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Description of Terms

Compliance with Background Screening

Providers and staff of the DD Medicaid Tier waivers, the Individual Budget Medicaid Waiver, including the CDC+ Program are required to have a cleared Level 2 Background Screening when they begin providing services and every five years after that. This screening helps protectindividuals by preventing anyone with a history of certain criminal activity from becoming a provider of services or working for a provider of services. Delmarva Foundation requests proof of this information as part of the Provider Discovery Review process.

Compliance with Staff Training

Providers of the DD Medicaid Waivers, including the iBudget Medicaid Waiver and the CDC+ Program are required to obtain training specific to the type of service being provided. Training helps ensure providers have the knowledge and skills necessary to be effective service providers. Delmarva Foundation requests proof of training as part of the Provider Discovery Reviews. Service specific training requirements for DD Waiver program providers are available in the Medicaid Coverage and Limitations Handbook. To access the Medicaid Handbooks go to:

  1. http://mymedicaid-florida.com/
  2. Under Provider Section (middle section) of site, select Public Information for Providers
  3. Under “Quick Links” box (right side of page), select Florida Medicaid Site
  4. “Welcome to Medicaid” page-scroll down to sixth (6th) paragraph and click on handbooks
  5. “Provider Handbooks” page-scroll down page and select desired handbook

To access information on the CDC+ Program go to: http://apd.myflorida.com/cdcplus/

Deemed Status

Each provider is eligible for a Provider Discovery Review (PDR) each contract year unless their review results warrant “deemed” status. Under the Florida Statewide Quality Assurance program “deemed status” is defined as any provider with a score of 95% or higher on their overall PDR with no “alerts” and no “billing discrepancy.” If a provider scores at the “deemed status” level, the provider will not have to be reviewed until the following contract year. (The contract year is defined as the period from January 1st to December 31st.) Deemed status does not apply to Waiver Support Coordination services.

Overall Provider Performance Score

This refers to the overall score from the Delmarva Provider Discovery Review. The score is a percentage, based upon the number of standards present or are “Met” and the total number of standards reviewed. Standards are weighted so that some, such as those pertaining to health and safety, make a greater impact on the provider’s score.

Service Specific Record Review Scores (SSRR)

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

Health and Safety

Each provider has to maintain documentation demonstrating the assurances of health and safety for each person served.

Review Date

This refers to the date of the last provider Delmarva PDR annual review. Each provider identified as eligible for an on-site review receives a PDR once each contract year unless their results warrant "deemed" status, thus making them ineligible for a review until the following contract year. The contract year is defined as the period from January 1st to December 31st.

Data from provider reviews that were recently completed may not yet be listed. Data are added to the website as soon as possible.

Remediation

All providers are expected to correct any and all standards that are not considered “met” during a Provider Discovery Review (PDR). Under the Florida Statewide Quality Assurance program the provider correction process is called “remediation.” Each APD Region has primary responsibility to work with each provider to direct and track remediation activities for all unmet standards until the standard is satisfactorily corrected. The Area staff must ensure that providers have corrected deficiencies cited by either the Delmarva Foundation or other APD monitoring sources.

Area staff works directly with providers with cited deficiencies to submit a plan of remediation that addresses each item cited in a discovery reviews. The Area staff will then track the progress of each item to be corrected until staff can verify that all items have been completed.

Although all identified deficiencies must be corrected to 100%, only those providers who receive an overall PDR score of 85% or less are required to complete a formal written plan of remediation and are tracked by the Area Regional office. The Area Regional office where a provider is located may be contacted to determine the status of a provider’s remediation activities.

 

 
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