Provider Enrollment

Provider Enrollment A. Providers of Assisted Living (AL) Waiver services must satisfy all requirements set forth in Title 23 Miss. Admin. Code Part 200, Rule 4.8 in addition to the listed provider-type specific requirements and provide to the Division of Medicaid. 1. A National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES), 2. A copy of the provider’s current license or permit, if applicable, 3. Verification of a social security number using a social security card, driver’s license with a social security number, military ID or a notarized statement signed by the provider noting the social security number. The name noted on verification document must match the name noted on the W-9, and 4. Written confirmation from the Internal Revenue Service (IRS) confirming the provider’s tax identification number and legal business name. 5. A copy of business registration with the Mississippi Secretary of State. B. To participate as a Home and Community-Based Services (HCBS) Assisted Living (AL) Waiver provider, the provider must, unless exempted in writing by the Division of Medicaid, at the time of application and at all times thereafter: 1. Attend mandatory orientation, score at least eight-five (85) on the orientation exam and submit a completed proposal package to the Office of Long-Term Care for approval by the Division of Medicaid. 2. Once a provider is enrolled, submit any proposed changes to location, supervisory staffing, or organizational contact information, to the Division of Medicaid for approval prior to implementing the requested change. 3. Be established as a business entity and provide the specified service(s) for a minimum of one (1) year prior to application. 4. Be approved for enrollment by Provider Enrollment and enter into a provider agreement with the Division of Medicaid within six (6) months of receiving an approved proposal package letter from the Office of Long-Term Care. 5. Have an advisory committee, representative of the community and beneficiary population, that meets quarterly to assure responsibility and accountability for performance and quality improvement. The advisory committee must maintain an agenda and minutes for each meeting and must provide public notice of the date, time, and location of each meeting at least twenty-four (24) hours in advance of the meeting. 6. Provide proof of financial solvency by: a) Establishing and maintaining a business line of credit for business operations from either a financial institution licensed to conduct banking or other Financial Deposit Insurance Corporation (FDIC) or National Credit Union Administration (NCUA) insured financial institutions. The approval amount for the business line of credit must be enough to cover operational costs/expenditures for at least three (3) months at all branch locations. b) Providing a copy of the provider’s most current filed tax return for the business along with confirmation verifying it was filed. Examples of acceptable forms of confirmation include the following: 1) 8879 form from a tax preparer, or 2) 9325 form from the IRS with the submission identification (SID) number. c) Providing a copy of the provider’s itemized expense report reflecting all income and expenditures for each month for the past twelve (12) months. 7. Establish an office within the facility. The facility office must: a) Have appropriate external signage with printed lettering that is visible and readable from the road, b) Be compliant with applicable federal, state and local building requirements as well as all zoning, fire, OSHA, health codes and ordinances. It must also meet the requirements of the Americans with Disabilities Act (ADA), c) Maintain an active business privilege tax license, d) Ensure that beneficiaries and/or family/caregivers have access to a designated private space where they can have confidential discussions with staff and have a reasonable expectation of privacy, e) Have lockable file storage for the security and maintenance of all files in compliance with HIPAA standards, f) Maintain regular office hours of Monday through Friday, 8am – 5pm, with the exception of any federal or state holidays, and g) Have a dedicated office telephone and a means to transmit secure electronic data, i.e., secure email/facsimile, that meets HIPAA standards. 8. Successfully pass a facility inspection by the Division of Medicaid depending on the provider type, as specified in Rule 3.3(c) below. 9. Prior to employment and every two (2) years thereafter, conduct a national criminal background check with fingerprints on all employees and volunteers participating in face- to-face interactions with beneficiaries. Maintain these records in the employee’s personnel file. 10. Conduct registry checks before employment and monthly thereafter to ensure that employees or volunteers participating in face-to-face interactions with beneficiaries are not listed on the Mississippi Nurse Aide Abuse Registry or the Office of Inspector General's Exclusion Database and maintain these records in the employee’s personnel file. The provider must not employ individuals whose name appears on the registry list. 11. Not have employed or currently employ individuals or volunteers participating in face-to- face interactions with beneficiaries who have been, convicted of, or have pleaded guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offense listed in Miss. Code Ann. § 45-33- 23(h), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, felonious abuse and/or battery of a vulnerable adult, regardless of whether any such conviction or plea which was reversed on appeal or for the conviction or plea. 12. Not applying for a Division of Medicaid provider number for the purpose of providing care to friends/family members. 13. Have written criteria for service provision, including procedures for dealing with emergency service requests. 14. Maintain policy and procedure manuals compliant with all state and federal laws and regulations, including Division of Medicaid’s regulations. 15. Maintain and ensure responsible personnel management which includes: a) Implementing an appropriate policy and process for the recruitment, selection, retention, and termination of employees. b) Developing written personnel policies and job descriptions that include educational requirements, work experience, job duties and responsibilities. c) Maintaining a current training plan as a component of the policies/procedures that document the method for the completion of required training. The training plan must require all employees to meet training requirements as designated by the Division of Medicaid upon hire and annually thereafter. d) Maintaining a personnel file on every employee and volunteer with required information including, but not limited to, credentialing documentation, training records, and performance reviews. These files must be made available to the Division of Medicaid upon request. e) Maintaining an organizational chart that includes the names and job titles of owners, operators, managers, administrators, and other supervisory staff. Any changes in organizational structure including ownership must be reported in writing to the Division of Medicaid within ten (10) business days. f) Maintaining an accurate, historical employee listing that captures names, staff identification numbers, tax identification numbers, employment hire dates and employment termination dates. 16. Maintain a roster of qualified personnel necessary to provide authorized services until employment termination. The roster must include the address of the designated workspace for all supervisory staff. 17. Comply with all applicable federal and state regulations including, but not limited to, tax and labor laws. 18. Ensure all protected health information (PHI) and personal identifiable information (PII) is stored and transported in a manner consistent with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 19. At the time of enrollment, not be owned or operated by any individual or organization currently under investigation based on a credible allegation of fraud or abuse by the Division of Medicaid Office of Program Integrity, the Medicaid Fraud Control Unit or any other government entity, or that has been found in violation of the Miss. Admin. Code or the Medicaid Provider Agreement within the eighteen (18) months leading up to their enrollment. 20. In the event a change of ownership occurs, and complies with all requirements of Miss. Admin Code, Part 200, Rule 4.3, submit to the Division of Medicaid a proposal packet for review and approval within thirty-five (35) days of the change. The effective date of enrollment is retroactive to the date of the licensure, if licensure applies. C. AL providers must satisfy the following training requirements, as applicable, to render services: 1. Assisted Living service providers must provide all staff, excluding any RN, LPN, or CNA who maintains an active and current unencumbered license to practice in the state of Mississippi or a privilege to practice in Mississippi with a compact license, with training upon hire prior to rendering services and annually thereafter in the following areas: a) Vulnerable Persons Act: Identifying, Preventing and Reporting of Abuse, Neglect & Exploitation, b) Person Centered Thinking including Participant Rights and Dignity, c) Assisting with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), d) Crisis Prevention/Intervention and Emergency Preparedness, e) Caring for Participants with Cognitive or Behavioral Conditions, f) Signs and Symptoms of Illness including Seizures, g) HIPAA Compliance and Confidentiality, h) Safety including Preventing and Reporting of Accidents/Incidents and the Operation of Assistive Devices, i) Professional Documentation Practices, j) Universal Precautions & Infection Control, k) Medication Assistance, and l) Medicaid Administrative Code and the Assisted Living Waiver 2. TBI Residential Waiver providers must provide training to all staff which consists of all topics listed in the Miss. Admin. Code, Part 208, Rule 3.3(C)(1) as well as the following areas: a) Stress Reduction, b) Behavior Programs, and c) Rational/Behavioral Therapy. 3. All staff must pass a facility-administered initial hands-on skills assessment to ensure the trainee’s ability to provide the necessary care safely and appropriately, 4. All staff must maintain current and active first aid and cardiopulmonary resuscitation (CPR) certification. 5. Each TBI residential provider must have a program manager who is nationally certified as a Brain Injury Specialist. E. AL Waiver providers must provide a licensed nurse at the facility for a minimum of eight (8) hours a day to assist the beneficiaries with medication administration or oversight. If the facility employs a licensed practical nurse (LPN), the LPN must have direct supervision by either a registered nurse, nurse practitioner, or a physician. Additionally, the facility must not aide or abet a licensed nurse to practice outside of their scope of practice or to violate the Nursing Practice Law or Administrative Code in any manner. F. If the facility utilizes volunteers, they: 1. Must be individuals or groups who desire to work with Assisted Living waiver beneficiaries. 2. Must successfully complete an orientation/training program. 3. Have responsibilities that are mutually determined by the volunteers and employees and performed under the supervision of facility staff members. 4. Have duties that either supplement required employees in established activities or provide additional services for which the volunteer has special talent/training. 5. Cannot provide services in place of required employees and can only be allowed on a periodic/temporary basis. 6. Must record their hours and activities. G. The Division of Medicaid may terminate or suspend a provider immediately for failure to comply with the requirements of the AL waiver program. The Division of Medicaid may also require providers to submit and implement a corrective action plan (CAP) in a timely manner. Failure to submit or comply with a CAP, approved by the Division of Medicaid, may result in a suspension or termination.