Current through Register Vol. 48, No. 38, September 20, 2024
a) All
services provided to CCP participants shall be delivered in accordance with
Provider Agreements entered into between certified provider agencies and the
Department.
b) For purposes of
administrative efficiency, the Department may initiate the provider
certification process for the CCP by a specific service, on a geographic basis,
or in accordance with other criteria determined by the Department.
c) Initial Certification
Any willing and qualified provider agency (see the federal
Medicaid waiver, this Part and
42 CFR
431.51 (2008)) interested in the opportunity
to enter into a Provider Agreement with the Department for the provision of CCP
services shall comply with the following certification procedures:
1) A provider agency requesting initial
certification of qualifications shall submit, in a form and manner prescribed
by the Department, material documenting the ability to comply with
administrative requirements, service specifications and any other
administrative or operational information required by the Department for the
applicable service.
A) The Department or its
designee will review the material submitted and, if necessary, will request
additional information. The Department or its designee will conduct on-site
reviews of a prospective provider agency for in-home service and adult day
service under the CCP unless a performance review of the provider agency has
already been completed by the Department or its designee within the prior 12
months. The Department reserves the right to conduct on-site reviews of a
prospective provider agency for emergency home response service and AMD service
under the CCP. Failure of a prospective provider to respond to the Department's
request for a site-visit may result in the denial of certification.
B) If additional information is requested by
the Department, the provider agency has 30 calendar days after the date of
request to submit this information.
C) After 60 calendar days, the provider
agency's request for certification of qualifications will be closed and all
information must be resubmitted to the Department if the provider agency wants
to continue to request certification.
2) Provider agencies will be notified in
writing of the results of the certification request. Those provider agencies
determined by the Department to be qualified will be certified for a period of
no more than 3 years and afforded the opportunity to execute a Provider
Agreement (generally for a three-year period) for the applicable
service.
d)
Recertification
The Department, or its designee, shall conduct
recertification of each provider agency with a valid Provider Agreement no less
frequently than every three years to determine continued compliance with
qualifications for the applicable service. The timing of recertification shall
be based upon the timing of the initial certification (see subsection (b)) or
of the most recent recertification.
1)
The Department, or its designee, shall notify each provider agency, in writing,
at least 30 calendar days prior to recertification to request the material
required for the recertification. Any provider agency interested in renewing
its Provider Agreement shall submit, in a form and manner prescribed by the
Department, material documenting the continued ability to comply with the
administrative requirements, service specifications, and any other
administrative or operational information required by the Department for the
applicable service.
2) Before
recertifying a service provider, the Department will conduct a performance
review under Section 240.1660.
3) Provider agencies will be notified in
writing of the results of the recertification.
4) Those provider agencies determined by the
Department to be qualified will be recertified for a period of no more than
three years and afforded the opportunity to execute renewal of the Provider
Agreement (generally for a three-year period) for the applicable
service.
e) Other
initial certification or recertification considerations include, but are not
limited to:
1) pending or current Departmental
on-notice or contract action for failure to adhere to Provider Agreement
requirements, including a history of non-compliance with the Provider
Agreement;
2) notification from
another governmental entity of similar contract actions or non-compliance
findings;
3) financial insolvency,
criminal indictment or conviction, or other legal issues that, in the opinion
of the Department, would make the award of a Provider Agreement contrary to the
best interest of the State;
4)
complaints forwarded to the Department by the Attorney General's office, the
Better Business Bureau or other consumer protection organizations; or
5) the current provider agency is not in good
standing with the Department.
f) The Department may require completion of
additional disclosure statements and/or background inquiries if there is reason
to believe offenses have occurred since completion of previous disclosures and
background inquiries.
g) The
Director shall represent and act for the State in all matters pertaining to the
Application for Certification process and Provider Agreements awarded. The
Director receives all recommendations and has the ultimate decision making
authority for issuing Provider Agreements. The Director reserves the right to
allow the applicant to correct inadvertent, technical errors in the application
when, in the Director's opinion, the best interest of the State will be served
by the correction.
h) Any provider
agency denied initial certification of qualifications or recertification for
the provision of CCP services shall be afforded the opportunity to submit
another request to the Department after a 60-day period of time after issuance
of the determination or notification of a final decision or other action on an
objection filed pursuant to Section
240.1645. The provider agency
may also object to the decision in a form and manner prescribed by the
Department in the written notification of denial (see Section
240.1645).
i) Provider Agreements
will be entered with qualified provider agencies on a schedule determined by
the Department, but no more frequently than semiannually after initial
certification.
