E. Vendor Holds and Disenrollment Initiated by DOH Waiver Management Staff
When DOH WMS is informed by the RRDS of an issue(s) regarding the provision of services by a waiver provider, DOH WMS may choose to restrict a provider's opportunity level (Vendor Hold). This is done by sending the provider a letter via certified mail advising the provider that it will be placed on Vendor Hold, specifying the reason(s) for the restriction, the effective date and time period of the Vendor Hold and request for a correction plan.
The provider will be informed that it is ineligible to receive new referrals of waiver participants. This restriction may be for one specific service or for all services that the waiver provider offers. Reasons for this may include:
- late SPs (refer to Section V - The Service Plan);
- late ISR (refer to Section V - The Service Plan);
- unacceptable provider practices;
- questionable quality of services;
- provider's inability to deliver the specific services; and
- the provider's inability to follow the NHTD waiver policies and procedures.
The waiver provider must submit to DOH WMS a plan describing actions to address the specific issue within seven (7) calendar days of receiving the certified letter so the Vendor Hold can be lifted. If this is successful, a letter will be issued to the waiver provider by DOH Waiver Management staff indicating the Vendor Hold has been ended.
If the matter is not corrected by the waiver provider within the allotted seven (7) calendar days, DOH WMS will initiate the provider disenrollment process.
DOH WMS initiates the disenrollment process by sending a Provider Disenrollment Notification letter via certified mail to the waiver provider agency Executive Director indicating that the sixty (60) day disenrollment process has begun and the date the provider agreement will be terminated. The letter also informs that waiver provider that Vendor Hold restrictions remain in effect. It further provides information regarding the process for waiver participants to select a new waiver provider agency(s).
To stop disenrollment, the waiver provider must submit a plan of action to DOH WMS. Upon review and approval of this plan, DOH WMS will decide whether to stop the disenrollment process. If the plan of action is approved, DOH WMS will issue a notice to the waiver provider executive director indicating this.
If DOH WMS does not approve the plan of action the SC must assist the participant(s) in choosing a new provider and with completing the Request for Change of Provider form (refer to Appendix C – form C.18). The SC will assist the participant(s) and the terminating waiver provider through the period of transition from current to new provider(s). The terminating waiver provider is responsible for sending the applicable new waiver provider(s) the following copies of all evaluations, ISR, a copy of the detail plan and an update on the participant's accomplished goals.
In situations where the service being terminated is Service Coordination, the notice must direct the participant to contact the RRDS to select another Service Coordination provider agency. The RRDS must assist the participant in completing the Request for Change in Service Coordinator Form (refer to Appendix B – form B.15). The RRDS must assure that all applicable documents (e.g. ISP, current SP, evaluations, current PRI/SCREEN, ISRs, Detailed Plans, etc.) are transferred from the current SC to the new SC.