CMS-10249 Additional Benchmarks – Addendum to the MFP Semi-Annual

CMS-10249
OMB 0938-1053 (Expires: TBD)

D.1 Additional Benchmarks – Addendum to the MFP Semi-Annual
Progress Report
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This section requests information and data on progress made towards achieving the
state’s additional MFP benchmarks, at least one of which reflects the state’s reinvestment
of savings generated under MFP to rebalance the state’s long-term care system. The
information below reflects your state’s additional benchmarks as described in the CMSapproved Operational Protocol. If your state has not achieved the benchmark measure for
this reporting period, please use the text box below to explain the barriers or challenges
that have hindered progress, and plans to address them.

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Benchmarks for grantees participating in the Tribal Initiative can be added here.

•

Please enter data for the relevant reporting period and year. Green outlined cells indicate
the PDF will auto-calculate the field.

•

Please submit this addendum to your project officer with your full MFP- SemiAnnual Report

Benchmark: [Please describe as specified in Operational Protocol]

Measure #1 [Please describe as specified in Operational Protocol]

Year

Measure
Target

Measure
First
Period
(Jan 1 June 30)

Measure
Second
Period
(July 1 Dec 31)

Measure
Entire
Year

%
Achieved
First
Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00% 0.00% 0.00%

2018

0.00% 0.00% 0.00%

2019

0.00% 0.00% 0.00%

2020

0.00% 0.00% 0.00%

Please explain your Year End rate of progress:

Measure #2 (If applicable) [Please describe as specified in Operational Protocol]
[..…………………………………………………………………………]

Year

Measure
Target

Measure
First
Period
(Jan 1June 30)

Measure
Second
Period
(July 1 –
Dec 31)

Measure
Entire
Year

%
Achieved
First
Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00% 0.00% 0.00%

2018

0.00% 0.00% 0.00%

2019

0.00% 0.00% 0.00%

2020

0.00% 0.00% 0.00%

Please explain your Year End rate of progress:

Measure #3 (if applicable) [Please describe as specified in Operational Protocol]

Year

Measure
Target

Measure
First
Period
(Jan 1 June 30)

Measure
Second
Period
(July 1 Dec 31)

Measure
Entire
Year

%
Achieved
First
Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00% 0.00% 0.00%

2018

0.00% 0.00% 0.00%

2019

0.00% 0.00% 0.00%

2020

0.00% 0.00% 0.00%

Please explain your Year End rate of progress: