(a) The performance of providers of Child Welfare (CW) services in implementing terms of the contract is assessed on an annual basis.

• (1) All providers of CW services participate in an assessment of service delivery annually.
• (2) Performance surveys are conducted with providers of CW services as determined necessary by the administrator of Continuous Quality Improvement (CQI).

(b) The administrator of the CQI unit or designee provides written notice to a provider agency at least one week prior to a performance survey.  A contractor chief executive officer (CEO) or designee may request that the survey be rescheduled for good cause by contacting the administrator of CQI or designee within three calendar days of receipt of the notice.  A change in schedule occurs at the discretion of the administrator of CQI or designee.

(c) Performance surveys are conducted by staff of the CQI unit who have spent a minimum of 80 hours in training related to the application of Division of Children and Family Services (DCFS) and Oklahoma Health Care Authority (OHCA) expectations regarding to service delivery.  CW staff serving as liaisons to an agency are encouraged to assist in conducting reviews.  Observations of CW staff which may result in a finding of non-compliance with the contract are verified by CQI staff.

(d) Performance surveys may assess the practices of a contractor relevant to any provision of the contract.  Providers are advised in advance of provisions that are routinely assessed.  The survey includes review of:

• (1) the delivery of services to a representative sample of children and families served by a contractor;
• (2) supporting evidence of claims for services provided to children and families through contract with DCFS or OHCA; and
• (3) administrative supports or practices, such as provider policies, training, licensure, and certification of staff.

(e) A private work area at the facility or contractor’s office is made available when requested for surveyors during the course of the review.  If space is unavailable, the provider makes copies of needed records available which may be taken by performance survey team members for review.

(f) Performance survey staff meet with the contractor CEO or designee upon initiation of an assessment to provide an overview of evaluation procedures, confirm the current scope and locations of contractor services, and make tentative arrangements for an exit conference.

(g) Performance surveys typically last one to two working days.  This time may vary based upon the number of staff available to assist with the review and the scope of services.

(h) Evidence of performance is secured through record reviews, interviews and observations.  Interviews and observations are conducted in a manner that minimizes disruption of provider operations.

(i) A Summary of Findings identifies performance issues that are not in compliance with the expectations of the contract.

(j) Performance survey staff provide a written Summary of Findings to the contractor CEO or designee prior to an exit conference.  A copy of the report is later provided to the DCFS administrator responsible for the contract, OHCA, and Oklahoma Commission on Children and Youth (OCCY).

• (1) Performance survey staff provide an explanation of findings.
• (2) Procedures for the review of findings are explained to the provider.

(k) During the exit conference the contractor may submit evidence contesting any finding of non-compliance.  Performance survey team staff review the information and for each contested finding may:

• (1) reverse the entire finding;
• (2) reverse a portion of the finding; or
• (3) affirm the finding.

(l) When dissatisfied with the findings of the performance survey team, the provider may request a DCFS administrative review by providing written notice and supporting evidence to the administrator of the CQI unit within one week of the exit conference.  A response confirming the findings of the appropriate DCFS administrators is mailed within two weeks of receipt of the request.

(m) The contractor may request further review by the division administrator of DCFS within two weeks of receipt of the response in this subsection (l).  A finding is issued within two weeks of the request.

(n) Within two weeks of the exit conference, regardless of the status of any request for review, the provider submits to the DCFS administrator responsible for the contract a notice which identifies the date by which conditions resulting in each finding of non-compliance will be resolved.

• (1) Any projected resolution date beyond two months from the exit date is accompanied by justification.
• (2) Interim performance targets are identified by the provider when a resolution interval of more than two months is requested.
• (3) Failure to submit a notice as required by this paragraph results in an expectation that all deficiencies are resolved within two months of the exit conference.
• (4) Concerns posing significant risk are resolved in less than two months.  The provider is notified of the expectation for expedited resolution.

(o) CQI staff conduct focused resurveys to assess resolution of identified concerns.

• (1) Focused resurveys typically occur after the approved resolution date.
• (2) Resurveys focus on issues identified as not complying with contract provisions during a performance survey, but may include any other element of performance addressed by the contract.
• (3) Issues to be reviewed are presented at an entry conference.
• (4) The contractor CEO is provided a written Summary of Findings at the conclusion of the focused resurvey.  Findings may include a determination that performance:
  • (A) complies with the terms of the contract;
  • (B) is not yet in full compliance with the terms of the contract but efforts are consistent with approved interim performance targets; or
  • (C)  performance is not in compliance with the terms of the contract.
• (5) The contractor may request a DCFS administrative review as provided at (l) and (m) in this subsection.

(p) The DCFS administrator responsible for the contract may authorize one or more sanctions when it is determined that a provider has not resolved identified concerns within approved time frames or when it is determined that the nature of a violation represents a gross disregard for the welfare of children or accountability for public resources.  Sanctions include:

• (1) vendor hold, which precludes the provider’s admission of any child or family receiving CW services;
• (2) disallowance of claims for services not provided.  Examples of circumstances which may result in the disallowance of claims are staff not having required training or credentials or not clearing required background check expectations; required staffing ratios not being met; or the contractor failing to provide required housing, meals, or treatment services;
  • (A) Disallowances may be proportional.  For example, if one of two staff on duty do not have required credentials, the disallowance may be for ½ of the claims filed during that interval; if three instead of four staff were available to provide support during a shift, ¼ of the claim for that interval may be disallowed.
  • (B) Disallowances may reflect the total amount of a claim during an interval when services were not provided in accord with the requirements of the contract when it is determined the violation represented a significant risk to individuals or a gross disregard for fulfillment of the conditions of service or the disallowance may be limited to the scope of deficiency for the sample included in the review.
• (3) termination of contract with DHS; or
• (4) recommendation of termination of contract with OHCA.

(q) The President of the Board or owner of a privately held enterprise is advised by mail of the imposition of any sanction.

(r)The CEO or designee of a provider contacts the administrator of CQI to provide notice of the resolution of concerns resulting in the imposition of a sanction.  A focused resurvey is conducted within one week of this notice to assess current practices.  Sanctions are terminated when it is confirmed that performance is consistent with the the terms of the contract.  Sanctions may be modified, continued, or intensified when identified performance deficiencies are not resolved within stipulated time frames.  The DCFS administrator responsible for the contract retains authority for such determinations.