B. Provider Responsibilities

  1. Providers applying for Assistive Technology (AT), Community Transitional Services (CTS), Congregate and Home Delivered Meals, Environmental Modifications Services (E-mods), Home Visits by Medical Personnel, Moving Assistance and Respiratory Therapy must satisfy the following conditions:
    1. Assure participant's right of choice;
    2. Establish and maintain current safety and emergency policies and procedures;
    3. Have personnel files on every employee including resumes and job descriptions; if a provider has more then one office and the personnel files are housed in the main office when the other office(s) is surveyed by DOH, the personnel files need to be provided to the surveyor(s) at that location per their request;
    4. Have knowledge of the NHTD Waiver's Incident Reporting Policy regarding Serious Reportable Incidents (SRI) (refer to Section X – Incident Reporting Policy and Complaint Procedure) including the obligation to report to the Service Coordinator (SC), and to cooperate with the Quality Management Specialist (QMS) in relation to the investigation of SRI, i.e. staff interviews;
    5. Establish and maintain a tracking system to ensure staff will provide the expected amount/type of service in accordance with the participant's Service Plan (SP);
    6. Establish and maintain an accurate system for documenting when services are provided and billed;
    7. Establish and maintain a process for surveying participant satisfaction of its service; this process includes obtaining information from the participant on his/her satisfaction of the service provided, was the staff able to make appointments, be on time and provided services as agreed upon;
    8. Establish and maintain a policy for handling complaints raised by participants, family members or advocates and concerns addressed by the SC, Regional Resource Development Specialist (RRDS) or QMS and documenting outcomes;
    9. Establish and maintain a file for each participant regarding the waiver participant's individual information provided by the SC including: a copy of the Notice of Decision (NOD), the first page of the SP and the page(s) describing the need for the requested waiver service(s); and
    10. Cooperate with New York State Department of Health, Office of Medicaid Inspector General (OMIG) and other government agencies with jurisdiction to conduct surveys and audits.
  2. All other providers applying to become a waiver provider must satisfy the following conditions:
    1. Assure participant's right of choice;
    2. Establish and maintain current safety and emergency policies and procedures;
    3. Establish and maintain personnel files on every employee including resumes and job descriptions; if a provider has more then one office and the personnel files are housed in the main office, when the other office(s) is surveyed by DOH, the personnel files need to be provided to the surveyor(s) at that location per their request;
    4. Follow the NHTD Serious Reportable Incident Policy and Procedure (refer to Section X – Incident Reporting Policy and Complaint Procedure);
    5. Establish and maintain policy and procedure for documenting Recordable Incidents; (refer to Section X – Incident Reporting Policy and Complaint Procedure);
    6. Establish and maintain a tracking system to ensure that staff is providing expected amount of service in accordance with the participant's SP;
    7. Establish and maintain a method for self-appraisal of service provision including suggestions and methods for improvements;
    8. Establish and maintain a process for surveying participant satisfaction of its service. This process includes obtaining information from the participant on his/her satisfaction of the service provided, was the staff able to keep appointments made, be on time and provided services as agreed upon;
    9. Establish and maintain a method for recording and addressing complaints made by the waiver participants, families, legal guardians and others; this information is included in an annual report stating the number and types of complaints made/received, including an analysis of these complaints and the provider's response to them;
    10. Establish and maintain a method for recording and addressing concerns expressed by the SC, RRDS, QMS and/or DOH Waiver Management staff (WMS);
    11. Establish and maintain participant records which include functional assessments, detailed plans, notation of every encounter and contact with the participant, a copy of all Individual Service Reports (ISR), documentation of all communication with the SC, documentation of the times of visits, billing records, current copy of the NOD, a copy of the current approved SP, and a copy of the current Waiver Participant Rights and Responsibilities (refer to Appendix C – form C.5);
    12. Provide training utilizing DOH established curriculum and where an agency's curriculum exists regarding the subject matter, have that written training curriculum approved by DOH WMS to meet the DOH training requirements (refer to Section VIII – Required Training for Waiver Service Providers); and
    13. Cooperate with New York State Department of Health, OMIG and other government agencies with jurisdiction to conduct surveys and audits.
      Note: Providers approved under B-II above are expected to attend the RRDS provider meetings. At times, these meetings cover policies and procedures relevant to the health and welfare of the participants. These meetings are a critical opportunity for the providers to remain current regarding NHTD policies and procedures. Not attending these meetings could result in noncompliance with policies and procedures, which will ultimately lead to restrictions to the provision of waiver services.