Ch. 45, § 28. Provider Certification Renewal

(a) The Division shall notify all providers that their waiver certification is expiring at least ninety (90) calendar days prior to the certification expiration date. The notification shall detail requirements that the provider shall meet in order to renew their certification. (b) The Division shall renew a provider certification at least once every three years. Based on the services provided, an on-site visit may be required. If an on-site visit is required, the Division shall provide notification to the provider at least thirty (30) calendar days prior to the visit. (c) Provider certification renewal includes a Division review of the provider's evidence of compliance with state and federal regulations for home and community based services, and a review of the provider's self-assessment of compliance. For providers who offer services in a setting they own, operate, or lease, the Division shall also review the provider's self-inspection of service settings and a current inspection report from an outside entity. (d) At any time, the Division shall conduct an on-site visit when a concern is identified during a complaint, incident report, or internal referral, if there is an indication the provider is not complying with state or federal rules and regulation, or at the Division's discretion. (e) Providers may sign a form verifying that they do not provide services in their home or a provider-owned, leased, or operated setting. The Division will not conduct on-site evaluations for providers signing these forms, but may verify the accuracy of these statements. Falsification of these forms may result in sanctions. (f) The Division does not require an on-site visit for a case manager, specialized equipment, or environmental modification certification renewal. (g) Providers shall submit verification that they have met all applicable certification renewal requirements to the Division at least forty-five (45) calendar days prior to their certification expiration date. (h) If a provider fails to submit the applicable certification renewal requirements to the Division as described in subsection (g) of this Section, the Division shall notify the provider in writing of the expiration of the certification. (i) If the provider does not meet the certification renewal requirements within twenty (20) calendar days of the certification expiration, the Division shall begin the decertification process. (ii) The provider shall be notified in writing through certified mail that their certification has expired. (i) During any certification renewal, the Division shall review provider certification requirements and compliance with all home and community based regulations, then complete a written report, including a statement of the recommendations that shall be addressed within thirty (30) calendar days in order to maintain certification. (i) The Division may approve a certification period for up to three (3) years depending on deficiencies noted during the certification renewal process. (ii) The Division may approve the certification for a period of less than one (1) year if deficiencies are identified that seriously affect the health, safety, welfare, rights, or habilitation of a participant, or if the provider has otherwise substantially failed to comply with the rules and standards applicable to the services they are providing. (iii) The Division may deny the certification. (j) Providers shall submit all certification renewal documentation and information. Providers shall not use outside entities to submit certification renewal information. (k) A provider may dispute an adverse action related to renewal of certification by a request for an administrative hearing, which will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.