(a) All enrolled
PRTFs shall be subject to the On-Site Compliance Review (OSCR) which monitors a
PRTF's overall operations for compliance with state and federal conditions of
participation as referenced in Section
4, as well as evaluate the quality of
clinical programs and services.
(b)
An OSCR may be conducted at any time, and may be conducted as a partial
off-site (review of records) and partial on-site (facility tour and
staff/resident interviews) compliance review. An interim review may be
scheduled at any time at the discretion of the Department to address specific
concerns.
(c) OSCR Ratings:
(i) Probation. A PRTF receiving this rating
shall be subject to the following actions by the Department:
(A) A hold on new admissions;
(B) Youth transfers shall be
considered;
(C) Guardian
notifications of PRTF ratings shall be initiated for all Wyoming Medicaid
clients receiving services from the PRTF; and
(D) Notification of facility rating shall be
provided to the PRTF's licensing and survey authority and the PRTF's Board of
Directors.
(ii)
Suspension. A PRTF receiving this rating shall be subject to the following
actions by the Department:
(A) A hold on new
admissions;
(B) Youth transfers
shall be initiated;
(C) Guardian
notifications of rating shall be initiated for all Wyoming Medicaid clients
receiving services from the PRTF;
(D) Notification of facility rating shall be
provided to the PRTF's licensing and survey authority and the PRTF's Board of
Directors;
(E) A PRTF receiving two
(2) suspension ratings during its course of enrollment with Wyoming Medicaid
shall be dis-enrolled as a Wyoming Medicaid provider. The suspension ratings do
not need to be consecutive; and
(F)
Petitions for re-enrollment shall be considered on a case by case basis, no
sooner than twenty-four (24) months after dis-enrollment. Dis-enrollment may be
considered by the Department after one (1) suspension rating depending on the
severity and scope of the findings.
(iii) Deferred. In cases of deferred status,
the Department shall re-contact the PRTF within ten (10) days to:
(A) Request additional information or
documentation, which shall then be provided by the PRTF within ten (10) days of
receiving the request;
(B) Schedule
a continuation of the OSCR, in which case additional team members may
participate in further on-site review of the facility, or
(C) Submit a final status ruling. The ten
(10) day request/submission response cycle shall continue until a final status
determination is made.
(d) Corrective Action Plan (CAP). Any
facility receiving a rating of Review, Probation or Suspension shall submit a
Corrective Action Plan (CAP). The CAP shall be received by the Department no
later than ten (10) working days following the PRTF's receipt of its status
ruling. The CAP shall address separately each concern cited in the OSCR
report.
