Description of Terms

Providers and staff of the DD Medicaid Tier waivers, the Individual Budget Medicaid Waiver, including the CDC+ Program are required to have a cleared Level 2 Background Screening when they begin providing services and every five years after that. This screening helps protectindividuals by preventing anyone with a history of certain criminal activity from becoming a provider of services or working for a provider of services. Qlarant requests proof of this information as part of the Provider Discovery Review process.

Providers of the DD Medicaid Waivers, including the iBudget Medicaid Waiver and the CDC+ Program are required to obtain training specific to the type of service being provided. Training helps ensure providers have the knowledge and skills necessary to be effective service providers. Qlarant requests proof of training as part of the Provider Discovery Reviews. Service specific training requirements for DD Waiver program providers are available in the Medicaid Coverage and Limitations Handbook. To access the Medicaid Handbooks go to:

1. http://mymedicaid-florida.com/
2. Under Provider Services Section heading, select Support
3. Under Support Section heading, select Handbook
4. Select Developmental Disabilities Individual Budgeting Waiver Services effective 9/3/2015

To access information on the CDC+ Program go to: http://apd.myflorida.com/cdcplus/

Deemed Status is a process utilized and applied by the QIO to any provider (with the exception of Waiver Support Coordinators) a certain score on their Overall Provider Performance Review. Specific criteria for Deemed Status is determined each year by APD State Office and AHCA. If a provider achieves Deemed Status, they will not be reviewed until the following contract year. The implementation of Deemed Status is at the discretion of APD State Office and AHCA.

In the event, a provider who has Deemed Status for PDRs has any Alerts and/or Billing Discrepancies identified during a PCR that provider shall lose its Deemed Status and a PDR shall be scheduled immediately at the direction of APD State Office and AHCA. APD Discovery review citations may result in a provider losing its Deemed Status. If Deemed Status is revoked, a PDR will be scheduled.

If a provider is in Deemed Status, it does not exempt them from other APD Discovery reviews, audits, and/or licensing/monitoring inspections.

This refers to the overall score from the Qlarant Provider Discovery Review. The score is a percentage, based upon the number of standards present or are “Met” and the total number of standards reviewed. Standards are weighted so that some, such as those pertaining to health and safety, make a greater impact on the provider’s score.

Each provider has to maintain documentation that certain service standards are met. Reviewers check the providers’ records for written documentation demonstrating the provider has the proper background screening and training, addresses health and safety, and that the provider bills Medicaid properly.

Each provider has to maintain documentation demonstrating the assurances of health and safety for each person served.

This refers to the date of the last provider Qlarant PDR annual review. Each provider identified as eligible for an on-site review receives a PDR once each contract year unless their results warrant "deemed" status, thus making them ineligible for a review until the following contract year. The contract year is defined as the period from January 1st to December 31st.

Data from provider reviews that were recently completed may not yet be listed. Data are added to the website as soon as possible.

Providers will complete an APD Plan of Remediation (POR) form to address any “Not Met” standards cited by the QIO (Quality Improvement Organization, currently Qlarant), APD discovery or any other source. Providers scoring 100% on their Provider Discovery Review (PDR) are not to complete a POR.

A provider who has one or more “Not Met” standard(s), a Plan of Remediation is required for APD. The provider must type all information on the POR form. No handwritten forms will be accepted. A provider completed POR must be submitted to the designated APD Regional/Field Office staff. Providers who score 85% or better with no Alerts or billing discrepancies have the option of sending their signed final POR copy via US Mail or hand deliver to the designated APD Regional / Field Office. Providers who score 84% and below, have Alerts or billing discrepancies are required to meet face to face upon completion of the POR.

Provider must sign and date the POR regardless of PDR score or circumstance. Original ink signature is required by all parties. The APD Regional/Field Office will maintain the original signed copy POR and documented evidence of each item remediated as well as documentation of action taken when remediation is not completed.