TITLE John F. McCann, IIII Director Provider Performance Unit - - PowerPoint PPT Presentation

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TITLE John F. McCann, IIII Director Provider Performance Unit - - PowerPoint PPT Presentation

Feb 04, 2023 384 likes •483 views

TITLE John F. McCann, IIII Director Provider Performance Unit Department of Behavioral Health & Developmental Disabilities 1 1 The Division of Developmental Disabilities ROLES AND RESPONSIBILITIES The Community Quality Review process

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The Division of Developmental Disabilities

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TITLE

Department of Behavioral Health & Developmental Disabilities

John F. McCann, IIII Director Provider Performance Unit

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The Division of Developmental Disabilities

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ROLES AND RESPONSIBILITIES

The Community Quality Review process is designed to ensure that provider agencies are providing quality services that are person- centered, outcome oriented, with assurances

  • f safeguards in place for a meaningful life in

the community.

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The Division of Developmental Disabilities

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Community Service Standards

 Community Service Standards are guiding

principles and minimum requirements to support all DBHDD Providers in Georgia to do the best job for all persons served;

 Community Service Standards or requirements of

DBHDD are applicable to all Providers of DD Services regardless of the type of services provided;

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The Division of Developmental Disabilities

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Community Service Standards

 The Community Service Standards for DD

Providers outline the required Organizational Practices and Outcomes of Services;

 The Community Service Standards are contained

in the DBHDD Provider Manual for Community Developmental Disabilities Providers, which is updated periodically.

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Critical Areas: Health & Safety

 Medication & Health Care Management  Adequate and Competent Staff  Individual Rights, Responsibilities,

Protections

 Behavior Support Practices

The Division of Developmental Disabilities

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The Division of Developmental Disabilities

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Community Service Standards Review Process

The initial review is scheduled within four to six months following approval to serve one or more individuals with developmental disabilities. For the review process refer to “Accreditation and Standards Quality Review Requirements for Providers of DD Services” (Policy 02-703) found in the Provider Manual.

Community Service Standards current certificate must be maintained for all approved services to provide services. All new providers must be reviewed and meet all requirements in the Community Service Standards for DD Providers and be in business for a minimum of 12 months before additional services and sites may be added

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The Division of Developmental Disabilities

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Sanctions Can and Do Occur

Recommendation to DCH for “Suspension” to be put in place whereby the provider agency is not permitted to admit any additional individuals, add additional services or add additional locations/sites until all issues are

  • corrected. Suspension can occur due to failure to submit a CAP and/or

failure to correct the immediate health and safety issues after an interim visit;

Additional monitoring visits by Regional staff and Service Coordinating Agency staff;

Referral to Medicaid’s Program Integrity Unit (PIU) to review billing for services not provided, misuse/waste of Medicaid funds/benefits, patterns of fraud and abuse; and

Non-renewal/Termination of Contract or LAO and recommendation to terminate Medica

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The Division of Developmental Disabilities

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Topic

Department of Behavioral Health & Developmental Disabilities

Questions?