Medical Eligibility Quality Improvement FAQs

If I have questions, who can I contact?

Send your questions to

The Report will not save when trying to download it from the website.  Can you email the Report so that we can save it?

Yes. Contact

If you would like to download the report from the website, click on the report link.

Can you provide the citation that addresses 'Good Faith Effort'?


Are we required to use the Adult Medical/Long-Term Care Case File Checklist, Family Medical Case File Checklist and Case Review Guide when reviewing cases?

 No.  These documents were created and provided upon request, in the event that a site wishes to use these documents.  They are not required.

What are you looking for in the Quality Plan?

The Annual Plan Review Tool provides sites with the information the Department will be reviewing for in the plans.

Eligibility Contact Information - The contact person specified will be the Department's contact for all information related to the Quality Plan.

  •  Section 1 - Tell us about your agency's mission, organization and staffing.  This will assist us in our review of the Quality Plan.
  •  Section 2 - Describe how you will identify your sample, who will pull the sample, when the sample will be pulled, etc.
  •  Section 3 - Describe your review process, who will conduct the reviews, how you will maintain the review materials, etc.  If you already use a review guide, include it with your plan.
  •  Section 4 - Describe your process for using the results of the review, which may include but is not limited to, training protocols, progressive feedback, measuring performance, identifying areas for improvement and efficiencies.
  •  Section 5 - Please add anything additional you feel is important to include with your Quality Plan.

Can we use reports from COGNOS to select our random sample?

Yes.  Specify the name of the report in your Quality Plan.

Are there any COGNOS reports in particular that we should use?

No.  Please contact the CBMS Help Desk at 303-764-7674 for MA Sites or 303-866-5204 for County Sites.

What do you want us to look for in the case review?

Look for the answers to the following 4 key questions:

  1. Was the application processed timely?
  2. Did the case file documentation support the eligibility determination?
  3. Was the data entered correctly to produce an accurate eligibility determination?
  4. Was the application authorized correctly?

 Enter the totals for these questions in the Quarterly Report.

Can you revise the Report template to allow for a review of less than 4 applications for small counties that may not receive 4 new applications in a month?

Yes.  Click here

In smaller counties where there is only one worker, the Director is the only one who can conduct the review.  Can a worker from another county (peer) conduct the review?

Yes. Describe this in your Annual Plan.

Can you provide a revised Appendix C that updates the Implementation Plan Due Dates?

Yes.  Click here