Description of Terms

Provider Support Level
A Provider Support Level is given to providers who participate in a CORE or WiSCC.  The Support Level tells you how well the provider helps people achieve goals and other dreams that matter most to them.  Achieving () is the highest level and Not Emerging () is the lowest level.

Achieving

• The provider always helps individuals achieve outcomes, or helps them take steps toward achieving the outcomes.
• The provider finds out from individuals what is most important to them and helps them achieve those important outcomes.
• The provider’s mission and practices always reflect person-centered philosophies.
• The provider knows the people receiving services, and keeps trying to learn more about them.
• The provider regularly takes steps to assist the people receiving services to understand their options.  This helps people to make informed decisions.

Implementing

• The provider usually takes steps to help people, but outcomes are not regularly being achieved. 
• The provider has tried to move toward person-centered philosophies, but this is not always occurring.
• The provider knows general information about the people receiving services.  They have some systems to learn about people but do not know enough about everyone they serve.
• The provider takes some steps to assist the people receiving services to understand their options.  This helps some people to make informed decisions.

Emerging

• The provider takes some action toward helping individuals achieve outcomes but overall outcomes are not being achieved.
• The provider knows general information about the people receiving services but it is limited.  They do not have good systems to learn more about people.
• The provider takes some steps to assist some of the people receiving services to understand their options.  Informed decisions are not often taking place.

Not Emerging

• The provider does little to help individuals achieve outcomes or to know what is important to them.
• Any of the provider’s actions to help people to achieve outcomes are either inconsistent or without direction.
• The provider has done little or nothing to move toward person-centered philosophies.
• The provider knows very little about the people receiving services or their choices and preferences. 
• The provider does not help the people receiving services to understand their options and make informed decisions.

Score
If the Review Date is after July 2004, this is the score for providers who had a Desk Review.  Providers who receive a Desk Review get a Percentage Score.   If a provider gets a Desk Review it means Delmarva did not visit the provider onsite to do a CORE or WiSCC review.

If the Review Date is before July 2004, this is the score for a Desk Review or a Provider Performance Review.  The Provider Performance Review was the onsite review Delmarva did up through June 30, 2004.  In this case, the provider is probably scheduled for a new review but it has not yet taken place.

Review Date
The date of the last Delmarva annual review is listed.  Data from provider reviews that were just finished may not be listed.  Data are added to the website as soon as possible.

Service Requirements
Each provider has to maintain documentation that certain service standards are met.  Reviewers check the providers’ records for written documentation the provider has the proper background screening and training, and bills properly.

Compliance with Background Screening
Providers and staff of DD and FSL Medicaid Waiver services are required to have a Level 2 Background Screening check when they first offer services and every five years after that.  This helps protect  individuals by preventing anyone with a history of certain criminal activity from becoming a provider of services.  Delmarva Foundation requests to see proof of this information as part of all the CORE, WiSCC and Desk Reviews. 

Compliance with Staff Training
Providers of DD and FSL Medicaid Waiver services are required to obtain different types of training based upon the type of service being provided.  Each training helps ensure providers have the knowledge and skills necessary to be effective service providers.  Delmarva Foundation requests to see proof of this training as part of all of the CORE, WiSCC, and Desk Reviews that are conducted.  Service specific training requirements are available in the Medicaid Coverage and Limitations Handbook. To access the Medicaid Handbook go to:

1. http://mymedicaid-florida.com/
2. Click Public Information for Providers
3. Click Provider Support
4. Click Provider Handbooks

Reimbursement and Monitoring Documentation
Records are reviewed to determine if the service provider or support coordinator has all the documentation needed to justify what was billed. For new providers, policies and procedures are also reviewed.

Service Authorization is Documented
Service providers have written authorization from the Agency for Persons with Disabilities to render the service. Waiver Support Coordinators have documentation for WSC services, and also that all other service providers used by the individual are authorized by an approved cost plan and service authorization. Also, service providers and support coordinators must bill as they are authorized to do so.

Compliance with Desk Review Process
Many providers of DD and FSL Medicaid Waiver services are required to participate in a Desk Review and do not receive personal visits from Delmarva representatives.  These providers are asked to submit certain documents for Delmarva to review.  Providers not submitting this information, after two requests from Delmarva and one from the State of Florida, are deemed Non-Compliant with the Desk Review process.  They are then at risk of losing the right to provide services on the DD or FSL Medicaid Waiver programs. 

Services Provided
This is a list of services the provider has offered and that are in the Medicaid Claims data. The services listed were billed to Medicaid by the provider within a year of the date Delmarva did the review.  Providers may offer other services that are not listed, but they have not yet billed for them.  They may no longer provide a service that is listed.  Please contact providers if you would like more information about the services they may offer.