Provider Enrollment Review process

Transcription

1 Department of Health Care Finance Home & Community Based Services (HCBS) Elderly & Persons with Physical Disabilities (EPD) EPD Provider Enrollment Addendum Prospective Provider: Thank you for your interest in becoming a service provider for the Elderly & Persons with Physical Disabilities (EPD) Waiver Program. Each prospective provider must submit a complete Provider Enrollment Package with all required documentation. An enrollment package shall include minimally: Provider must submit a Letter of Intent (LOI) to the Long Term Care Administration (LTCA) at dhcf.epdproviderenrollment@dc.gov Provider must attend the Mandatory Provider Information Session provided by LTCA within 90 days of submitting the LOI Certificate of attendance stating that the prospective provider attended the information session. The application must be submitted within 90 days of attending the Provider Information Session. EPD Waiver Provider Enrollment Addendum (EPD - Supplemental) Medicaid Provider Application (Institutional) Program Policies and Procedures for each service provision Administrative Policies and Procedures (personnel, training, fiscal management, billing) Provider Enrollment Review process Step 1: Provider Enrollment Packages are received by Xerox. Xerox logs in the application and assigns the tracking and Control Reference (CR) number. Xerox then forwards the application to DHCF. Step 2: The provider application is received by DHCF, Division of Public and Private Provider Services (DPPPS). DPPPS screens the application for all pertinent information. Once the initial screening has been completed, the Provider Enrollment Package will be forwarded to the division of Long Term Care. Step 3: Provider Enrollment packages are received and screened by LTCA. LTCA will return incomplete applications to prospective providers within fifteen (15) business days of receipt. The application package will be returned via US mail or arranged pick up. Step 4: LTCA will coordinate a readiness review team to review enrollment packages submitted. The team will complete a readiness review that includes a face-to-face interview/meeting with key personnel and an inspection of the physical site (if appropriate). If a prospective provider is unable to successfully meet the requirement for the readiness review, a denial letter is issued. The readiness review may take up to 30 business days including an on-site inspection of the business and/or facility.

2 Step 5: If a prospective provider meets all requirements, LTCA will submit a formal recommendation of acceptance to DPPPS within five (5) business days of successfully completing the readiness review. Step : The prospective provider will then receive a letter via notifying them that they must attend a Mandatory Orientation for all providers listed as Moderate and High risk. This orientation is conducted by Xerox. The provider must schedule the orientation within 30 days of receipt. Step 7: Once the provider completes the orientation Xerox will notify DHCF. The Provider Enrollment Package will then be signed and approved by the Supervisor of DPPPS. The Enrollment Package will then be forwarded to Xerox where they will assign a provider number and generate a Welcome Letter that will be mailed to the provider. Submission of a Provider Enrollment Package does not constitute acceptance into the program. Please anticipate approximately forty-five (45) business days to complete the provider enrollment review process. To access the Provider Enrollment package, go to and download the Institutional Provider Application.

3 To access EPD Waiver regulations, State Plan Amendments, Transmittals and other resources go to Mail Completed Medicaid Provider Enrollment Application and Addendum Package to: Xerox State Healthcare Solutions Attention: Provider Enrollment Post Office Box 3471 Washington, DC Direct questions to: Department of Health Care Finance/LTCA th Street NW, Suite 1000S Washington, DC Attention: LTCA/EPD Waiver Provider Enrollment 202/ dhcf.epdproviderenrollment@dc.gov

4 Provider/Agency Name: Service Location: Department of Health Care Finance Elderly & Persons with Physical Disabilities Waiver Provider Application Review Checklist Telephone: Fax: website: List Service(s): check all that apply Case Management Assisted Living Personal Care Aide Homemaker Respite Chore Aide Personal Emergency Response Systems (PERS) Environmental Accessibility & Adaptation (EAA) Required Information + - N/A Medicaid Provider application Provider Enrollment Application EPD Supplemental Provider Agreement Ownership Disclosure Business License (District of Columbia) Certificate of Occupancy Certificate of Good Standing Articles of Incorporation/By-Laws Proof of Insurance NPI Number Professional License/Certification(s) List of key personnel Organizational Chart (detailed) Audited financial statement (recent) Job descriptions Qualifications/Credentials /14/1

5 Administrative Policies & Procedures (minimal) Personnel policies Training/orientation program Program Policies & Procedures (minimal) Intake Discharge Incident reporting & investigation Handling Complaints Quality Assurance Plan Advisory/Board of Directors W-9 Copy of all accreditation Copy of all license issued by any District of Columbia agency Proof of $50,000 surety bond as required *Required for providers of PCA services only Tips: All information should be presented in an organized fashion, preferably a 3-ring binder; each section properly labeled Emphasis on person-centered approaches in service coordination and delivery Policies and Procedures must comply with EPD waiver regulations (DCMR 29; Chapter 42) Signed all documents as required To access program regulations, transmittals and other resources, go to: To access EPD Provider Enrollment Information, go to: /14/1