T. Process for Changing a Provider
The participant's ability to change a waiver service provider is an essential component of assuring participant choice. It also allows a waiver service provider the opportunity to recognize that it can no longer meet the participant's service needs.
A. Participant Request
If the participant chooses to change their waiver service provider, the SC must comply utilizing the following procedure:
- The participant or his/her current SC informs the current waiver service provider of the participant's intention to change providers;
- The SC will provide the participant with a list of approved and available waiver service providers for the participant to interview and choose from;
- Upon selection of a new waiver service provider, the participant will inform the SC of his/her preference. The Service Coordinator will complete the Change of Provider Request form (refer to Appendix C - form C.18) with the participant and send the completed and signed form to the selected waiver service provider agency;
- The requested waiver service provider must review the form and complete the statement of Requested Provider indicating the approval of the participant's request or the denial of the participant's request with reason. The form must then be returned to the Service Coordinator;
- When the requested waiver service provider declines the participant's request for services, the SC must inform the participant and ask him/her to select another waiver service provider agency from the list. The selection process proceeds. The Service Coordinator maintains all completed Change of Provider forms in the participant's record;
- When the requested provider accepts the participant's request, the SC submits the Change of Provider Request form to the RRDS for review and determination. The RRDS's decision is documented on the Change of Provider Request form and sent back to the SC;
- If the RRDS approves, the SC will establish a date and time for the Transition Meeting and documents this on the Change of Provider Request form.
Note: The Transition Meeting provides an opportunity for current provider(s) to meet with newly selected providers to exchange information ensuring the success of the new provider(s) with the least amount of disruption to the participant. The SC documents this information on the Change of Provider Request form;
- The RRDS reviews the request and upon approval, sets an effective date for the change. The RRDS will send the approved Change of Provider form to the participant, SC, and all current and new waiver service providers;
- If the RRDS can not approve the request for change in waiver service provider, the RRDS will indicate the reason why (e.g. Vendor Hold status or the waiver service agency is no longer an approved provider of NHTD services) on the Change of Provider Request form and immediately notify the SC, sending the form back to the SC to be maintained in the participant's record. No NOD is issued by the RRDS in this case. However, for all other instances where the RRDS can not approve a request for change in waiver service provider, the RRDS will complete and send the NOD- Denial of Waiver Provider/Waiver Service form to the participant and others designated on the form;
- The SC must work with the participant to select another waiver service provider restarting the Change of Provider process;
- When the request for Change in Provider is approved by the waiver service provider agency and the RRDS, the SC must facilitate the Transition Meeting where participant information is reviewed and transferred to the new provider, assuring a smooth transition occurs;
- Once this process is completed, the SC must update the Waiver Contact List and provide a copy to the participant and other current waiver service providers as appropriate;
- If the participant chooses to change the Service Coordination agency, the RRDS must work directly with the participant through the above process (refer to Appendix B - form B.15); and
- The participant, SC or any provider should contact the RRDS if this procedure is not followed.
B. Provider Request
When a waiver service provider is unable to or wishes to no longer provide services to a participant, the following procedures must be followed:
- The waiver service provider agency must inform the participant of its intent to terminate service provision. This must be done at a minimum of ten (10) calendar days prior to stopping the provision of service(s);
- Notification must be sent via certified letter or directly delivered to the participant. A copy of the letter must also be sent to the Service Coordinator and the RRDS;
- Reasons for the termination must be included in the letter;
- The SC must provide the participant with a list of available waiver service providers from which to interview and select;
- If it is the SC agency requesting termination, then the RRDS is responsible for providing the participant with a list of available SCs/agencies from which to select;
- Upon selection of the new waiver service provider, the participant must inform the SC (or RRDS as appropriate) who will assist the participant through the completion of the Change of Provider Request form;
- The current provider agency must work closely with the newly requested provider agency and the SC (or RRDS, as appropriate) to assure a smooth transition occurs and that all appropriate documentation is provided to the new agency; and
- The SC must amend the Service Plan to reflect the change in waiver service provider.
Note: The above procedures do not replace any professional requirements which a provider must follow in accordance with professional credentialing or licensing rules.
C. As a Result of Staff Leaving
When a staff member of a waiver service provider agency will no longer be providing services to a participant, the following procedures must be followed:
- The staff member or agency supervisor must notify the participant of the employee's intent to leave his/her current agency and directs the participant to discuss the impact of their leaving with his/her SC. The participant can remain with the agency or choose to change providers. If it is the SC who is leaving the agency, the participant will be directed to the RRDS to select a new SC.
- The staff member or the agency supervisor notifies the SC of the staff member leaving the agency.
- The SC meets with the participant to determine if a new provider agency is desired. If the participant desires a new waiver service provider agency, the SC will assist him/her through the Change of Provider process (refer to Changing Waiver Provider section above).
- If the participant chooses to remain with the current waiver provider agency, the SC must work with the participant and agency supervisor to assure no lapse in staff coverage occurs.
- The SC will amend the current Service Plan to reflect the change, if needed.
- When it is the SC leaving the agency, the RRDS will talk with the participant about his/her continued interest in remaining with this Service Coordination agency. If the participant desires to change Service Coordination agencies, the RRDS will assist him/her through the change of Service Coordination process.
- If the participant chooses to remain with the current Service Coordination agency, the agency will work with the participant and agency supervisor to assure no lapse in staff coverage occurs.
D. Establishing the Date of Termination
As a final step in the process of changing waiver service providers, the RRDS will establish the date of termination to assure no lapse in service provision occurs to the participant. In doing so, the following must occur:
- Service Coordination must change on the first of the month (refer to Section VI - Waiver Services); and
- Other waiver services may be changed within ten (10) business days from the RRDS receipt of the signed Change of Provider form. The RRDS may make the change of providers effective upon receipt of the Change of Provider Request form if it is determined that the health and welfare of the participant is at risk. This may be accomplished verbally or in writing.
During the transition period, the SC will arrange for a Transition Meeting between the current and new providers and the participant to exchange information. In the event the SC is the staff member leaving, the RRDS will arrange for a Transition Meeting between current and new provider to exchange information. The current provider is responsible for providing the new provider with copies of all evaluations, Individual Service Reports, and an update of what has been accomplished since the last Service Plan. This process must comply with all laws, such as the Health Insurance Portability and Accountability Act (HIPAA), regarding confidentiality and the release of medical and NHTD waiver services material.