DV Standards Format
The highlighted area has notes to the DVC about a specific reporting section and any nuances or differences that the DVC may encounter during the review of that reporting section. The Part C Grievances reporting section includes an example note below.
Grievances (Part C)
To determine compliance with the standards for Grievances (Part C), the DVC (reviewer) assesses the following information:
- Organization meets deadline for reporting annual data to CMS
- Data submitted or re-submitted to CMS via HPMS
- Written response to OAI Sections 3 and 4, and documentation requested per OAI Sections 5 and 6
- Outlier/data integrity notifications – See OAI 4.3.3 for instructions on how to retrieve notices
- Results from the organization's data systems changes during the reporting period (e.g., because of a merger, acquisition, vendor change, or upgrade)
- Definitions are in accordance with 42 CFR §423, Subpart M and the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance Manual when performing calculations
- Results of interviews with organization staff
- Census or sample data
- Other related information provided by the organization