Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 05 - Developmental Disabilities Services
Rule 016.05.18-008 - Repeal of the Community and Employment Supports Waiver Provider Manual; Community and Employment support Waiver Minium Certification Standards and Amendments to DDS Policy 1091
Current through Register Vol. 49, No. 9, September, 2024
ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES SERVICES DDS DIRECTOR'S OFFICE POLICY DDS POLICY 1091 CERTIFICATION AND MONITORING POLICY FOR FIRST CONNECTIONS-PART C OF THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA)
1. Purpose.
The Arkansas Department of Human Services, Division of Developmental Disabilities Services ("DDS") is the lead agency for the federal early intervention program in the State of Arkansas for infants and toddlers with disabilities and their families, under Part C of the Individuals with Disabilities Education Act ("First Connections"). DDS, as the lead agency, is responsible for the implementation, general administration and oversight of the First Connections program. As part of its oversight responsibility, DDS must ensure that the activities of participants in the First Connections program align with Part C of the Individuals with Disabilities Education Act ("IDEA") and the guidelines issued by the Office of Special Education Programs ("OSEP"). DDS carries out this oversight responsibility through a certification and monitoring program.
This policy has been prepared to implement Ark. Code Ann. 20-48-201 et. seq,, for the purpose of establishing the policies and procedures applicable to the First Connections certification and monitoring program. An appeal of any decision made pursuant to this policy may be filed according to procedures outlined in DDS Policy #1076, or any replacement or successor appeals policy.
2. Scope.
This policy applies to:
3. Definitions
Standards. Procedures relating to the Monitoring Reviews are provided in Section 7 herein.
4. DDS Certification and Monitoring Program Generally.
Federal regulations require DDS to ensure that only qualified personnel are providing First Connections services, and that all certified Providers are performing First Connections services in a manner that complies with the applicable federal and state regulations and guidelines. As a result, DDS has established the First Connections Certification Standards and First Connections Policies and Procedures with which all Providers must be in substantial compliance in order to participate in the First Connections program. The purpose of the certification and monitoring program is to ensure that all participants in the First Connections program are in substantial compliance with these First Connections Policies and Procedures and First Connections Certification Standards at all times.
The certification status of a Provider is dependent on the extent of the Provider's substantial compliance at any given time with the currently effective First Connections Policies and Procedures, and First Connections Certification Standards, as determined through Periodic Monitoring Reviews. DDS shall separately certify an individual or organization for each First Connections service that the individual or organization seeks to provide. A certification is valid and effective only for the individual or organization to which the certification is issued, and a certification may not be transferred to another individual or organization.
Once certified to provide a First Connections service, the Provider must be able to produce a copy of the certification upon request and also appropriately upload the certification into CDS.
5. Certification Status Levels.
Each Provider will always be certified under one of the following classifications:
? "Temporary Certification'" is the preliminary certification status granted to a new Provider, or an existing Provider offering a new First Connections service, upon the Provider demonstrating compliance with the First Connections Certification Standards relating to the service(s) seeking to be offered. Temporary Certification will be provided for a term of up to one hundred eighty (180) days, and is discussed in more detail in Section 6 herein.
? "Regular Certification" is the certification status granted to a Provider when the Provider is found to be in substantial compliance with all First Connections Certification Standards and First Connections Policies and Procedures.
? "Regular Certification with Requirements" is a downgrade from Regular Certification given to a Provider when they are found to be substantially out of compliance with applicable First Connections Certification Standards and/or First Connections Policies and Procedures by a Monitoring Specialist during a Periodic Monitoring Review. A downgrade to Regular Certification with Requirements does not affect a Provider's ability to offer First Connections services, but does trigger an automatic thirty (30) day corrective period within which the Provider must correct any identified non-compliance issues. When a Monitoring Specialist can provide written documentation of a Provider's efforts towards correcting any non-compliance issues, the Monitoring Specialist may grant up to a sixty (60) day extension to the preliminary corrective period. Under no circumstances may a corrective period be longer than ninety (90) days.
? "Suspended Certification" means that a Provider is removed from the CDS database as a Provider and is prohibited from providing any First Connections services.
6. Procedural Guidelines: New Provider Certification Process
All owners of the Provider must be listed on the application for ownership. If a change of ownership occurs, it must be reported to First Connections within thirty (30) days.
An applicant that is denied Regular Certification will have to wait until the next DHS determined open enrollment for new providers before they will be allowed to apply for certification under the First Connections program again.
7. Procedural Guidelines: General Supervision/Monitoring Reviews:
A Periodic Monitoring Review of a Provider may be conducted by a Monitoring Specialist at any time and for any reason. A Monitoring Specialist will conduct a Monitoring Review of every assigned Provider to ensure continued substantial compliance by the Provider with IDEA program requirements, First Connections Certification Standards, and First Connections Policies and Procedures. Monitoring Reviews may be conducted through on-site visits, electronic off-site records review, or a combination of both. Monitoring Specialists, as part of a Monitoring Review, may conduct fiscal monitoring, may interview staff and may interview parents of children currently or formerly served.
A Periodic Monitoring Review may involve only off-site information review through CDS by the Monitoring Specialist, and a Monitoring Specialist may or may not provide advance notice to a Provider of their intent to conduct a Periodic Monitoring Review. Examples of situations where Periodic Monitoring Reviews might be conducted include, but are not limited to:
? During Temporary Certification for a new Provider;
? As a follow-up to a Monitoring Review report, to monitor whether noncompliance issues set out in the report have been corrected;
? Conducting random, unscheduled monitoring throughout the year to ensure consistent compliance with First Connections Certification Standards and First Connections Policies and Procedures;
? At the end of a specified timeframe relating to a corrective action, enforcement remedy or certification downgrade to determine if required action has been performed;
? When any information gathering is necessary to investigate a formal concern or complaint (as provided in the First Connections Policies and Procedures) filing with DDS; and
? Any other situation where DDS or the Monitoring Specialist determines that a Periodic Monitoring Review is warranted.
The objective of off-site information review is to analyze various sources of Provider information available, primarily through CDS, to identify any areas of concern, non-compliance or other issues, and to focus the efforts of the Monitoring Specialist during any on-site review, if an on-site review is deemed necessary. The Monitoring Specialist may collect and analyze information from all available sources, including without limitation:
? Service concerns or formal complaints submitted to DDS during the prior year;
? Review of attendance of any required training, personnel development, or technical assistance requested by the QA Monitoring Specialist;
? Fiscal audit;
? Documentation from the Provider requested in advance;
? The results of any Periodic Monitoring Reviews during the prior year, and;
? Contact with the parents of individuals served by the Provider.
Certifications are renewed every three (3) years. Each Provider organization is responsible for ensuring that every one of its employee Providers has all necessary certification material uploaded appropriately into CDS prior to certification expiration date. Monitoring Specialists may conduct a Certification Review of a Provider at any time to ensure compliance with First Connections Certification Standards and to confirm all the necessary certification material has been uploaded into CDS.
If the Monitoring Specialist determines that potential instances of non-compliance with Part C Program requirements set forth by IDEA and/or the Office of Special Education Programs or First Connections Certification Standards and/or First Connections Policies and Procedures or other concerns and issues found during the off-site information review warrant additional investigation and review, the Monitoring Specialist may set up dates for conducting on-site information collection and review with the Provider Program Administrator.
The Monitoring Specialist will contact the individual listed as the Executive Director of the Provider Program to arrange a date and time for the on-site information review and identify which staff need to be present/involved. Each Provider will be responsible for providing the Monitoring Specialist access to its premises, records, staff, and individuals and families served to facilitate the on-site information review. The Monitoring Specialist will request any additional information that the Provider must submit prior to the on-site review. If the Monitoring Specialist has questions and needs additional information during the on-site review, he/she will request it from the Provider at the visit or request that it be sent following the on-site visit.
The extent and depth of the on-site information review necessary shall be determined on a case-by-case basis by the Monitoring Specialist based upon the severity and/or urgency of the non-compliance or other issues and concerns discovered by the Monitoring Specialist during the off-site information review.
An on-site information review may consist of any one or more of the following:
? Review of Provider on-site paper or electronic records
? Interviews with Provider administrators or other staff
? Interviews with parent(s) of individuals served by the Provider
? Tour of any Provider facilities
? Any other reasonable information gathering activities requested by the Monitoring Specialist
To the extent feasible, the Monitoring Specialist will attempt to maintain open and ongoing dialogue with the Executive Director of the Provider throughout the on-site information review and shall take reasonable steps to minimize the disruption to the Provider's day-to-day operations during any on-site information review.
The Monitoring Specialist will conduct an exit interview at the end of the on-site review. During the exit interview, the Monitoring Specialist will review all noted areas of noncompliance.
8. Monitoring Review Report
The Monitoring Review report will describe the collective findings of the Monitoring Specialist during the QA Monitoring Review and identify the specific IDEA and or First Connections Certification Standards and or First Connections Policies and Procedures with which the Provider is out of compliance.
A Periodic Monitoring Review report will be prepared and sent to a Provider only (i) if non-compliance with the First Connections Certification Standards and/or First Connections Policies and Procedures was found during the Periodic Monitoring Review, (ii) if the Periodic Monitoring Review was a follow-up to a prior corrective action, enforcement remedy or certification downgrade; or (iii) if the Monitoring Specialist feels the circumstances require a Periodic Monitoring Review report. If a Periodic Monitoring Review report is prepared, then the report will set out the findings, any corrective action and or other enforcement remedy, ics that are to be initiated (explained in more detail in Section 9), and, if applicable, a timeline for completion.
A Monitoring Specialist is required to initiate a referral to the Medicaid Audit division for investigation, if, in the course of any Periodic Monitoring Review, they identify instances of non-compliance with Medicaid billing. The results of the Medicaid Audit alone may result in DDS imposing enforcement remedies on a Provider, including, but not limited to, the recoupment of funds and or decertification. Any Provider placed on the Medicaid excluded provider list or that has its Medicaid billing number terminated or suspended will be automatically decertified as a Provider in the First Connections program.
9. Enforcement Remedies
DDS may impose various enforcement remedies upon a Provider when a Monitoring Specialist discovers non-compliance with IDEA regulations, OSEP Part C Program requirements, First Connections Certification Standards, and/or First Connections Policies and Procedures. This section lists in detail the various enforcement remedies, in approximately increasing order of severity, which DDS may impose upon a Provider when a Monitoring Specialist discovers ongoing noncompliance. These enforcement remedies are not mutually exclusive, and any one or more of these remedies may apply to a Provider simultaneously. Additionally, enforcement remedies may be applied to only one or more First Connections services provided by a Provider (and not affect other First Connections services offered by the Provider) or may be applied to an entire organizational Provider and every one of its employee Providers.
The number and severity of enforcement remedies applied to a Provider will be determined on a case-by-case basis by the Monitoring Specialist who conducted Monitoring Review, as applicable. The enforcement remedies applied will be based in part upon:
* Frequency of Non-compliance: Providers which are habitually found to be in non-compliance will face increasingly severe enforcement remedies.
* Responsiveness in Correcting Non-compliance: The less responsive a Provider is in correcting previous and/or current issues of non-compliance within timelines the more severe the enforcement remedy.
*Re-lanse Non-compliance: Providers found to be out of compliance in areas previously addressed will face increasingly severe enforcement remedies when later found out of compliance for the same issue.
* Non-compliance Constituting Intentional Fraud: Non-compliance (either monetary or document falsification or other attempts to cover up an issue of non-compliance) constituting intentional fraud will result in more severe enforcement remedies.
Provider action or inaction that jeopardizes the health or safety of an individual (child served or family member) will be reported to the appropriate agencies for investigation. Substantiated reports will result in dc-certification of the Provider.
Reports of noncompliance will be referred to the Division of Child Care and Early Childhood Education for any Providers who arc also licensed by them.
A Monitoring Specialist must obtain the consent of the First Connections Part C Coordinator prior to imposing any of the enforcement remedies set out in subsection D through H below. An appeal of any enforcement remedy outlined in subsection D through H below may be filed according to procedures outlined in DDS Policy #1076, or any DDS replacement or successor appeals policy.
Directed In-Service Training and/or Targeted Technical Assistance is mandatory, required, targeted support, training, and/or technical assistance to assist Providers in correcting compliance deficiencies. The Monitoring Specialist determines:
A Directed Plan of Correction is a plan of action developed by the Monitoring Specialist that includes whatever the Monitoring Specialist reasonably believes is required to correct the various areas of Provider non-compliance. Achieving substantial compliance through completion of the Directed Plan of Correction is the responsibility of the Provider. A time frame for each specific action will be specified in the plan.
If a Provider is not in substantial compliance with First Connections Certification Standards and First Connections Policies and Procedures within the timeframe stated in a Monitoring Review Report, the status of the Provider will be downgraded to a Regular Certification with Requirements.
A downgrade to Regular Certification with Requirements docs not affect a Provider's ability to offer First Connections services, but does trigger an automatic thirty (30) day corrective period within which the Provider must correct any identified non-compliance issues. When a Monitoring Specialist can document a Provider's efforts towards correcting any non-compliance issues, the Monitoring Specialist may grant up to a sixty (60) day extension to the preliminary corrective period, but under no circumstances may a corrective period be longer than ninety (90) days.
During the correction period, the Provider shall submit weekly progress reports regarding compliance efforts to the Monitoring Specialist. In order to achieve restoration of its Regular Certification, the Provider must correct all identified deficiencies and demonstrate substantial compliance with all state and federal policies, guidelines and requirements. Failure of the Provider to correct all deficiencies and move into substantial compliance may result in suspended certification, withholding of payments, and/or recoupment of funds.
Withholding payments to a Provider relating to invoices for First Connections services rendered will be reserved for specific circumstances, including, but not limited to, the following:
? A suspended or de-certified Provider (i.e. a Provider that is not certified to perform First Connections services) submitting an invoice for the performance of a First Connections service;
? Reasonable evidence that a Provider has engaged in fraudulent activities;
? Withholding of funds until the Provider follows through with agreed to provisions of a Directed Plan of Correction or other enforcement remedy; and
? Any other circumstance where there is reasonable and documented justification for withholding the payment of funds.
If justified by the circumstances, DDS reserves the right to require the repayment of funds previously paid to a Provider relating to First Connections services. Such circumstances include, but are not limited to, the following:
? Payments were attributable to First Connections services that were not actually performed;
? Payments were attributable to a First Connections service that may have been performed but has not been delivered after documented attempts (i.e.: evaluation was completed but First Connections did not receive the evaluation report and the report is not present in the child's electronic record);
? Payments were attributable to First Connections services that were not performed in accordance with the First Connections Certification Standards and/or First Connections Policies and Procedures;
? Overpayments made by First Connections to a Provider;
? Repayment required by court order, federal agency or other applicable state or federal law; and
? Any other circumstance where the lead agency has reasonable, documented justification for requiring the re-payment of funds previously paid to a Provider.
Moratorium on Expansion is an enforcement remedy that prohibits a Provider from expanding capacity for current First Connections Service delivery in existing certified service areas and expanding to offer current or new First Connections in new service areas. While a provider is in this status, they may continue to offer services to existing families on their caseload, however First Connections will withhold referrals for new families and children until the provider has been restored to Regular Certification. A Moratorium on Expansion shall remain in place until the Provider is in substantial compliance with First Connections Certification Standards and First Connections Policies and Procedures, and the Monitoring Specialist believes the Provider is willing and able to remain in substantial compliance.
A downgrade in certification to Suspended Certification removes a Provider from the CDS database, and prohibits a Provider from providing First Connections services. A Provider will not be assigned new individuals or families entering First Connections while under Suspended Certification. Additionally, families of children already being served the Provider will immediately be contacted and informed of the Suspended Certification, and will be given the opportunity to be reassigned to another area Provider in good standing. During the term of a Suspended Certification, the Provider shall submit weekly progress reports regarding its compliance efforts until all non-compliance deficiencies have been corrected. Suspended Certification status will not be removed until the Monitoring Specialist has determined the Provider has returned to substantial compliance with the First Connections Certification Standards and First Connections Policies and Procedures. The failure of a Provider to substantially comply within sixty (60) calendar days of its downgrade to Suspended Certification will result in decertification of the Provider.
Dc-ccrtification of a Provider prevents the Provider from performing any further First Connections services as of the date of de-certification, and the Provider will be removed from CDS. If the Provider is an organization, the same would apply to its entire staff of employee Providers. All individuals actively receiving First Connections services from the Provider will be re-assigned to other area Providers in good standing. DDS may withhold any payments to a de-certified Provider for a reasonable amount of time to determine the appropriateness of the requested payment, even if the First Connections services submitted for payment were performed prior to de-certification. A Provider that is de-certified will have to wait a minimum of three (3) years before they will be allowed to apply for certification under the First Connections program again.
