Rule 37.40.1409 - HOME AND COMMUNITY BASED SERVICES FOR ELDERLY AND DISABLED PERSONS: QUALITY ASSURANCE REVIEWS(1) As used in this rule, the term "provider" means case management teams, independence advisors, and financial managers.(2) The department will conduct comprehensive provider evaluations at least once every three years, to assure 1915(b) and 1915(c) waivers meet department and federal quality assurance requirements pursuant to 42 CFR 441.302.(3) The department will conduct quality assurance reviews (QARs) on the provider's premises and/or through desk audits. Upon the department's request, providers must supply the documentation that the department determines is necessary to complete a QAR no later than 30 days following the request for documentation.(4) The department will determine when reviews will take place. The department will assess compliance with the following service delivery standards: (a) required documentation;(b) service plan completeness;(c) service plan reevaluation requirements;(d) health and safety requirements;(e) principles of charting;(f) waitlist requirements;(g) plan facilitator requirements; and(h) financial accountability.(5) The department will assess compliance with the following standards related to provider-prepared areas: (a) administration and use of the member survey;(b) case manager qualifications;(d) serious occurrence reporting requirements; and(e) quality improvement project reporting.(6) The department will review a provider's case samples comprising at least 10 percent of Big Sky Waiver members, along with a 5 percent random sample of members admitted during the specific review period.(7) Compliance requires that the provider meet all established standards in 86 percent of the cases reviewed, under both service delivery and provider-prepared standards. (a) If compliance is below 86 percent in both areas, or if it is 50 percent or less in one or both areas, the next QAR will be scheduled within one year.(b) If compliance is below 86 percent in one or two areas, but more than 50 percent in both areas, the next QAR will be scheduled within two years.(c) If compliance is 86 percent or greater in both areas, the next QAR will be scheduled in three years.(8) Incidents of non-compliance identified through a quality assurance communication (QAC) require a remediation plan or recovery of HCBS funds. Any QACs must be responded to and resolved by a provider within 30 days.Mont. Admin. r. 37.40.1409
NEW, 2025 MAR, 37-1089, Eff. 1/11/2025AUTH: 53-2-201, 53-6-113, 53-6-402, MCA; IMP: 53-2-201, 53-6-101, 53-6-402, MCA