a review within the next 90 days. The names of twoindividuals served by each support coordinator are randomly selected. For consultantsserving people through the CDC program at least one individual receiving service throughCDC may be selected for a PCR; however Consultants may get 1 CDC, 2 CDC or none ifpeople served have already been sampled. The Delmarva QAR calls the WSC and/or CDC consultant and notifies them regarding the selection of individuals for a PCR.A list of individuals for each WSC and Consultant is generated from APD’s Allocation, Budgetand Control (ABC) database or it is provided the WSC onsite if needed. Claims data fromFMMIS may also be used to further identify all individuals who receive services from theWSC/Consultant. The list is randomly ordered and stratified by DD Waiver and CDC participant. First, a 20 percent sample of CDC participants is chosen from Consultants,with no more than one per consultant, as possible. The first participant on the list isselected. Second, DD Wavier participants are selected, with a maximum of two perWSC/Consultant—two DD waiver participants or one Waiver and one CDC participant.Scheduling the face-to-face interview/sending a confirmation letterThe WSC and CDC consultant are tasked with contacting the person selected for a PCR. Ifthe person agrees to participate in the PCR process the QAR calls the person, reiterates thepurpose of the interview, and confirms if the person would like to participate. If the personDFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 12 of 39

chooses not to participate the PCR concludes; however for individuals participating in theCDC program a Provider Discovery Review (PDR) occurs for the person’s Representative.Demographic information such as social security number and residential setting, along withthe reason for declining, is captured in the data for persons who decline.The WSC or CDC consultant is asked to contact the next person on the randomly orderedlist. If the person chooses to participate, the WSC or consultant schedules the date, timeand location for the interview based on the person’s preferences. Reviewers maintaincontact with support coordinators to gather information on interview locations, dates andtimes. Once the interview has been confirmed, the reviewer enters the information intothe scheduling component of the web based application. This triggers the mailing of aconfirmation letter to the person, outlining the purpose of a Person Centered review, toolsused and examples of questions the Delmarva reviewer may ask. If the interview replaces alast minute cancellation a letter will not be sent.Information covered by the QAR during the initial phone call with WSC will include thefollowing at a minimum: Sharing names of persons sampled for PCR. Coordinating with WSC to assist with contacting and scheduling PCR. Confirming with Agency the number of WSC’s, hire dates, gather caseloadinformation, sample PCRs for any WSC’s not in original sample.Pre-Interview Information Gathering for the InterviewPrior to conducting the NCI Adult Consumer survey, PCR Interview and the Health Summaryit is important for the QAR to collect information from the WSC that may be beneficial tothe person and the QAR to help ensure the interview is successful. This information couldinclude the person’s communication style; if the person needs assistance from specificsupports during the interview or uses a communication device; or if the person’s primarylanguage is different than spoken English. It is important for the QAR to have thisinformation before the interview. If the person chooses, Delmarva obtains an interpreterto assist during the interview, e.g. sign language, Spanish, or Creole.Review of information from APDDelmarva notifies APD of the upcoming PCR reviews for the month, including the name andcontact information of the reviewer. A request is made for information pertaining toincidents, concerns, complaints or grievances associated with the WSC. This information isdiscussed with the WSC during the interview if applicable.DFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 13 of 39

Scheduling Support Coordinator/Consultant participation in the PCRPrior to the date of the actual PCR, the reviewer calls the support coordinator/consultant todiscuss participation in the process and the date of the PCR. Once dates for the individualinterviews have been confirmed, the reviewer establishes firm dates and times for thesupport coordinator interview, used to follow up on information gathered from theindividual interview and complete the WSC central record review(s). Typically, theinterview with the support coordinator, and central record review occurs after theindividual interview has been completed.Other Medicaid waiver services received by the individual are documented in the PCRreport.Confirmation with Support CoordinatorOnce the QAR and support coordinator have determined the actual dates of the supportcoordinator follow up and record review, this information is entered into the web basedapplication. A phone call is made to the support coordinator to confirm date, location andtime of review, and includes a list of documents that need to be available for review such asthe cost plan, support plan, eligibility worksheet, and progress notes as noted in thenotification letter. Subsequent calls to the WSC will be initiated by the QAR to: Finalize and confirm PCR times and locations Gather background information for NCI Schedule WSC interview Schedule WSC PDR review to include Administrative and Service Specific RecordReview (SSRR)Claims Data PullQARs access Medicaid claims data prior to the face-to-face interview. Claims data are usedto compare the WSC documentation of services rendered to the person with actual billedclaims to demonstrate whether the documentation matches what the WSC billed with whatwas paid. The comparison will also show whether the WSC billed according to the specificservice(s) requirements and according to the approved rate on the approved cost plan. Thecomparison of claims data and service records will occur while meeting with the WSC toreview the individual’s records.Interview/Record Review ActivitiesFace-to-Face Interviews (NCI, PCR Interview Tool and Health Summary)The interview with the individual takes place at a date, time and location of the person’schoosing. During the initial face-to-face contact with the person the QAR confirms theperson’s willingness to participate in the interview, and confirms the person has approvedDFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 14 of 39

the participation of any other people in attendance, including the support coordinator andfamily members (excluding the guardian). The QAR may gather additional informationrelated to service delivery and satisfaction from family, guardian/legal representative,and/or support staff. These interviews may be needed to corroborate information or ifthere are significant gaps in information provided by the person. If the person no longerchooses to participate in the process, the PCR concludes; however for persons on the CDC program a Provider Discovery Review (PDR) occurs for the persons Representative. Forthose who choose to participate, the PCR consists of the National Core Indicators AdultConsumer Survey, individual interview and Health Summary.The QAR explains the two distinct components of the interview: 1) gathering informationfor the NCI; 2) gathering additional information using the PCR Interview Tool and HealthSummary. Required NCI protocol is followed while administering the NCI survey to ensurethe data are suitable for inclusion in the HSRI national database of information.NCI - The NCI covers specific areas and consists primarily of choosing the most appropriateresponse from five possible responses. The purpose of the NCI is to identify and measurecore indicators of performance of state developmental disabilities service systems, such assatisfaction with services, community integration, and choice. The survey consists of fourparts: Pre-Survey Form which is used to gather information to be used during schedulingand conducting interviewsBackground Information which consists of:o demographic,o health,o residential,o employment,o behavior support needs, ando other support information.Direct interview with the person which covers:o employment/day activity,o home,o health and safety,o friends and family,o satisfaction with services, ando self-directed supports.Interview with the person or other respondents which includes:o community inclusion,DFMC FLDD OperationalPoliciesandProceduresManual 2017 0201Page 15 of 39

o choices, and rightso access to needed services.The NCI is conducted face-to-face with the individual receiving services. Individuals mayhave someone present who knows them best, to assist during specific sections of thesurvey; however the first section must be answered by the individual independently. Afterthe NCI is conducted, the QAR informs the person of the NCI’s conclusion, the confidentialnature of the interview, and then begin the PCR Interview Tool and Health Summary. TheQAR also gives to the person a feedback survey and self-addressed/stamped envelope tocomplete at their leisure.PCR Interview Tool - Data specific to the individual’s desired goals and outcomes, arecollected through the PCR Interview Tool. The Interview Tool covers for four key areas: Person Centered Supports: Individuals needs are identified and met through PersonCentered Practices. Community: Individuals have opportunities for integration in all aspects of theirlives including where they live, work, and gain access to community services andactivities and opportunities for new relationships. Health: Individuals are in best possible health. Safety: Individuals are safe.The interview consists of open-ended questions such as: What services and supports are you receiving? How did you have input into deciding which services you receive? How are you offered options of services and supports? Who is providing your supports and services? How did you have input into choosing who provides your services? How were your service pr

APD – Agency for Persons with Disabilities. Regional Office – APDs Regional office responsible for managing one of APDs six service Regions. CDC – Consumer Directed Care Plus Program is a permanent Medicaid State Plan Option under 1915j of the Social Secu