Operating Procedures, Monitoring and Sanctioning Service Providers, Outcome Measures

DEPARTMENT OF ELDER AFFAIRS
Division of Volunteer and Community Services

RULE NO: RULE TITLE
58B-1.003: Operating Procedures
58B-1.005: Monitoring and Sanctioning Service Providers
58B-1.009: Outcome Measures

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 32 No. 50, December 15, 2006 issue of the Florida Administrative Weekly.

The changes are being made in response to comments received from the rule hearing conducted on January 10, 2007 and comments received from the Joint Administrative Procedures Committee dated January 19, 2007. The changes are as follows:

58B-1.003 Operating Procedures.

(1) SERVICE DELIVERY and ACCESSIBILITY. At a minimum, information shall be provided to all persons accessing the ARC by telephone, the Internet, or in person.

(a) through (b) No change.

(c) The ARC shall ensure there is a system in place for answering and responding to calls received outside of the regular business hours.

1. The system shall, at a minimum, identify the agency, hours of operation, and give callers the option to leave a message or speak with a live attendant. The live attendant may be a private answering service.

2. through 3. No change.

(d) No change.

(2) through (4) No change.

(5) RECORDS: The ARC shall maintain books, records, and documents (including electronic storage media) in accordance with generally accepted accounting principles and sound business practices that sufficiently and properly reflect all revenues and expenditures of funds provided by the department. This documentation shall be made available upon request for monitoring and auditing purposes.

(a) No change.

(b) The ARC shall be audited annually by an independent accounting firm and shall submit the final report of the audit to the Department within nine six months after the end of the ARC’s fiscal year.

(6) No change.

Specific Authority 430.08, 430.2053(12) FS. Law Implemented 430.2053 FS. History–New_________.

 

58B-1.005 Monitoring and Sanctioning of Access Points Service Providers.

This rule applies only to access points that have a direct monetary funding agreement with the ARC.

(1) MONITORING: The ARC shall perform administrative, programmatic, quality assurance, and, if applicable, fiscal monitoring of access points to ensure compliance with ARC agreements.

(a) Monitoring Elements: As part of the monitoring process, the ARC shall ensure that, at a minimum, the areas referenced in 1. through 7. of this subsection are reviewed. Access points shall have this information available for the ARC’s review: At a minimum, the ARC shall perform an annual on-site administrative, programmatic, quality assurance, and, if applicable, fiscal monitoring of access points to ensure compliance with ARC agreements.

1.(a) The ARC shall ensure An appropriate methods for monitoring and sanctioning access points, including a grievance process is in place for a subcontracted entity, if the entity is eligible to file a grievance;.

(b) In addition to monitoring access points in accordance with ARC agreements, ARC monitoring procedures shall include, at a minimum, the following elements:

2.1. Ensuring that Pprofessional staff has the minimum educational and experience requirements required in Rule 58B-1.003, F.A.C.;

3.2. Functional screening and financial eligibility are timely and accurate Timeliness and accuracy of the functional screening and financial eligibility;

4.3. Eligibility determination and enrollment procedures are timely and accurate Timeliness and accuracy of eligibility determination and enrollment procedures;

5.4. Effectiveness of Iinformation and referral services and long-term care options counseling provide accurate information that meet the individual’s needs;

6.5. Effectiveness of Pprocesses for receiving and acting on complaints and resolving client grievances and other persons who use ARC services are appropriate and effective; and

7.6. Training and technical assistance needs are identified Identification of training and technical assistance needs.

(b) Monitoring Procedures. The ARC shall adhere to the following:

1. At a minimum, the ARC shall perform an annual on-site administrative, programmatic, quality assurance, and, if applicable, fiscal monitoring of access points to ensure compliance with ARC agreements.

2. The ARC executive director shall submit a written report by certified mail to the access point no later than 21 calendar days from the last date of the on-site monitoring visit. The report shall outline the monitoring findings, that a corrective action plan shall be submitted to the ARC within 21 calendar days from the date of the report, if deficiencies are identified, and other sanctions the ARC determines is warranted, if applicable. The report shall indicate that the access point has the right to request an informal review and/or file a grievance pursuant to its agreement with the ARC.

3. The access point’s failure to submit a corrective action plan within the 21 calendar day time frame shall result in sanction(s) pursuant to subparagraphs (2)(a)2. through 12. of this rule.

4. The ARC shall determine if the corrective action plan is acceptable and shall notify the access point if further action is required within 21 calendar days from receiving the report.

(2) SANCTIONING: ARC access points that do not meet requirements of the ARC agreements shall may be subject to sanctioning. Sanctions may include, but are not limited to, the following:

(a) Sanctions may include the following, depending upon the severity of the violation:

(a) through (l) renumbered 1. through 12. No change.

(b) Sanctioning procedures: The ARC shall follow the procedures below to sanction access points:

1. The ARC executive director shall submit a written notification by certified mail to the access point.

2. The notification shall outline the sanction(s) to be implemented and the reason(s) the ARC is levying the sanctions against the access point.

3. The notification shall include language that the access point has the right to request an informal review and/or file a grievance pursuant to its agreement with the ARC and the method by which to do so.

Specific Authority 430.08, 430.2053(12) FS. Law Implemented 430.2053 FS. History–New_______.

 

58B-1.009 Outcome Measures and Quality Assurance Standards.

(1) OUTCOME MEASURES: The ARC governing body shall ensure that ARCs perform the following minimum outcome measures:

(a) No change.

(b) Demonstrate that the average monthly savings for per clients receiving for home and community based services is less than the Medicaid cost for as compared to nursing home care for comparable client groups.

(c) Establish a baseline measures for the processing time for applicants seeking services under the programs outlined in Section 430.2053(11)(a) through (g), F.S., which are administered by the ARC through its contract with DOEA.

1. The processing time shall begin on the date applicants make their initial contact with the ARC and end on the date they are enrolled to receive services.

2. In addition to establishing the baseline information as outlined in subparagraph (1)(c)1. above, the ARC shall implement measures to track and report processing time on an ongoing basis for each of the programs referenced in Section 430.2053(11)(a) through (g), F.S.

3. This requirement does not apply to applicants who are placed on an assessed priority consumer list for services.

(2) QUALITY ASSURANCE STANDARDS: The ARC governing body shall adhere to the following ensure that the ARC develops quality assurance standards to provide assurance that clients are receiving appropriate services that meet their needs and access points are adhering to the terms of the ARC agreements. This activity shall include the following elements:

(a) No change.

(b) Ensuring that clients receive appropriate care and services that meet their needs while living in the community in order to avoid nursing home placement. This shall be accomplished through periodic clinical review of client care plans, client progress towards goals, and client satisfaction surveys.

(c) No change.

Specific Authority 430.08, 430.2053(12) FS. Law Implemented 430.2053 FS. History–New________.