State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)

APPENDIX A-4

SITE VISIT OBSERVATION PROTOCOL

This page has been left blank for double-sided copying.

Site Visit Observation Protocol

Evaluation of Demonstrations of Direct Certification with Medicaid for Free and Reduced-Price Meals (DCM-F/RP)

State:	Date of Observation:
Site Location:	Observer:
Activity Observed:	Time/Duration of Activity:

A. Description of staff completing data process

	Observations
Job title of staff member(s) completing the process
Does the same person always complete this data process, or do other people in the [State/district] also complete it?

B. Description of data process

	Observations
Objective of data process
Data sources used
How often data process is conducted
Length of time to complete data process
Description of how the data process is conducted
How does the DCM-F/RP process differ from direct certification with other programs?
How does the process for reduced-price meals differ from direct certification for free meals only?
What are the manual steps in the process?
What are the automated steps in the process?

C. Assessments of data process

	Assessments
Are any aspects of the data process designed to prevent errors?
Do any aspects of the data process appear vulnerable to errors?
Are any aspects of the process designed to increase efficiency?
Do any aspects of the process seem unnecessary?
Other observations