Department of Public Safety and Correctional Services (DPSCS), in accordance with Family Law Article, §5-561, Annotated Code of Maryland, to the provider agency and maintained in the individual’s personnel file. Required Criminal Background Checks for Expressive and Experiential Behavioral Service Providers Who Enroll as Individual Providers: For each individual that has enrolled individually to provide expressive and experiential behavioral services to participants and their families in the HCBS benefit, the individual must request a State and Federal Bureau of Investigation child care criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services (DPSCS), in accordance with Family Law Article, §5-561, Annotated Code of Maryland, to be sent to the Department. Required Check for Abuse or Neglect: For each individual providing services to participants and their families in the HCBS benefit, the provider shall: Before employing any individual, submit a notarized Consent for Release of Information/Background Clearance Request form to the Department of Human Resources (DHR) or a local department of social services (DSS) in the jurisdiction in which the individual lives, pursuant to COMAR 07.02.07.19; and
Quality Improvement Strategy (Describe the state’s quality improvement strategy in the tables below): Discovery Activities Remediation Discovery Evidence (Performance Measures) Discovery Activity (Source of Data & sample size) Monitoring (agency or entity that conducts discovery activities) Remediation (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) Frequency of Analysis and Aggregation Service plans address assessed needs of 1915(i) participants, are updated annually, and document choice of services and providers. 1. % of participants who had a CFT meeting at least every 45 days. 2. % of participants whose plan of care (POC) was updated to include change in progress, services or other areas within five (5) days of the CFT meeting. 3. % of participants whose POC indicates they were afforded choice in the selection of services and providers Defensible sample of case files (electronic or paper) of participants who were enrolled during the time period under review Review of all POC during identified time period for a defensible 1. DHMH/MHA, with CSAs 2. DHMH/MHA with CSAs 1. Every 12 months 2. Every 12 months 1. DHMH/MHA with CSAs 2. DHMH/MHA with CSAs If a performance improvement plan is needed, a program director must submit a proposal within 10 working days. The final performance improvement plan must be submitted to MHA, ASO, and CSA, as applicable, within 30
4. Utilization review of services on POC in conjunction with provider authorization and claims data sample of participants who were enrolled during the time period under review Review of all POC during identified time period for a defensible sample of participants who were enrolled during the time period under review Review of all POC during identified time period for a defensible sample of participants 3. DHMH/MHA with CSAs 4. ASO 3. Every 12 months 4. Every 12 months 3. DHMH/MHA with CSAs 4. DHMH/MHA with ASO & CSAs working days of notice of program deficiencies. The CSA will follow up with the program 3 months after the final of the performance improvement plan.
who were enrolled during the time period under review Providers meet required 1. % of providers who have submitted 1915(i) HCBS claims who are approved as providers by Maryland Medicaid 2. % of providers who meet the initial and ongoing requirements established by DHMH/MHA 1 & 2. Defensible sampling strategy of provider files and related The sample will be drawn from providers who filed claims for services provided under the HCBS benefit during the time period under review. 1 & 2. ASO Annually DHMH/MHA If a performance improvement plan is needed, a program director must submit a proposal within 10 working days. The final performance improvement plan must be submitted to MHA within 30 working days of notice of program deficiencies. The CSA will follow up with the program 3 months after the final
of the performance improvement plan. Settings meet the home and setting requirements as specified in this SPA. 1. % of youth who reside within approved living situations or who are disenrolled as a result of moving to a setting that is not authorized in this SPA. 1. sampling of entire enrolled roster 1. DHMH/MHA with the CSAs Semi Annually DHMH/MHA Based on the findings, OHS and MHA will create a performance improvement plan within 30 working days of identification of deficiencies The SMA retains authority and responsibility for program operations and oversight. 1. % of quarterly progress reports submitted to DHMH/Office of Health Services 2. % of enrollment census updates distributed to OHS 3. Medical Eligibility/enrollment Oversight 1. Quarterly reports are provided to OHS by MHA 2. Review of distribution list for census updates issued by MHA 3. Review CASII/CONS documentation 1&2. DHMH/MHA 3. ASO/MHA Annually DHMH/MHA& DHMH/OHS Based on the findings, OHS and MHA will create a performance improvement plan within 30 working days of identification of deficiencies. The SMA maintains financial through payment of claims for 1. % of HCBS benefit service claims processed appropriately against fund source, authorization history, service limitations, and coding. 2. % of participants with completed financial eligibility reviews in accordance with policy at Defensible sampling strategy; point in time review of services received. DHMH/ASO Annually DHMH/MHA If a performance improvement plan is needed, a program director must submit a
of potential fraud and abuse. The state identifies, addresses and seeks to prevent incidents of abuse, neglect, and exploitation, including the use of restraints. % of reportable events involving abuse, neglect, and/or exploitation reported that are resolved according to policy All Reportable Event Forms are reviewed for compliance DHMH/MHA Quarterly DHMH/MHA If a performance improvement plan is needed, a program director must submit a proposal within 10 working days. The final performance improvement plan must be submitted to MHA within 30 working days of notice of program deficiencies. The CSA will follow up with the program 3 months after the final of the performance improvement plan.