C. Qualified Providers

1. The state verifies that providers meet required licensure and/or certification standards and adhere to other standards prior to their furnishing waiver services; and the state verifies on a periodic basis that providers continue to meet required licensure and/or certification standards and/or adhere to other state standards; and the state monitors non-licensed/non-certified providers to assure adherence to waiver requirements.

  1. NYS will only enter into Provider Agreements with agencies that meet the requirements for qualified staff.
  2. Prior to approval of waiver service providers, the RRDS conducts interviews of potential waiver service providers which include evaluation of employee resumes to ensure employees meet the required qualifications. During implementation of the waiver, DOH WMS and QMS may also participate in the interview process of potential providers using a standard interview form (refer to Section III - Becoming a Waiver Provider).
  3. Waiver providers are responsible for assuring their staff meets all qualification requirements set by the waiver.
  4. The RRDS submits recommendations to DOH WMS regarding qualified providers.
  5. Character and competency verification will be obtained by DOH WMS through direct contact with other State agencies where applicable.
  6. Certain waiver providers are mandated to obtain Criminal History Record reports from the U.S. Attorney General's Office for all prospective direct care and supervisory staff prior to employment other than those persons licensed under Title 8 of the Education law or Article 28-D of the Public Health Law.
  7. If licensure or certification is a requirement for a waiver provider, DOH WMS verifies waiver provider agency qualifications before approving the agency as an NHTD waiver provider.
  8. The waiver provider must report any subsequent change in status to DOH WMS and/or RRDS/QMS (i.e. the provider is unable to maintain qualified staff and therefore, is unable to provide the waiver service(s), or if license or certification status changes).
  9. DOH will survey all licensed and/or certified and non-licensed/non-certified waiver provider agencies within the first three-years of the waiver including a component on staff qualifications.
  10. DOH conducts surveys of waiver providers to assure they adhere to policies and procedures including Incident Reporting, Detailed Plans and Individual Service Reports, concerns/grievances and SPs.
  11. During surveys of waiver providers, DOH will also evaluate whether waiver provider employees meets job qualifications.
  12. The RRDS communicates specific concerns regarding waiver provider practices to DOH WMS, possibly leading to DOH survey, audit by OMIG or other further action.
  13. If a waiver provider is found not to have met licensure/certification requirements (including the mandatory statutes for Employee Criminal History Record checks), DOH WMS reserves the right to place a Vendor Hold against the waiver provider and/or terminate the Provider Agreement.
  14. A number of processes allow the RRDS, QMS and DOH WMS to develop an understanding of waiver provider capabilities and competencies. These are: review of SPs, SRI reports, annual waiver provider Incident Reports, training materials and staff interactions.
  15. The data gathered regarding this assurance must be included in the RRDS and/or QMS Quarterly Reports for review by DOH WMS. That staff, in consultation with the QMS and RRDS will evaluate the need to change and/or improve policies/procedures.

2. The state implements its policies and procedures for verifying that provider training has been conducted in accordance with state requirements and the approved waiver.

  1. DOH WMS provides ongoing training and educational programs for QMS, RRDS and NE.
  2. DOH provides training modules for "Overview of NHTD and TBI Waiver Programs", HCSS, Service Coordination, and ILST. These are to be used by waiver providers unless they have their own DOH approved training.
  3. The Program Manual sets forth areas of training and competencies required for all staff of each waiver provider.
  4. Waiver providers are responsible for maintaining ongoing training for their staff to assure waiver standards are met.
  5. The RRDS provides training that includes Basic Orientation Training, Participant Rights, and service specific training programs to all approved waiver providers utilizing the training course "Overview of NHTD and TBI Waiver Programs." The RRDS will maintain a list of all those trained and include this information in quarterly reports.
  6. The RRDS conducts 8-10 training programs per year to waiver providers in their region.
  7. Documentation of training includes training curriculum, qualifications and name of trainer, attendance records, date and place of training, goals, and evaluation tools by waiver providers.
  8. During DOH surveys and audits of waiver providers, documentation is reviewed to assure compliance with training standards. If compliance is not met, a plan of correction will be required and, if unsatisfactory, may lead to termination of the Provider Agreement.
  9. DOH WMS, QMS or RRDS may examine waiver provider's training curriculum or training records at any time.
  10. The data gathered regarding this assurance must be included in the RRDS and/or QMS Quarterly Reports for review by DOH WMS. That staff, in consultation with the QMS and RRDS will evaluate the need to change and/or improve policies/procedures.