POLICIES AND PROCEDURES

Transcription

1 Purpose: To define the scope and frequency for performing Physical Accessibility Reviews (PAR) in a consistent manner. To ensure the following contracted provider sites are in compliance with applicable local, state, federal, and Central California Alliance Health (the Alliance) standards for physical accessibility: 1. Primary Care Provider (PCP) sites 2. High-volume Seniors and Persons with Disabilities (SPD) sites offering the following services: a) Ancillary services as defined in Department of Health Care Services (DHCS) All Plan Letter (APL) ; and b) Community-Based Adult Services (CBAS). Physical accessibility for all members, including those with disabilities, is assessed using the State-mandated Facility Site Review (FSR) and Physical Accessibility Review (PAR) tools referenced in MMCD Policy Letter (PL) , and DHCS APL Policy: The Alliance conducts PARs for new PCP sites at the time of initial credentialing or contracting, and then every three years thereafter as a requirement for participation in the California State Medi-Cal Managed Care Program. PARS are conducted for PCP sites regardless of the status of other accreditation and / or certifications. The following types of providers will be excluded from PAR site visits: Non-contracted providers; Transportation providers ; DME pick-up sites; Laboratories out of service area; Licensed and State-certified long-term care facilities; and Delegated entities, including Vision Services Plan (VSP), Managed Behavioral Health Services, and Pharmacy Benefit Managers (PBMs) The Alliance will collaborate with hospitals in its provider network to assess the hospital s compliance with each of the components of Attachment C, and that records support its assessment of the hospital s physical accessibility. A PAR will be conducted utilizing the California Department of Health Care Services Medi- Cal Managed Care (MMCD) Facility Site Survey Tool, Attachment C, D, or E when appropriate. Assessment includes, but is not limited to, parking, building, elevator and clinic areas, exam rooms, lobbies and restrooms. Medical equipment assessed may include, but is Page 1 of 5

2 not limited to, height adjustable exam tables, member accessible weight scales, infusion chairs and/or beds, physical therapy equipment, and imaging equipment such as for mammography or Magnetic Resonance Imaging (MRI). Alliance staff members are trained to conduct the PAR utilizing the requirements and process as described in MMCD PL and DHCS APL Definitions: Ancillary Service Providers: Free standing facilities that provide diagnostic and therapeutic services, such as, but not limited to: laboratory, infusion, radiology, imaging, cardiac testing, renal dialysis, occupational therapy, speech therapy, physical therapy, pulmonary testing, and cardiac rehabilitation. High Volume Specialists: Any (non-primary care) provider whose monthly average of encounters for seniors and persons with disabilities (SPD) is above the monthly average of encounters. Procedures: 1. Physical Accessibility Review a) PCP Sites: Upon receipt of a completed contract and credentialing application from a prospective Provider, Provider Services notifies Quality Improvement nurses of the date the prospective Provider is scheduled for member assignment or availability of services. Providers must have a PAR as a part of the initial review process, and then the PAR is conducted at least every 3years. b) High-Volume Specialists, Ancillary Provider Sites, and CBAS Provider Sites: Upon receipt of the annual high-volume PAR report, the QI nurse, or designee, will conduct a new PAR for newly identified sites within the current year, otherwise a PAR will be conducted within 3 years of the last review for all providers meeting high-volume benchmarks according to MMCD PL and DHCS APL c) Providers that move to a new physical location, or who significantly alter their existing site, must receive a new PAR. The new PAR is completed as soon as possible after the Provider moves to the new location, or remodels their site. d) Provider Services notifies site reviewers of relocating / relocated Providers and the appropriate date (site opened or notification date, whichever is most recent) to establish the PAR timeline. e) Access designations are documented in the Alliance s Provider Directory as required by the most current MMCD policy letter specific to physical accessibility. The Provider Directory (paper or electronic) is kept current by the Provider Services Department. Page 2 of 5

3 2. Disclosure of Process to Providers Education of Providers in the Alliance s contracted network is carried out by Alliance Staff in several ways: a) Information about the PAR Survey process is available on the Alliance Web Site Provider Page under Clinical Resources and Facility Site Reviews. b) Providers are educated about the PAR process through provider workshops, the Provider Bulletin, and/or individual education by Provider Services Representatives, Quality Improvement Nurses, and / or other delegated staff who may be trained to conduct PARs. 3. Physical Access Designation a) PCP Sites: parking, building, elevator, doctor s office (as appropriate), exam room (as appropriate) and restroom. To meet the Basic Access requirements, 29 Critical Elements (CEs) must be met. The CEs are described in the PCP PAR Tool MMCD PL Attachment C. ii. Limited Access: doctor s office (as appropriate), exam room (as appropriate) and iii. restroom. Deficiencies in one or more CEs are encountered. Medical Equipment Access is a separate designation (as appropriate): The Provider has a height adjustable exam table and member accessible weight scales (for wheelchair/scooter plus member). b) Ancillary Sites: parking, building, elevator, diagnostic and treatment use, and restroom. To meet the Basic Access requirements, 34 CEs must be met. The CEs are described in the Ancillary Services PAR Tool DHCS APL , Attachment D. ii. Limited Access: diagnostic or treatment use, and restroom. Deficiencies in one or more CEs are encountered. Page 3 of 5

4 iii. Medical Equipment Access is a separate designation (as appropriate): The provider has accessible equipment including but not limited to imaging equipment, infusion chair/bed, and/or a height adjustable exam table. c) CBAS Sites: parking, building, elevator, participant areas, and restroom. To meet the Basic Access requirements, 24 CEs must be met. The CEs are described in the CBAS PAR Tool, DHCS APL Attachment E. ii. Limited Access: participant areas, and restroom. Deficiencies in one or more CEs are encountered. References: Alliance Policies: Impacted Departments: Provider Services Care Management Regulatory: Legislative: Contractual: DHCS Medi-Cal Contract Exhibit A, Attachment 18, Provision 4.e MMCD Policy Letters: MMCD Policy Letter: DHCS All Plan Letter: NCQA: Supersedes: Other References: Attachments: Lines of Business This Policy Applies To Medi-Cal Alliance Care IHSS Medi-Cal Access Program (MCAP) LOB Effective Dates (01/01/1996 present) (07/01/2005 present) (02/01/2009 present) Page 4 of 5

5 Revision History: Reviewed Date Revised Date Changes Made By Approved By 10/02/ /02/2012 Kaite McGrew Barbara Flynn 05/20/ /20/2013 Kelly Salazar, RN, FSR Nurse CQIW 02/21/ /21/2014 Kelly Salazar, RN, QI Nurse CQIW 01/22/ /22/2015 Kelly Salazar, RN, QI Nurse CQIW 01/20/ /17/2016 Dominique Teaford, RN, QI CQIW Nurse 02/24/ /24/2017 Peg Behan, RRT, QI CQIW Manager 04/27/ /27/2017 Peg Behan, RRT, QI Manager CQIC Page 5 of 5