Current through Register Vol. 35, No. 18, September 24, 2024
A. Sanctions, as
follows, may be imposed for the reasons listed in Section 11. The severity of
the action taken by the department depends upon the specific facts in each
case, the seriousness and history of the events prompting the department to
take action, and the ability and willingness of the agency to promptly take
adequate corrective action.
(1) REVOCATION:
The LCA cancels certification, making it void. The medicaid provider agreement
terminates on the date of revocation.
(2) SUSPENSION: The LCA temporarily revokes
certification until the identified deficiencies are corrected and the LCA
approves the corrections. The medicaid provider agreement terminates on the
date of suspension.
(3)
NON-RENEWAL: The LCA refuses to renew certification and issues a notice stating
that the certification is void as of a specific date, on or about the date of
expiration. The medicaid provider agreement terminates on the effective date of
non-renewal.
(4) DENIAL: The LCA
refuses to issue certification.
(5)
ADMISSIONS HOLD: The LCA restricts the program from accepting any new clients
until the identified deficiencies are corrected and the LCA approves the
corrections.
(6) EXPANSION HOLD:
The LCA restricts the program from expanding into additional services until the
identified deficiencies are corrected and the LCA approves the
corrections.
(7) MAINTENANCE OR
REDUCTION IN PROGRAM CAPACITY: The LCA directs the program to maintain or
reduce the capacity of the program to a designated client census until the LCA
determines that all of the deficiencies resulting in the sanction have been
corrected.
(8) COMPLIANCE MONITOR:
The LCA may select and assign a compliance monitor and assign it to an agency
for a specified period of time to oversee an agency's compliance efforts. The
compliance monitor has the authority to review all applicable facility records,
including financial records and policies, and the authority to interview
facility staff and clients. The compliance monitor may also advise the program
regarding steps to correct violations and improve overall clinical programming.
The compliance monitor reports to the LCA on a weekly basis or more often when
indicated. The agency pays all costs of the compliance monitor.
(9) TEMPORARY MANAGEMENT: The LCA appoints
temporary professional management with expertise in the field of the child and
adolescent mental health and/or substance abuse services provided by the
program. The temporary management assumes primary responsibility to oversee the
operation of the program; to protect the health and safety of its clients; to
assess and direct the correction of deficiencies; and/or to facilitate an
orderly closure. The temporary management reports to the LCA. The agency pays
all costs of temporary management.
B. EXTENUATING CIRCUMSTANCES: In assessing
the appropriateness or severity of sanctions, the LCA may consider any relevant
factor(s) that may mitigate or exacerbate the situation precipitating the
sanction.
C. CORRECTION OF
DEFICIENCIES: When the LCA determines that deficiencies exist, the program must
correct the deficiencies according to the following time frames or further
sanctions may be imposed:
(1) Health and/or
safety deficiencies are corrected immediately.
(2) Deficiencies that do not compromise
health and/or safety are corrected within a period of time specified by the
LCA.
D. SERVICE OF
NOTICE: The department provides notification, by fax and certified mail or
personal service/delivery, of its imposition of any emergency sanction against
a program. A notice of contemplated action under these certification
requirements may be sent by fax and mail, personal service or delivery, or by
certified mail. Each notice of emergency sanction or contemplated action will
be forwarded by fax to the medical assistance division immediately. (The
medical assistance division of the human services department is responsible for
any notices related to medicaid payments sent to the provider.)
E. NEW OWNERSHIP: In the event a provider
sells or otherwise transfers its interest in its certified program to another
entity, and a sanction or other corrective measure is pending, the sale of the
certified program does not stay or otherwise impact the pending sanction. The
new owner/entity must comply with all areas of correction noted in the sanction
or action plan. If a sanction(s) is pending, the LCA will proceed with the
appeals process and may issue a notice of final action pursuant to these
certification requirements.
