ADvantage and State Plan Personal Care FY17 Provider Audits
This letter is to advise you of Medicaid Services Unit-Quality Assurance/Improvement (MSU-QAI) department activities for Fiscal Year (FY) 2017 as related to Provider Agency audits performed by the Department of Human Services, Aging Services (DHS/AS).
An annual audit will be conducted of your agency during FY2017 (July 1, 2016 – June 30, 2017). Please note that some follow-up reviews of audits completed in FY2016 (July 1, 2015 – June 30, 2016) will be completed during FY2017. Because these are follow-up to FY2016 Annual ADvantage and State Plan Personal Care Audits, they will not prevent your agency from receiving an Annual ADvantage Audit in FY2017.
The Consumer-Focused Quality of Care Review (CFQCR) tool serves as a guide for the MSU Provider Audit team. It does not strictly dictate what is to be audited, nor will the document restrict additional audit activities which may become necessary as a result of information gathered during the audit. Any supplementary review will not go beyond your agency's responsibility of meeting all contractual and policy requirements.
A new condition has been added to the FY2017 Consumer-Focused Quality of Care Review (CFQCR) tool for ADvantage Case Management. This condition is regarding the timeliness of submission of the reassessment service plan. Additionally, conditions related to Person-Centered Service Planning have been combined and will be reviewed for 1) inclusion of a personal goal, and 2) to ensure all specific needs and abilities identified on any of the following:
- Nursing Assessment/Monitoring Form
- IDT minutes are addressed in the Service Plan Goals
A new Comparison Worksheet (enclosed) has been designed as a checklist to compare needs and abilities, including Personal Goals, on the documents listed above to make certain they are addressed in the Service Plan Goals.
The format of the FY2017 audit tools is unchanged from the last fiscal year. A copy of each audit tool that relates to the service(s) your agency provides is enclosed (ADvantage Case Management, ADvantage Home Care and State Plan Personal Care). A few process modifications have been made for FY2017. Please see the attached document, Updated Audit Process, for those details.
Assisted Living and Adult Day Health Providers will also be audited for FY2017 using newly developed Consumer-Focused Quality of Care Review (CFQCR) tools. These audits will include emphasis on the final rule from Centers for Medicare and Medicaid (CMS) regarding Home and Community Based Settings, as well as requirements of the ADvantage Service Standards, Conditions of Provider Participation, and state policy.
Financial/Staffing Quality Reviews (FSQR) may not be conducted by the MSU-Quality Assurance/Improvement department on an annual schedule at this time. All ADvantage providers may be subject to a random FSQR audit to ensure the integrity of provider billing for ADvantage waiver services.
The Provider Report Cards remain active on the www.okdhs.org website. This report gives Members, Families & Caregivers the ability to make an informed decision when selecting an agency for the ADvantage or State Plan Personal Care Programs. If you would like to order bookmarks to share with Members/Families/Caregivers, you may obtain copies by calling 877-283-4113 (toll-free) or by faxing an order to (405)962-1741 with your name, address, phone number, the DHS Publication number (14-24, issued 05/2014), and desired quantity.
Finally, MSU-QAI department and the Medicaid Services Unit-ADvantage Administration (MSU-AA) continue to provide full day workshops at various locations across the state. If your agency has not attended one of these workshops, please contact MSU-AA or visit the ADvantage Administration website at http://www.okdhs.org/services/aging/pages/ADvantageAdmin.aspx for information regarding registration. Although these workshops are not mandatory, we hope that you will make plans to attend. The frequently asked questions from the FY2015 QAI Workshops have been compiled and are attached to this email.
Specific questions about the Quality Assurance/Improvement tools and procedures can be directed to the Oklahoma DHS/Aging Services Quality Assurance/Improvement Programs Assistant Administrator, Miranda Kieffer, at 405-522-0278 or email Miranda.Kieffer@okdhs.org. Member-specific questions need to be sent through secured email (SmarterMail) to Provider Questions at AAUProviderquestion@aau.okdhs.org.
We appreciate your commitment to provide quality services to Members of the ADvantage Waiver and State Plan Personal Care Programs. Thank you for what you do every day and for your dedication to the people we serve.