My Experience As A Research Manager Essay

My Experience As A Research Manager Essay

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The example I will use in this supplemental item for my experience in planning, implementing, and evaluating a new health program is related to my experience as a Research Manager I. Our unit was informed several years ago, that after the expiration of a 1915(c) home and community-based services waiver (HCBS Waiver) associated with providing long-term care services to developmentally disabled individuals, our unit would establish a rate setting process for this new program. To provide a brief narrative of the waiver process, within broad Federal guidelines, States can develop HCBS Waivers to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. Waivers are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid. In particular, the waiver should achieve measurable progress towards diverting individuals from institutions and transitioning individuals from less-integrated to more-integrated settings. After 6 years under the provisions of this particular 1915(c) waiver, it was decided that our unit would establish rates for 6 provider types, and become a State Plan program and will require the establishment of rates providing various levels of care in the inpatient nursing facility (NF) setting.
Although the transition of this new health program and the establishment of these facilities rate structure has not fully transitioned, the metrics for the planning, implementing, and evaluating this program have been are in process. The first step is to establish regulatory changes. This process entails the discussion of the proposed licensing regulations and coordination of transition ...


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...loading” of the new rate in the system.
The last step would be the evaluation and measurement of access levels. Our unit will be responsible for the access monitoring for these providers. The annual access monitoring is accomplished using the A&I audits of the facility cost reports. My unit will continue to conduct an annual access monitoring report, which uses reported and audited cost data from these providers. The report provides the occupancy and vacancy rates to help determine capacity availability. DHCS is directly responsible for ensuring access to health care services for beneficiaries enrolled in the fee-for-service delivery system, where the Medi-Cal program serves as the primary source of coverage. Our access analysis includes an evaluation of service utilization identified as a means of detecting the early signs of health care access disruptions.

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