Mont. Admin. R. 37.40.1023 - SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: PROVIDER COMPLIANCE
(1) Providers of
Community First Choice Services (CFCS) will be subject to compliance reviews to
provide assurance to the department that services are being provided within the
rules and policy of the program.
(2) The department will conduct compliance
reviews on the provider's premises and through documentation requests. The
provider must supply documentation requested by the department in a reasonable
time frame and no later than 30 days following the request.
(3) The reviews will take place at times
determined by the department.
(4)
The department will determine compliance in the following service delivery
areas:
(a) service authorization
documentation;
(b) health-care
professional authorization;
(c)
high-risk authorization;
(d)
amendments and temporary authorization;
(e) service plan and member choice;
(f) service delivery;
(g) agency program oversight; and
(h) health and welfare and serious occurrence
reports.
(5) The
department will determine compliance in the following administrative areas:
(a) staff credentials, certification, and
training;
(b) principles of
charting;
(c) maintenance of
serious occurrence reports;
(d)
member satisfaction surveys;
(e)
required documentation;
(f) agency
manuals and handouts, including complaint process;
(g) workers' compensation, liability, and
automobile coverage; and
(h)
service billing.
(6) The
department will determine compliance in the following person-centered planning
delivery areas:
(a) plan facilitator
certification documentation;
(b)
member and plan facilitator rights and responsibility documentation;
(c) person-centered plan and member choice;
and
(d) risk assessment and
mitigation.
(7) The
department will examine a minimum of three cases or five percent of the
provider's case load for the purpose of the compliance review, whichever is
greater. The department will review additional cases, when necessary.
(8) The provider must meet all standards in
ninety percent of the cases to be considered in compliance. If ninety percent
compliance is not met, a second compliance review will be scheduled.
(9) The provider must meet all standards in
ninety percent of the cases in the second review or it will be subject to
department sanctions as provided in ARM
37.85.401.
Notes
53-2-201, MCA IMP: 53-2-201, 53-6-113, MCA;
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