C. Application Process
The following eight (8) steps describe the application process for becoming a waiver provider:
STEP 1 - Provider Inquires
The potential waiver service provider for the NHTD Waiver will obtain a copy of the Program Manual from the DOH website or the RRDS, which includes the application forms for becoming a waiver provider (refer to Appendix A – forms A.1 and A.2).
STEP 2 - Application
The potential waiver service provider submits the Provider Application Packet to the RRDC in the region/regions it wants to serve. The packet includes:
- Letter of Intent describing:
- The agency's history of providing services to individuals with disabilities and/or seniors. If this experience is limited, a description of how the agency proposes to develop the expertise to effectively provide services must be included;
- A list of service(s) for which the provider is seeking approval; and
- Identification of the RRDC region(s) and/or counties within the RRDC region where service(s) would be provided.
- Employee Verification of Qualifications form (refer to Appendix A – form A.1) and resume for at least one individual providing the waiver service requested.
- Signed original Provider Agreement Form.
- Signed original eMedNY Provider Enrollment Form. The Category of Service 0260 needs to be completed by potential providers of Home Visits by Medical Personnel and Respiratory Therapy. All other potential providers need to complete the Category of Service 0263.
- Signed original Disclosure of Ownership and Control Form, including:
- A list of the Board of Directors, including any relationships that exist between Board members (e.g. spouses, children, etc.), or individuals with the same last name; and
- The location of the agency including street address, even if the mailing address does not include a street or road.
- Copy of the Federal Employee Identification Number (FEIN).
- A copy of provider's licensure, certification and other requirements, as applicable, which support the requested services and satisfies the requirements of being a provider of the waiver service specified in the prospective provider application.
- A copy of provider policies and procedures which include:
- HIPAA compliance;
- Safety and emergency procedures;
- Human Resource (personnel) records;
- Serious Reportable and Recordable Incident Reporting;
- Service provision tracking system;
- Plan for self-appraisal of service provision including suggestions and methods for improvements;
- Participant satisfaction survey;
- Recording and addressing waiver participant complaints and grievances;
- Recording and addressing concerns of RRDS, QMS, SC, and DOH WMS; and
- Record keeping/ documentation.
The completed Provider Application packet must be submitted to the RRDS(s) for review and recommendations in the region/regions they will be serving. If a prospective provider is interested in providing services in more than one region, the Application Packet must be sent to each RRDC for review by the RRDS(s).
STEP 3 - RRDS Preliminary Review
Prior to arranging an interview with the potential provider, each RRDS will review the Provider Enrollment Application Packet for potential providers in his/her region and determine preliminary eligibility. This includes reviewing and verifying the provider meets the licensure, certification and staff qualifications which support the services requested. When two or more RRDCs are involved, the RRDSs will contact each other to discuss preliminary reviews and then set up a joint interview with the potential provider.
STEP 4 - RRDS Interview and Review
The RRDC administering the waiver in the region(s) for which the provider is requesting approval is responsible for the review and decision about the application. A primary component in this determination is the RRDS(s) interview with the potential provider. In this interview the RRDS(s) will:
- Explain the NHTD waiver, its philosophy and services;
- Interview the potential provider and complete the Waiver Service Provider Interview form (refer to Appendix B – form B.8);
- Review resumes of proposed staff and Employee Verification of Qualifications forms (refer to Appendix A – form A.1);
- Review training materials developed by the provider (refer to Section VIII - Required Training for Waiver Service Providers);
- Review provider policies and procedures that were submitted (refer to Step 2-h).
The RRDS must visit the proposed site for a Structured Day Program Services and obtain a copy of the Certificate of Occupancy.
STEP 5 - RRDS Recommendations
The RRDS is responsible for making recommendations to the Department of Health regarding approval of the proposed service(s) based on: personnel qualifications which meet all the requirements described above; the capacity of the agency to develop and maintain high quality services; and the provider's understanding of and willingness to adhere to the philosophy and policies of the waiver.
The RRDS must submit to DOH WMS the completed Provider Enrollment Application Packet and the Waiver Service Provider Interview form, which includes and describes the RRDS decision to DOH WMS including the RRDS(s) recommendations for whether to approve the potential provider and which waiver services to approve.
If there is a difference of opinion between the potential provider and the RRDS about whether the provider should be approved or what services the provider will be able to provide, DOH WMS will be responsible for the final decision.
STEP 6 - DOH Waiver Management Staff Decisions
If any additional information or clarification is needed, DOH WMS will contact the RRDS or the potential provider agency, as appropriate. DOH WMS will send written notification to the potential provider indicating which, if any, services are approved and the starting date of the approval. If the provider disagrees with the decision, the potential provider may discuss concerns with DOH WMS.
DOH WMS is responsible for making a judgment about the character and competence of each potential provider as it impacts the provider's ability to deliver waiver services. DOH WMS must obtain reasonable assurances that the applying agency is capable of delivering services in accordance with the operational standards and intent of this waiver. DOH WMS may contact other New York State agencies or their counterparts in other states to gather information about the current status and background of the potential provider including any past experience in providing Home and Community-Based Services waiver services.
STEP 7 - Billing
DOH WMS will forward the necessary provider information to the appropriate DOH office for processing to become approved to bill Medicaid. This office informs the approved provider about eMedNY and ePACES for billing instructions. The Billing Manual will be available at www.eMedNY.org.
STEP 8 - Lists of Approved Providers
DOH WMS notifies the appropriate RRDS(s) of the Medicaid approval and services approved. The RRDS adds the provider to the list of approved providers for the RRDC region.