P. Delinquent Individual Service Reports (ISR) From Waiver Service Providers
Waiver service providers are responsible to submit their ISR at least six (6) weeks prior to the end of the current Service Plan or at the Team Meeting to the SC to avoid interruption of service to the participant (with exceptions as noted in Section VII - Record Keeping). The SC is also required to submit a complete and timely ISR as part of the development of the RSP.
At the Team Meeting, if a waiver service provider determines that changes need to be made to the ISR to better reflect the participant's needs, that waiver service provider may request one (1) additional business day to revise and resubmit the ISR to the SC. In some situations an ISR can only be completed after decisions are reached during the Team Meeting.
Each waiver service provider is responsible to develop and submit ISRs in accordance with timelines established in this Section of the Program Manual. Therefore, when a waiver service provider does not submit a timely ISR or does not communicate with the SC the need for additional time to submit an ISR, the SC must notify the RRDS within one (1) business day after the Team Meeting for technical assistance. The RRDS will send a Late Notice (refer to Appendix B - form B.14) to the waiver service provider agency supervisor informing him/her that the ISR is delinquent, giving the provider agency seven (7) calendar days to complete and submit the ISR to the SC.
If at the end of the seven (7) calendar days the waiver service provider agency has not complied with the submission of the ISR, the SC must contact the RRDS for further technical assistance. The RRDS notifies DOH WMS of the continued delinquency. DOH WMS sends a Letter of Vendor Hold via certified mail to the waiver service provider agency's Executive Director and SC Supervisor giving him/her seven (7) calendar days to submit the ISR. The letter includes notification that continued failure to submit the ISR will initiate the sixty (60) day Provider disenrollment process. Upon receipt of the ISR, the SC notifies the RRDS. Upon review and approval of the ISR by the RRDS, the RRDS notifies DOH WMS who may send the provider agency Executive Director a Letter of Vendor Hold termination.
If the waiver service provider agency fails to comply within the seven (7) calendar days the SC notifies the RRDS that no ISR has been received. The RRDS contacts DOH WMS. DOH WMS will issue the sixty (60) calendar day Notice of Pending Provider Disenrollment indicating the effective date of disenrollment.
Upon receipt of the ISR, DOH will determine whether a notice will be issued by DOH terminating the disenrollment process. However, if there is an ongoing pattern of late Service Plan submission, DOH WMS has the right to continue the disenrollment process.
In circumstances where the waiver service provider may not be able to submit the ISR on time, it is imperative that the waiver service provider maintains open communication with the SC regarding the reasons for late submission. The SC must contact the RRDS and communicate this delay. The RRDS makes a determination regarding a reasonable plan of action for submission of the ISR by the waiver service provider. The RRDS will send a Late Notice via certified mail to the waiver service provider agency supervisor including documentation of the expected action plan for submission of the ISR.
The SC should proceed with the development of the Service Plan to maintain the timeline for submission to the RRDS for review.
If the delinquent waiver service provider agency fails to comply with the action plan for submission of the ISR to the SC, the SC contacts the RRDS. The RRDS notifies DOH WMS of the waiver service provider's continued delinquency. DOH WMS will proceed with sending a Letter of Vendor Hold to the waiver service provider agency's Executive Director. If the agency fails to comply further, the RRDS will contact DOH WMS to begin Provider disenrollment procedures of the delinquent waiver service provider agency.