Certification Reviews

Certification Reviews A. DMH conducts both Administrative and On-Site reviews of agency providers to ensure provider compliance with the applicable rules in the DMH Operational Standards. B. Administrative Compliance Reviews are defined as reviews during which DMH requests that information (such as policies and procedures, staffing plans, employee training, minutes of governing authority, etc.) be submitted from the agency provider for a DMH administrative review. C. On-site Compliance Reviews are defined as reviews that are conducted by DMH at the provider’s administrative or service location(s). D. Administrative and On-Site Compliance Reviews will take place (if applicable) for certification of the following: 1. New agency provider organizations. 2. New services or service locations for an existing DMH-certified agency provider. 3. Additional services or service locations for an existing DMH-certified agency provider. 4. Modification of a service location for an existing DMH-certified agency provider. 5. Adherence to a Plan of Compliance. E. During the certification period of a certified agency provider, a comprehensive, on-site compliance review will be conducted to ensure continued adherence to the DMH Operational Standards, guidelines, contracts, data, and/or grant requirements, as applicable. On-site comprehensive compliance reviews will be conducted at least biennially during the certification period of the agency provider. Other administrative or on-site reviews of a more focused nature may occur annually, or on a more frequent basis, on a schedule as determined by DMH. F. Depending on the agency’s certification type, certified services, and/or certification status, specific components of administrative or on-site reviews (comprehensive or focused) may include any of the following: 1. Health and Safety Reviews, on a schedule as determined by DMH. 2. DMH Operational Standards (comprehensive or focused) compliance reviews. 3. Plan of Compliance verification reviews. 4. Fidelity Reviews: DMH conducts fidelity reviews of certain services/supports and/or programs certified by DMH. A fidelity review is an evaluation process which assesses whether a service or program is being implemented as intended, following prescribed protocols or guidelines. Fidelity Reviews are only conducted on programs receiving funds from/through DMH. 5. Financial/Grants Management Reviews. 6. Peer Reviews: All DMH funded/certified agency providers, services, and service locations are subject to a DMH-approved peer review/quality assurance (Q/A) evaluation process. Review team members obtain information from peers and agency provider personnel about satisfaction with services, quality of life measures, and support provided from professional personnel; review services and people’s records (when applicable) and dialogue with mental health administrators. 7. Pre-affidavit screening reviews: DMH may conduct audits of randomized samples of pre-affidavit screenings conducted by CMHCs to evaluate the effectiveness of the process and the appropriateness of recommendations. 8. CMHCs: Performance audit reviews on a schedule, as determined by DMH. 9. HCBS Settings Final Rule compliance reviews. 10. Reviews to assist in a provider grievance/complaints investigation process, as needed. 11. Other types of reviews, as may be determined by DMH. G. DMH reviews may be unannounced. H. For the purposes of DMH compliance reviews only, as outlined above, the agency provider should maintain records from the review for at least four (4) years following the compliance report release.