R. Delinquent Submission of the RSP by the SC
Late submission of a RSP by the SC can result in the interruption of services to a participant and potentially lead to Vendor Hold or Disenrollment of the Service Coordination provider agency. A complete, acceptable RSP Packet must be submitted to the RRDS for approval at least thirty (30) calendar days prior to the end date of the current Service Plan.
When the SC is facing unforeseen circumstances that affect the submission of the Service Plan within the required timeframe, the SC makes immediate contact with the RRDS for technical assistance. A plan must be established that will prevent disruption of services to the participant, potential penalties to the Service Coordination agency, and billing concerns for all waiver service providers.
When a RSP Packet is not submitted to the RRDS by the SC at least thirty (30) calendar days prior to the end date of the current Service Plan, the following protocol must be followed:
1. Late Letter
A Late Letter will be sent to the Service Coordination agency supervisor by the RRDS via certified mail any time a RSP packet is not submitted by the required timeframe (thirty (30) calendar days prior to the end of the current Service Plan period). It informs the Service Coordination agency supervisor that communication with the RRDS is necessary and a plan to submit the RSP packet within seven (7) calendar days is expected. It further informs the supervisor that failure to comply will lead to the initiation of Vendor Hold process.
2. Vendor Hold
Vendor Hold restricts the Service Coordination agency from accepting any new NHTD referrals. If the SC does not submit the RSP packet to the RRDS within seven (7) calendar days, the RRDS notifies DOH WMS. DOH will send a certified Letter of Vendor Hold to the Service Coordination agency supervisor and Executive Director informing him/her of continued non-submission of the RSP packet. The letter informs the agency that a completed and signed RSP packet must be submitted within seven (7) calendar days along with a plan of action to prevent further submission of late service plans. Failure to submit an acceptable RSP packet within this time frame constitutes breach of the Provider Agreement, leading to provider disenrollment.
It is the responsibility of the SC to contact all waiver service providers involved in the RSP that billing for waiver services is now prohibited until the RRDS receives and approves the RSP packet.
If the Service Coordination agency submits an acceptable RSP packet to the RRDS within the seven (7) calendar day period, DOH may terminate the Vendor Hold process with a written notification to the agency.
3. Pending Provider Disenrollment
If the Service Coordination agency fails to comply with the terms of the Vendor Hold notification, the RRDS notifies DOH WMS. DOH WMS sends the Service Coordination agency Executive Director, Service Coordination Supervisor and SC a Notice of Pending Disenrollment via certified mail.
This notice informs the agency that due to continued non-compliance with the request for submission of the RSP packet, the agency will be disenrolled from the NHTD waiver sixty (60) calendar days from the notice date. During this time Vendor Hold status remains in effect.
If at any time during this process the Service Coordination agency complies with the submission of the RSP packet and establishes a satisfactory plan of action to prevent delinquencies, DOH WMS may stop the disenrollment process.
Repeated late submissions of RSP packets will result in the initiation of the Provider disenrollment process whereby the Service Coordination agency will no longer be able to serve NHTD waiver participants.
4. Provider Disenrollment
A Notice of Disenrollment is sent via certified mail by DOH WMS to the Service Coordination agency's Executive Director when the agency has failed to provide the requested information (e.g. RSP or ISR) and/or has not provided an acceptable plan of action. The letter specifies the final date of disenrollment. It informs the agency of the requirements for transitioning all waiver participants to new waiver service provider agency(s).