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37.40.1106    PERSONAL CARE SERVICES, PROVIDER COMPLIANCE

(1) Providers of personal care services shall be subject to compliance reviews to provide assurance to the department that services are being provided within the rules and policy of the program.

(2) Compliance reviews shall be conducted by department staff on the provider's premises.

(3) The reviews shall take place:

(a) on an annual basis;

(b) 90 days after the enrollment of a new provider; and

(c) at other times as determined by the department.

(4) The department shall determine compliance in the following service delivery areas:

(a) response to referrals;

(b) service initiation;

(c) physician orders;

(d) recipient needs intake;

(e) service delivery;

(f) attendant orientation to recipient;

(g) supervisory visits;

(h) service breaks;

(i) prior authorization; and

(j) service termination.

(5) The department shall determine compliance in the following administrative areas:

(a) attendant basic training;

(b) attendant in service training;

(c) nurse licensure;

(d) response to complaints;

(e) maintenance of incident reports;

(f) recipient surveys;

(g) attendant pool; and

(h) development of agency manuals and handouts.

(6) The department may choose to review other areas of the program at its discretion.

(7) The department shall examine 15 cases or 5% of the provider's case load for the purpose of the compliance review.

(8) The provider must meet all standards in 90% of the cases to be considered in compliance. If 90% compliance is not met, the provider will be given the results of the review and a second compliance review will be scheduled.

(9) The provider must meet all standards in 90% of the cases in the second review or it will be subject to department sanctions as provided in ARM 37.85.401, 37.85.502, 37.85.505, 37.85.506, 37.85.507, 37.85.511, 37.85.512 and 37.85.513.

History: Sec. 53-6-101, 53-6-113 and 53-2-201, MCA; IMP, Sec. 53-6-101 and 53-6-113, MCA; NEW, 1995 MAR p. 1191, Eff. 7/1/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

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