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HomeMy WebLinkAboutIDD-504 Waiver Provider Qualifications and Disqualifications1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Waiver Provider Qualifications/Disqualifications PROCEDURE NUMBER: IDD-504 Effective Date: January 1, 2008 Date Revised: November 4, 2022 Reference: ODP Announcement 22-005: Provider Qualification Process INTRODUCTION: In response to the request for a renewal of the Consolidated Medicaid Waiver, the Office of Developmental Programs received correspondence from the Centers for Medicare and Medicaid Services (CMS) asking for evidence that Waiver service providers are qualified Statewide. CMS requires that Waiver service providers are qualified using consistent statewide standards, that people who receive Waiver services have the opportunity to obtain services from any willing and qualified provider, and that qualified providers have the opportunity to enroll as Waiver service providers. It is the policy of Franklin/Fulton MH/IDD/EI Program to comply with all provisions of the State and Federal laws and regulations governing the qualification/disqualification of providers as outlined by the Office of Developmental Programs. This policy has been developed to establish uniform methods to guarantee that providers are qualified to administer supports and services to individuals who qualify for waiver services and to ensure health and safety. DEFINITIONS: Centers for Medicare and Medicaid Services (CMS) – Federal agency which administers Medicare, Medicaid, and the State Children's Health Insurance Program. Office of Developmental Programs (ODP) Waiver – Program that provides funding to eligible persons, so that they can receive supports and services in the community. 2 Everyday Lives – A philosophy that empowers individuals to decide what will make them happy; how to live their best lives, supports they will need and how they will spend the money in their individual budgets. Home and Community Services Information System (HCSIS) – HCSIS is a web enabled information system that serves as the information system for all Department of Human Services (DHS) program offices that supports the Home and Community-Based Services including Medicaid Waivers. Office of Developmental Programs (ODP) – ODP is the state office that currently houses the Bureau of Intellectual Disabilities Services and the Bureau of Autism Services. Quality Management Framework – Measures, addresses and enhances quality of life, services and supports and organizational practices. PROCEDURE: All provider agencies, individual professionals, and vendors that provide ODP waiver services must meet the qualification criteria outlined in the Waiver for the service that they currently provide or intend to provide. The Administrative Entity is responsible to qualify Waiver providers initially and at least triennially thereafter. For providers that operate in multiple areas in the Commonwealth, it is the responsibility of the AE who is designated as the assigned Administrative Entity in the Quality Assessment and Improvement Process for providers to qualify the assigned providers. PROCESS: Franklin/Fulton will follow the statewide process for qualification: 1. The Provider will access the DP 1059 to initiate the qualification application for the services they intend to provide and respond to the questions by the deadline of March 31st of the qualification year. 2. The Provider will “submit” the DP 1059 to the assigned Administrative Entity for review. Providers will provide hard copies or electronic copies for all supporting documents (including liability, automobile, and worker’s compensation insurance documents) via fax or mail to the Administrative Entity for review by March 31st of the qualification year. Providers will also complete the ODP Provider Qualification Documentation Record Spreadsheet and forward to the Administrative Entity. The spreadsheet notifies the provider of all documentation needed to complete the review. 3. The Administrative Entity will review the ODP Provider Qualification Documentation Record and the supporting documents submitted by the provider as per the ODP approved methods. 3 4. The Administrative Entity will verify the documentation and determine if the provider meets the defined qualification criteria for the specialties designated by the provider on the Administrative Entity portion of the DP 1059 by April 30th of the qualification year. 5. The Administrative Entity will send the DP 1059 to the provider for them to submit with their PROMISe application for qualification. 6. Should a provider, individual professional, or vendor want to add a new service, they would access the DP 1059 to add the new service and complete steps 1-5. A Waiver provider can be restricted through disqualification for a particular service or statewide if:  They failed to meet qualifications criteria by the appropriate deadline.  They failed to comply with the Provider Agreement.  They furnished services at a frequency or amount not consistent with the ISP.  They furnished services of a quality that does not meet professionally recognized standards of health care. Franklin/Fulton MH/IDD/EI will contact ODP within seven (7) days to provide documentation to support the restriction of a provider. ODP will make the determination of the qualification status within 15 days. If ODP determines that restrictions will be placed on the provider through disqualification, the provider with receive advance notice of at least 30 days. The Administrative Entity and Supports Coordination Organization will assist individuals supported by providers who are disqualified in choosing new service providers by June 30th of the qualification year.