F irst Health S ervices South Carolina Quality Assurance Review Process Discovery … Remediation … Improvementpage 1 Did Agency Receive Letter? Sample 5% Random Sample Start Establish Annual Review Calendar Upload State Sample Data into Review Database Send Review Notification Letter to Agency 2 weeks prior to review First Health CSR calls Agency to confirm receipt of notification letter First Health CSR provides verbal notification and faxes letter to Agency Entrance Conference 1. Review process explained 2. 1st day’s sample provided 3. NCI Agency surveys distributed 4. NCI Consumer Survey Pre-Surveys distributed 5. Agency administrative review initiated Administrative Review completed Administrative Reconsideration Conference conducted Are any findings overturned? Overturned indicators corrected in remote database Review of services initiated NCI Consumer Surveys initiated First Health interviewer coordinates obtaining consents and appointments with agency staff, individuals, and legally responsible family/advocates Agency provides service files and completed NCI Pre-Surveys Services Reconsideration Conference conducted Are any findings overturned? Overturned indicators corrected in remote database A B Yes No Yes No Concurrent Process

F irst Health S ervices South Carolina Quality Assurance Review Process Discovery … Remediation … Improvementpage 2 A B Next review sample provided to agency Review of services continues Services Reconsideration Conference conducted Are any findings overturned ? Overturned indicators corrected in remote database Exit Conference 1. Administrative findings/trends reviewed 2. Service findings/trends reviewed 3. Consumer Interview s trends reviewed 4. Follow-up procedures reviewed First Health makes mandated reports to all applicable agencies First Health provides immediate report to state agency Did individual or legal representative request direct communication to agency? Report of Findings Sent to provider agency and state agency 30 days following Exit Conference 1. Agency review findings 2. De-identified NCI Consumer Survey outcomes 3. Recommendations 4. Plan of Correction template for each recommendation Does provider agency appeal findings? Appeal State agency, supported by First Health, conducts Appeal Was review of 5% sample completed? Did any events require mandated reporting? C Yes No Yes No Yes No Yes

F irst Health S ervices South Carolina Quality Assurance Review Process Discovery … Remediation … Improvementpage 3 Follow-Up Review First Health conducts onsite Follow-Up Review within 120 days of approval of Plans of Correction Was agency compliant implementing POCs? Technical Assistance First Health provides technical assistance Quarterly Reports First Health provides state agency with Quarterly Report that includes aggregate quarterly and year-to-date review findings, statewide trends, and conclusions Annual Report First Health provides state agency with Annual Report that includes: 1. Aggregate annual review findings 2. Statewide trends/analysis 3. NCI Consumer Survey data 4. NCI Provider Survey data 5. NCI Family Survey data 6. Data analysis 7. Crosswalk with CMS HCBS Quality Framework Outcomes / Systemic Recommendations Plans of Correction Provider agency develops action steps to address findings... due to First Health within 30 days of receipt of Report of Findings Did First Health approve submitted Plans of Correction? Technical Assistance First Health provides technical assistance to enhance Plans of Correction Agency resubmits Plans of Correction No Yes No Yes C Follow-Up Report Sent to provider agency and state agency 30 days following Follow-Up Review Repeat Process