The purpose of this review is to assure adherence to clinical standards and assess quality indicators through the provider agency's clinical documentation and practices. This includes a determination of clear and consistent inter-connection among the diagnosis, assessed needs, ITP provisions, and actual services and interventions delivered.

Medicaid Record Review

# MEDICAID RECORD REVIEW 'Item Score'
Record Review
(Total of all scores for item/number of records reviewed) 1, 3, 5, N/A
1 The current Individual Treatment Plan (ITP) reflects the individual's assessed needs and has been updated per consumer's progress and changing needs.
2 There is evidence of changes in or re-evaluation of treatment needs and/or services during periods of sudden changes in functioning or symptoms.
3 Treatment is consumer driven as evidenced in clinical documentation.
4 Treatment provided builds on the identified strengths of the consumer.
5 All treatment needs as identified on the Mental Health Assessment are being addressed in the ITP and in the actual service and are prioritized based on importance/severity.
6 There is congruence between the information in the Mental Health Assessment and the Functional Assessment/ LOCUS/Ohio/Columbia Scales.
7 There is evidence in the clinical record that primary health care coordination and integrated care is occurring with the primary physical health care provider.
8 There is documentation that the provider is assisting the consumer with utilizing natural supports in the community.

Non-Medicaid Record Review

# NON-MEDICAID RECORD REVIEW Yes / No
9 There is documentation that the provider is working to connect the consumer with benefits / entitlements (such as Medicaid benefits).
10 There is documentation that the provider is assisting the consumer with utilizing natural supports in the community.