Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 23 - Behavioral Health Services › Rule 016.23.13-001 - Arkansas Access to Recovery Program Manual

Current through Register Vol. 49, No. 6, June, 2024
Changes or Exceptions to the Provider Manual
The Access to Recovery (ATR) Provider must comply with state
				and federal laws, rules and regulations applicable to the furnishing of health
				care and service adjuncts funded in whole or in part by state or federal funds.
				All services must conform to professionally recognized behavioral health
				rehabilitation and recovery models. If any statute or regulation (to include
				the AR ATR Provider Manual or any of its forms, policies and procedures,
				changes in services or rates) is enacted or promulgated requiring changes to
				the Voucher Agreement, the Agreement will be considered to be automatically
				amended to comply with the newly enacted statue or regulation as of the
				effective date of the statute or regulation.
In Accordance with the Arkansas Administrative Procedures Act,
				all changes to the Manual will be publically announced and provided for public
				comment. If deemed an emergency (as defined by the Administrative Procedures
				Act), DBHS may make changes effective immediately followed by standard
				promulgation within thirty (30) days of the effective date of the emergency
				rule.
DBHS will notify Providers in writing within thirty (30) days
				of any necessary changes or amendments to statutes or regulations. Providers
				may be notified of changes by website update, provider calls, e-mail
				notification or certified mail.
Grandfathering Clause
Changes to ATR provider qualifications will not affect
				providers who were certified for services prior to (enter effective date of
				Manual). All new applicants for ATR certification after this date must meet the
				qualifications as specified for each service included in the application.
				Existing providers requesting to add services must meet the qualifications
				specified in this manual.
Existing providers will have sixty (60) days after the
				effective date of this Manual to provide the additional documentation required
				and/or to develop and submit the required program description.
General ATR Program
				Information
Introduction
In October, 2010, the Arkansas Department of Human Services
				(DHS), Division of Behavioral Health Services (DBHS) was awarded a four year
				grant by the United States Department of Health and Human Services, Substance
				Abuse and Mental Health Services Administration (SAMHSA) to provide recovery
				support services to Arkansans diagnosed with a Substance Use Disorder (SUD)
				under the Access to Recovery III program. The Arkansas Access to Recovery (AR
				ATR) program is consistent with the DBHS "recovery-oriented system of care" or
				Recovery Oriented System of Care (ROSC) model and integrates substance abuse
				prevention, treatment, and recovery support services. AR ATR provides funding
				for individuals through vouchers issued to contracted providers to purchase
				services and supports linked to their recovery from SUD.
ATR funding does
				not replace or supplant existing services and/or funding streams.
Rather
				it increases the array of available community -based services, supports, and
				providers and supports the individual's choice to receive services through
				either faith-based or non-faith based providers. The AR ATR Program is designed
				to provide recovery support services to assist the client in their recovery
				once they have completed their course of treatment.
A total of $13,119,440 was awarded for the 4 year period with
				80% of the funds available for services. The annual funding is approximately
				$3,000,000. The grant period is from September 29, 2010 through September 29,
				2014. During the lifetime of the grant, a minimum of 7,649 clients will be
				served (879 in Year 1; 2,662 in Year 2; 2,589 in Year 3; and 1,519 in Year 4).
				Through a sub-grant with the University of Arkansas - at Fayetteville (UAF)
				Partners for Inclusive Communities (Partners), DBHS and Partners jointly
				administer the AR ATR project. Both agencies provide day-to-day project
				management with DBHS having the ultimate program authority.
This is a pilot project with services available to residents of
				the thirteen (13) pilot counties (Benton, Craighead, Crawford, Faulkner,
				Garland, Independence, Jefferson, Lonoke, Pulaski, Saline, Sebastian,
				Washington and White). As a condition of the grant, all clients MUST be offered
				choice of providers for both care coordination services and recovery support
				services. Referrals are made through the AR ATR referral website at
http://www.humanservices.arkansas.gov/dbhs/pages/AcessToRecovery.aspx
.
To ensure complete choice of all services including care
				coordination, there must be a minimum of two (2) providers per county per
				individual service certified and
under contract with DBHS and listed
				on the aforementioned website before the county and/or service may be offered
				or vouchered. There is an open enrollment for the first three years of the
				grant with new providers and services added continually. Visit the website for
				a current listing of providers and services available. DBHS may expand
				certification of services or providers based on lack of accessibility to
				services in specified communities or geographic regions.
At its discretion, DBHS may declare there are not a sufficient
				number of providers of a particular service available in a county and open that
				service to clients who chose to move or relocate in order to obtain the
				service. DBHS may also deem a service open in an ATR county if an insufficient
				number of providers exist. This in no way nullifies the residency eligibility
				for a client.
The AR ATR is operated through a web-based system hosted by
				FEi, a DBHS contracted vendor. The system is an Electronic Health Record system
				(EHR) through which vouchers for all services (care coordination and
				treatment/recovery support) are issued and accepted by contracted providers,
				service delivery is documented, claims are submitted and payment is processed.
				The EHR system is called AR Web Infrastructure for Treatment Services (AR WITS)
				and, once a provider is certified and a contract (or voucher agreement) is
				signed, may be accessed through the website.
I GUIDING PRINCIPLES:
The AR ATR program is based on the following:
1. Individuals with substance use disorders
			 and their families have
the right to choose recovery and
			 the recovery-related services and supports that best meet their needs, and
			 receive those services in their own community.
2. Client choice is enhanced by a
			 recovery-oriented system of care that honors each client's familial, cultural,
			 spiritual, economic, and logistical needs.
3. Individualized choice enhances client
			 retention in treatment and strengthens client commitment to and success in
			 recovery.
4. Participation in AR
			 ATR is
voluntary
and can be
			 terminated by the client at any time,
without repercussion
			 to the client and or family
member.
Participation
cannot
be court ordered, or required
			 by a state agency (e.g., as a condition of parole/release or as a part of
			 reunification with the client's child(ren).
ATR Client Eligibility Criteria:
In order to receive ATR services, a client must meet o//five
				(5) of the following eligibility criteria:
1. Have an existing Substance Use Disorder
			 (SUD) determined by using a standardized alcohol and drug abuse screening tool;
and
2. Reside in one
			 of the thirteen (13) covered counties (Benton, Craighead, Crawford, Faulkner,
			 Garland, Independence, Jefferson, Lonoke, Pulaski, Saline, Sebastian,
			 Washington, or White);*
and
3. Be 18 years of age or older;
and
4. Gross income at
			 or below 200% of the Federal Poverty Level;
and
5. Be a member of
one
of the following populations:
- 1-3 Driving Under the Influence (DUI) or Driving While
				Intoxicated (DWI) convictions within the last
- 18-24 months, with the most recent conviction within the past
				six (6) months
(Note: Does not include drug possession charges);
				or
- Pregnant women with SUD;
or
- Combat Veteran (Army Reserve/National Guard/Activity Duty);
or
- A custodial parent or custodial family member involved or
				at-risk of involvement with the DHS Division of Children and Family Services
				(DCFS) or Division of Youth Services (DYS),
AR ATR reserves the right to approve exceptions to the
				eligibility criteria on a case by case basis. All exceptions must be submitted
				in advance in writing using the approved Eligibility Exception Request Form
				(see Forms Section of this Manual). A written response will be provided within
				three (3) working days of the request. No services, including care
				coordination, may be provided prior to receiving written approval.
Note: A client must be a resident of one of the thirteen
				(13) covered counties but may choose to relocate to one of the other covered
				counties in order to receive residential treatment or drug-free supportive
				transitional housing services.
Exceptions for individual clients may be requested using
				the
ATR Eligibility Exception Request Form or the ATR Service Exception
				From
found in
the Forms Section
of this
				manual.
ATR Referral Process
Potential ATR clients with a documented substance use disorder
				(SUD) may access ATR covered services (care coordination and recovery support
				services) through the ATR website at:
http://humanservices.arkansas.gov/dbhs/Pages/AccessToRecovery.aspx
1. Referral sources may be the potential
			 client, a family member, friend, authorized representative, substance abuse or
			 mental health treatment providers, medical professionals, state agencies, etc.
			 The referral source accesses the referral link listed below where a list of
			 Care Coordinators for the potential client's home county is provided,
https://dhs.arkansas.gov/dbhs/atr/
2. The Potential AR ATR Client selects a Care
			 Coordinator of their choice from the web site listing. (Each client must be
			 offered a choice from among at least two Care Coordinators).
3. The referral source electronically selects
			 the ATR Care Coordinator of the client's choice which will link them to an ATR
			 Referral Form
(See Forms Section: AR ATR Referral
			 Form).
4. The Referring
			 source will complete the ATR Referral Form and send it to the selected Care
			 Coordinator by e-mail through the link. A copy of the Referral Form is
			 automatically sent to the ATR Program Office.
5. The Client-Selected ATR Care Coordinator
			 will retrieve the ATR Referral Form and accept or reject the referral. If
			 accepted the ATR Care Coordinator will contact the potential ATR Client to
			 schedule an ATR Assessment. If the potential client is rejected for reasons not
			 due to eligibility by that ATR Coordinator, he/she will assist the potential
			 client in selecting another Care Coordinator and will initiate another
			 referral. If preferred, the referral source may make an appointment with the
			 Care Coordinator directly while the client is present. The client-selected ATR
			 Care Coordinator will note in the ATR referral website the results of the
			 referral (client accepted/not accepted/ineligible) and the reason. If the ATR
			 Electronic Referral System is not used during the referral process, it is the
			 responsibility of the Client-Selected ATR Care Coordinator to enter the client
			 in the electronic system and obtain a client referral number to be used when
			 entering the client's information in the AR WITS system.
Note: The ATR Electronic Referral
				System is the single point of entry for all ATR clients. Care Coordinators
				shall ensure that the client information is in the ATR referral system BEFORE
				entering the client in the AR WITS System. Failure to comply with this
				requirement constitutes contract non-compliance and may result in contract
				remedies being applied.
ATR PROVIDER CERTIFICATION
AND CONTRACTING
				INFORMATION
ATR Provider Enrollment Process
ATR providers may be either organizations or individuals. All
				payments made to providers are 1099 reportable. A contract (voucher agreement)
				to provide ATR services between an individual and DBHS does not in any way
				establish an employee/employer relationship, therefore all required taxes and
				withholding are the responsibility of the individual.
Individuals/organizations interested in providing ATR services
				must be either located in one of the thirteen (13) target counties or in a
				county adjacent to one of the target counties. Applications are available on
				the website or by contacting Partners at 1-501-682 -9000.
Note: Ark. Code Ann. § 19-ll-104(c)(l) prohibits
				state employees from entering into professional or consultant services
				contracts with the state. Ark. Code Ann. §
									19-4-1604 imposes additional
				limitations on paying
any
compensation (other than actual
				expenses) to an employee of another agency, regardless of whether the payment
				is under a professional or consultant services contract or by any other means.
				Therefore, in accordance with Arkansas State Law, state employees may not
				enroll as individual providers or serve as employees under an organization
				under this program.
Enrollment is a five-step
				process:
Step I: Certification
Certification by DBHS is required to participate in the ATR
				Program. Interested parties must complete the ATR Program Application Form (see
				Forms Section), include all required documentation, and submit to DBHS for
				Approval. Applicants must attach copies of all of the required documents
				associated with each service for which you are applying as indicated in
				Services and Qualifications Section of this Manual.
Applications must be organized. If applying for more than one
				service, documentation of qualifications for each individual must be collated
				(grouped) by service with a cover page separating each group of credentials by
				service. Applications not organized in this manner will be returned. Additional
				documentation will be requested for Incomplete applications. Incomplete
				applications will be pended until documentation is
				received.
A pended application will expire in thirty (30) days after
				documentation is requested and will be denied for incomplete application.
				Re-consideration for certification will require submission of a new
				application. Please note that organizations applying for certification must
				submit credentials for each employee who will provide services under
				ATR.
Applicants will be notified in writing regarding the results of
				the application. Certification is for a twelve (12) month period and all
				providers must be recertified prior to the end of their certification.
Step II: Voucher Agreement (Contract)
Certified individuals/organizations will be sent a contract
				packet by the ATR Finance Officer. Providers are responsible to read all of the
				documents before signing as they provide specific requirements for providers
				and remedies for failure to comply with any or all of the requirements. Failure
				to comply may place you/your agency in jeopardy of losing participation in this
				program, other DHS programs, and/or certification as an ATR provider. Once the
				packet is completed it must be sent in its entirety to the ATR Finance Officer
				for review.
Step III: Required Training
All applicants are required to attend initial ATR training.
				Once an individual/organization has submitted their completed voucher agreement
				and submitted for approval, they will be notified of the next available
				training date and must register and attend training prior to final contract
				approval. Care coordinators must attend a three day ATR initial training and
				the one day initial WITS training before they can become certified.
				Organizations with multiple care coordinators must send each individual care
				coordinator to the training. Treatment/recovery support services providers must
				send at least one representative to the first day of the three-day
				training.
Individuals/organizations who do not attend the required
				training will not be eligible to participate in the ATR Program.
Individuals/organizations may also be required to attend other
				mandatory training as deemed necessary by DBHS. Additional trainings may
				include, but not be limited to, GPRA training, Advanced WITS training, and
				Advanced Care Coordination training.
Step IV: Provider Set-up in the WITS System
Upon completion of the required training, the Voucher Agreement
				will be reviewed by ATR staff. If approved, ATR staff will sign and return a
				signed copy to the provider for their files. Please be aware that any changes
				such as addition/deletion of services, changes in staff, changes in billing
				staff, physical address, e-mail address or telephone number changes must be
				reported to DBHS in writing within five (5) working days of the change.
				Dependent upon the type of change, an amendment to your contract or submission
				of new forms may be required. After the voucher agreement has been approved and
				training has been completed, you/your agency's agreement will be established in
				the ATR WITS System. Providers will be notified when set-up is
				completed.
Step V: Provider Set-Up on the ATR Referral
				Website
Upon set-up in the WITS system, new providers will be listed on
				the referral website. Providers (both care coordinators and service providers)
				must appear on the website before they can be offered as a choice to clients or
				prior to accepting referrals. Services cannot be provided until the entire
				certification process and voucher agreement approval process have been
				completed. Any services provided prior to completion of the entire process will
				not be reimbursed and are the sole responsibility of the provider. Services are
				paid for on a reimbursement basis only and are not paid in advance.
Certification Procedures
DBHS shall certify each qualified individual or organization
				and their staff providing ATR services.
A certification is valid and effective only for the individual
				or organization to which the certification is issued.
A certification is not transferable to another individual or
				entity.
A certified provider is responsible for compliance with all
				applicable building codes, zoning requirements, ordinances, rules, statutes and
				similar regulations that are required by city, county, state, or federal
				jurisdictions. Where such codes are not in effect, it is the responsibility of
				the certified provider to consult one of the national building codes generally
				used in the area for all components of the building type being used or
				constructed. Nothing in this procedure relieves a certified provider of these
				responsibilities.
being used or constructed. Nothing in this procedure relieves a
				certified provider of these responsibilities.
The validity of a certification is contingent on continued
				substantial compliance with applicable program requirements. A certification is
				subject to corrective action or interim adverse action which may be imposed by
				DBHS at any time upon a finding of substantial noncompliance.
DBHS shall have access to the premises, staff, individuals
				served and their families, and all records of a certified provider at all times
				for the purpose of conducting Abbreviated Reviews, Certification Reviews,
				Service Concern Investigations, or Surveys concerning compliance with
				applicable Program requirements.
Certification Definitions:
"Certification"
means a written designation issued
				by DBHS declaring that a provider has demonstrated compliance with applicable
				program requirements.
"Certification Review"
means a formal evaluation
				of a new provider or certified provider by DBHS to ensure program quality and
				compliance with applicable program requirements. The evaluation may be
				conducted through a desk review of submitted information or through an on-site
				inspection of provider facilities.
"Certification with Requirements"
means that DBHS
				finds a certified provider has been substantially out of compliance with
				applicable Program requirements for more than thirty (30) days, and has been
				given "requirements" to fulfill a Corrective Action Plan (CAP).
"Focused Review"
means an onsite targeted
				evaluation of a certified provider due to non-compliance with state and/or
				federal regulations and/or contract requirements based on data submitted to
				DBHS.
"Service Concern Investigation"
means a specific
				inspection of a certified provider by DBHS with regard to a complaint or
				complaints.
Procedural Guidelines: Certification Application Process.
Certification
Certification by DBHS is required to participate in the ATR
				Program. Interested parties must complete the ATR Program Application Form
				(Application Form is located at the end of this section), include all required
				documentation, and submit to DBHS for Approval. Applicants must attach copies
				of all of the required documents associated with each service for which you are
				applying as indicated in Services and Qualifications Section of this Manual.
Applications must be organized. If applying for more than one
				service, documentation of qualifications for each individual must be collated
				(grouped) by service with a cover page separating each group of credentials by
				service. Applications not organized in this manner will be returned. Additional
				documentation will be requested for Incomplete applications. Incomplete
				applications will be pended until documentation is received.
A pended application will expire in thirty (30) days after documentation
				is requested and will be denied for incomplete application. Re-consideration
				for certification will require submission of a new application. Please note
				that organizations applying for certification must submit credentials for each
				employee who will provide services under ATR.
Applicants will be notified in writing regarding the results of
				the application.
Procedure to Add Staff
Certification is based on individual qualifications and, as
				such, anytime new providers plan to add staff to their certification/contract,
				a request must be submitted to the DBHS Certification Representative. The
				request must include:
1. A cover
			 letter listing each staff member's name and the service(s) each will
			 provide;
2. Copies of all required
			 documentation of qualifications for each service; and
3. ATR Provider Staff Information Sheet
			 listing each new staff member's contact information.
Once approved, the provider will be notified in writing and a
				copy of the staff information sheet will be submitted to the ATR Finance
				Officer for staff access to the AR WITS system.
Procedure to Add Services
To add a service to a contract, the provider must submit a
				written request to the DBHS Certification Representative. The request must
				include:
1. A cover letter listing the
			 services to be added;
2. Copies of
			 all required documentation of qualifications for staff who will provide that
			 service; and
3. ATR Provider Staff
			 Information Sheet (if there is new staff not currently on the WITS System).
Once approved, the provider will be notified in writing. The
				DBHS Certification Representative will notify the ATR Finance Officer for
				service addition in the AR WITS system. After completion of this process, the
				ATR Referral Website will be updated.
Procedural Guidelines: Certification Monitoring
				Process
DBHS provides monitoring and oversight of ATR providers by
				conducting periodic reviews of certified providers to ensure continued
				compliance with ATR program requirements. If DBHS determines that the certified
				provider is in substantial non-compliance with applicable Program requirements,
				DBHS imposes corrective actions or sanctions or both. Certification review may
				include, but is not limited to, a review of client records, service delivery
				documentation, client interviews, client satisfaction surveys, and billing
				records.
DBHS will send notice of the Certification Review to the
				provider and will identify any information that DBHS requires a certified
				provider to submit prior to the Certification Review. For example, DBHS may
				request copies of client files to review against applicable ATR program
				requirements, or copies of current licenses to determine continued
				certification.
DBHS will provide the certified provider with a written report
				documenting the findings made during the Certification Review within thirty
				(30) calendar days of completion.
If the Certification Review Report contains a deficiency that
				is classified as substandard quality of care, DBHS provides the certified
				provider with a written report concerning the nature of the substandard quality
				of care within fifteen (15) days of the date of the exit conference.
				Substandard quality of care is defined as a deficient practice related to
				Program requirements concerning Individual or Service Provision.
When DBHS finds that a certified provider is in substantial
				compliance but has deficiencies that constitute a pattern or widespread
				practices, a written Corrective Action Plan (CAP) is required.
Corrective Action Plan
A Corrective Action Plan (CAP) is a written statement developed
				by a certified provider to describe both short-term remedial steps to achieve
				compliance and permanent practices and procedures to sustain compliance.
In order for a CAP to be acceptable, it must:
- Contain elements detailing strategies the certified provider
				will use to correct the deficiency as it relates to the individual
				served;
- Indicate methods the certified provider will use to protect
				individual service in similar situations;
- Include the measures the certified provider will take or the
				systems it will alter to ensure that the problem does not recur,
- Indicate how the certified provider plans to monitor its
				performance to make sure that solutions are sustained; and
- Provide dates when corrective action will be completed.
				Completion dates will be determined in conjunction with DBHS.
Note: See Contract Compliance Corrective Action Plan in
				the Forms Section of this Manual.
DBHS approves the CAP if it satisfies the elements described
				above. If DBHS does not approve the CAP, DBHS shall provide the certified
				provider with a written explanation stating the reasons the CAP does not
				satisfy the elements described above. The certified provider will be given an
				opportunity to revise the CAP for approval within five (5) business days. If
				the CAP is still not approved by DBHS, then a DBHS directed CAP will be
				assigned and monitored or the provider may be subject to additional
				sanctions/remedies. All revisions must be completed and submitted to DBHS
				within five (5) working days.
Within thirty (30) days of acceptance of the CAP but not before
				the latest date of corrective action proposed by the provider, DBHS will
				conduct a follow-up review The review may be off-site or on-site. Reviews will
				focus on the actions taken by the certified provider since the correction dates
				listed on the plan of correction.
DBHS will send a written report documenting the findings made
				during the follow-up Review within fifteen (15) calendar days of the
				review.
Enforcement Sanctions
DBHS may impose any of the Sanctions described below alone or
				in combination with any other Sanctions or monitoring measures to ensure or
				enforce quick compliance with program requirements.
Certification Downgrade
Certification with
				Requirements
:
If a certified provider is not in
				substantial compliance with applicable program requirements within thirty (30)
				calendar days after receiving notice of noncompliance in a Certification Review
				Report, the status of the certified provider's Regular Certification will be
				downgraded to a Certification with Requirements. In order to achieve
				restoration of its Certification, the certified provider corrects all
				identified deficiencies and demonstrates substantial compliance with program
				requirements within sixty (60) calendar days of being downgraded to
				Certification with Requirements.
Directed Corrective Action Plan (CAP)
A directed plan of correction is a sanction wherein DBHS
				develops a plan to require a certified provider to take action within a
				specified timeframe. Achieving substantial compliance is the responsibility of
				the certified provider whether or not a directed plan of correction is
				followed. If a certified provider fails to achieve substantial compliance after
				complying with a directed plan of correction, DBHS may impose additional
				sanctions until the certified provider achieves substantial compliance or is
				subject to certification revocation.
DBHS may impose a directed CAP fifteen (15) calendar days after
				the certified provider receives notice in non-immediate jeopardy situations and
				two (2) calendar days after the certified provider receives notice in immediate
				jeopardy situations.
The date a directed CAP is imposed does not mean that all
				corrections must be completed by that date.
Directed In-Service Training
Directed in-service training is a sanction that DBHS imposes
				when it believes that education is likely to correct the deficiencies and help
				the certified provider achieve substantial compliance. This remedy requires
				provider staff to attend an in-service training program.
DBHS may provide special consultative services and technical
				assistance for obtaining this type of training. At a minimum, DBHS will compile
				a list of resources that can provide directed in-service training and make this
				list available to certified providers and other interested parties.
The certified provider bears the expense of directed in-service
				training.
If a certified provider fails to achieve substantial compliance
				after completing directed in-service training, DBHS may impose additional
				sanctions until the certified provider achieves substantial compliance or
				certification is revoked.
Referral to DHS Quality Assurance Unit for Investigation
Referral to DHS Quality Assurance Unit for Investigation is an
				sanction that DBHS imposes in response to identifying specific information that
				a certified provider has received inappropriate payment for services or receipt
				of a complaint regarding service provision.
If results of the investigation reveal that a certified
				provider has demonstrated a reckless or intentional practice of non-compliance
				with the ATR program requirements or the terms and conditions of the ATR
				Voucher Agreement (contract), DBHS may impose additional sanctions, including
				without limitation, certification revocation, exclusion or debarment.
State Monitoring
State Monitoring is a sanction that DBHS imposes when DBHS
				determines that oversight of the certified provider's efforts to correct cited
				deficiencies is necessary as a safeguard against further harm to individuals
				served when harm or a situation with the potential for harm has
				occurred.
A State Monitor is an appropriate professional who:
- Is an employee, contractor, or designee of DBHS,
- Is not an employee or contractor of the monitored
				provider,
- Does not have an immediate family member who is served by the
				monitored provider, and
- Does not have any other conflict of interest with the
				monitored provider.
When State Monitoring is imposed, DBHS selects the State
				Monitor. Monitoring may occur anytime in a program or program component. State
				Monitors shall have complete access to the premises, staff, individuals served
				and their families, and all records of the certified provider at all times and
				in all instances for performance of the monitoring task.
Some situations in which State Monitoring may be appropriate
				include without limitation:
- History of non-compliance , i.e. a pattern of substandard
				quality of care, multiple complaints,
- DBHS concern that the situation has the potential to
				significantly worsen, or
- Substandard quality of care or immediate jeopardy exists and
				the certified provider has demonstrated inadequate corrective action.
State Monitoring is discontinued when the certified provider
				demonstrates substantial compliance with program requirements and practices
				that ensure continued substantial compliance. A certified provider can
				demonstrate continued compliance by adherence to a CAP that delineates systemic
				changes to ensure prevention of the recurrence of the deficient
				practice.
Moratorium on New Admissions
Moratorium on New Admissions may be imposed when a certified
				provider is out of substantial compliance. DBHS imposes a Moratorium on New
				Admissions when a certified provider has demonstrated substantial noncompliance
				sixty (60) calendar days after the last day of the Certification Review
				identifying the deficiency.
DBHS provides written notice of the moratorium on new
				admissions at least fifteen (15) calendar days before the effective
				date.
Generally, if the certified provider achieves substantial
				compliance that is verified through a follow-up Abbreviated Review or credible
				written evidence, DBHS lifts the Moratorium on New Admissions. However, when a
				Moratorium on New Admissions is imposed for repeated instances of substandard
				quality of care, DBHS may continue the sanction until the certified provider is
				in substantial compliance and DBHS has the assurance that the certified
				provider will remain in substantial compliance. Lack of demonstration of
				substantial compliance subjects the provider to additional adverse actions or
				sanctions.
Moratorium on Expansion
Moratorium on Expansion may be imposed when a certified
				provider is found to be out of substantial compliance with program requirements
				after sixty (60) calendar days of Provisional Certification. A Moratorium on
				Expansion may include adding new services or expanding to new counties.
The failure of a certified provider to substantially comply
				with program requirements after sixty (60) calendar days of Provisional
				Certification is evidence that the certified provider is unable or unwilling to
				take necessary corrective action. A Moratorium on Expansion continues until the
				certified provider is in substantial compliance with applicable standards, and
				DBHS believes the certified provider is willing and able to remain in
				substantial compliance.
If the certified provider has made considerable progress toward
				substantial compliance with applicable program requirements during the period
				of Provisional Certification, the DBHS Director or designee may grant an
				extension before a Moratorium on Expansion is imposed.
Specific Service Prohibition
A Specific Service Prohibition may be imposed when DBHS finds
				that a certified provider's service delivery has harmed a client by
				inappropriate eligibility determination, violation of client rights to include
				client choice, substandard delivery of services, failure to provide services in
				a timely and consistent manner, or failure to provide services. DBHS may impose
				the prohibition against serving a specific individual or individuals or against
				a specific class of individuals. The prohibition may be permanent or for a
				specific term depending on the circumstances of the case.
Certification Revocation
When considering whether to revoke the certification of a
				certified provider, DBHS considers many factors, particularly the provider's
				noncompliance history (e.g., it is consistently in and out of noncompliance),
				the effectiveness of alternative corrective actions or sanctions when
				previously imposed, and whether the certified provider has failed to follow
				through on an alternative corrective actions (e.g. directed plan of correction
				or directed in-service training) or if the certified provider fails to achieve
				substantial compliance after one hundred and eighty (180) calendar days of
				Provisional Certification.
Voluntary Surrender of Certification
If a certified provider intends to voluntarily surrender an ATR
				Certification, the certified provider is responsible for notifying DBHS
				immediately. As a condition of certification to provide ATR services,, the
				certified program or individual agrees to assist DBHS with transitioning
				consumers to discharge from services or to other services or providers when the
				ATR Certification is surrendered.
Transitioning Consumers
DBHS has the ultimate responsibility for transitioning
				consumers when an ATR certification is revoked. In some instances, the
				certified provider may assume responsibility or be expected to follow ethical
				guidelines to assist in the safe and orderly transition of consumers when the
				certification of the provider is revoked. However, this does not relieve DBHS
				of its ultimate responsibility to transition consumers. The goal of
				transitioning consumers is to minimize the period of time during which
				consumers receive less than adequate care.
ATR CONTRACT COMPLIANCE
Under the terms and conditions of the ATR Voucher Agreement
				providers agree to accept reimbursement received from DHS as full and final
				payment for all services covered by the Agreement. Clients may not be charged
				additional program fees, deposits, or completion certification fees over and
				above those reimbursed under the Agreement.
ATR supplemental needs funds shall not be used to pay for
				program fees, deposits, and completion certificate fees for clients who are
				receiving Supportive, Transitional, Drug-Free Housing or Residential Treatment
				services.
DHS reserves the right to recoup payments through current and
				subsequent payments to the Provider.
DHS is not obligated to pay any bills received more than thirty
				(30) calendar days after the expiration of the Voucher unless the prior
				approval is granted. DHS is not liable for untimely billing.
Providers agree that any services provided prior to the
				effective date of the ATR Voucher Agreement or prior to receiving and accepting
				a voucher for services in the WITS system are the sole responsibility of the
				provider and in no way establishes DHS liability for payment of services
				rendered prior to the effective date of the Agreement/voucher.
All ATR providers (of either direct services or care
				coordination services) are required to comply with all state and federal
				regulations (e.g. the ATR Program Manual, the ATR GPRA Manual, and the ATR
				Voucher Agreement, and any other related ATR documents). If any statute or
				regulation is enacted or promulgated requiring changes to the Voucher
				Agreement, the Agreement will be considered automatically amended to comply
				with the newly enacted statute or regulation as of the effective date of the
				statute or regulations. Providers will be notified in writing within thirty
				(30) days of the receipt of any necessary changes or amendments resulting from
				newly enacted state or federal statutes or regulations.
Contract Cancellation
ATR Providers may cancel their contract by giving DBHS thirty
				(30) calendar days written notice. Delivery of the notice of cancellation may
				be either in person or by certified mail, return receipt requested, restricted
				delivery. Providers are required to continue to provide services during the 30
				day period in compliance with all terms and conditions of the ATR Program until
				the end of the 30 days (to include all GPRA Data Collection Requirements).
				Providers are required to participate in transitioning their current clients to
				other providers by notifying the care coordinator (if providing direct
				services), or by following the requirements for transfer of care coordinators
				as specified in the Care Coordination Procedures of this Manual.
DBHS takes all necessary measures to prevent, detect,
				investigate and prosecute any acts of fraud and abuse committed against the AR
				ATR project. This may include, but is not limited to, on-site, review by DBHS;
				referral to the DHS Audit Section to review financial records, provide
				technical assistance, or conduct an audit; and/or referral to the DHS Fraud
				Unit for investigation.
Fraudulent Practices for AR ATR project purposes include but
				are not limited to:
- Falsifying information on the provider application or
				omitting relevant material facts
- Misrepresenting staff credentials or qualifications or
				billing for services provided by unqualified staff
- Falsifying client files, records or other
				documentation
- Billing for services not rendered
- Billing multiple times for the same services
- Accepting payment for services not rendered
- Improper billing to clients for services rendered
Abusive Practices for AR ATR project purposes include but are
				not limited to:
- Making improper diagnoses
- Providing client services that are not necessary or services
				that are inappropriate for the client's condition
- Knowingly not billing a primary payor for an eligible
				client
- Offering or accepting payment to refer clients to a
				particular provider
- Misrepresenting client outcomes
If a provider or any of its employees, volunteers, or board
				members commits client abuse, neglect or exploitation; malpractice; or fraud,
				embezzlement, or other serious misuse of funds, DBHS may terminate the
				provider's participation in the ATR project immediately upon written notice to
				the provider and may seek repayment of funds.
If a client commits fraud or other serious misuse of funds,
				DBHS may terminate the client's participation in the ATR project immediately
				upon written notice to the client and providers and may seek repayment of
				funds.
In addition to the ATR Program specific fraud, waste and abuse
				protections, providers are also liable for violation of additional federal
				fraud, waste and abuse.
1. Executive
			 Order #13520 of November 20, 2009
When the Federal Government makes payments to individuals and
				businesses as program beneficiaries, grantees, or contractors, or on behalf of
				program beneficiaries, it must make every effort to confirm that the right
				recipient is receiving the right payment for the right reason at the right
				time. The purpose of this order is to reduce improper payments by intensifying
				efforts to eliminate payment error, waste, fraud, and abuse in the major
				programs administered by the Federal Government, while continuing to ensure
				that Federal programs serve and provide access to their intended
				beneficiaries.
2.
USC 18, Chapter 47
Providers and their employees/authorized representatives who
knowingly and willfully:
1.
falsify, conceal, or cover up
by any trick, scheme, or device a material fact; and/or
2. make any
materially false,
			 fictitious, or fraudulent statement
or representation; or
3. make or use
any false writing or
			 document
knowing the same to contain any materially false, fictitious,
			 or fraudulent statement or entry.