Description of Terms

iBudget Waiver providers and staff, including the CDC+ Program, are required to be background screened through the Agency for Health Care Administration Background Screening Clearinghouse Results Website prior to providing services to individuals, and every five years thereafter. This screening helps protect individuals 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.

iBudget providers and staff are required to meet minimum education and experience requirements, obtain basic training, and training specific to the type of service being provided. Training helps ensure providers have the knowledge and skills necessary to be successful in rendering services. Qlarant requests proof of training as part of the Provider Discovery Reviews. Service specific training requirements for the iBudget Waiver program providers are available in the Developmental Disabilities Individual Budgeting Waiver Services (iBudget) Coverage and Limitations Handbook.

To access the most current iBudget Handbook go to: https://ahca.myflorida.com/medicaid/rules/adopted-rules-service-specific-policies

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

Deemed Status is a designation applied to providers who obtain a pre-determined score on their overall Provider Performance Review (PDR). Criteria are determined on an annual basis by the Agency for Healthcare Administration (AHCA) and the Agency for Persons with Disabilities (APD). Deemed status can be revoked statewide or for a specific provider at the discretion of either entity. A provider that meets deemed status criteria may skip a year of review.

Deemed status is defined differently for a Qualified Organization (QO) than for providers of other services. A QO that meets deemed status criteria will still have a PDR but may be sampled for one PCR per WSC per APD region. This modified form of Deemed status for QO’s is implemented at the direction of AHCA and APD and only when the Qlarant contract necessitates a reduction in PCRs.

In the event a provider who has Deemed Status for PDRs has any Alerts 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.

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

Each provider has to maintain documentation that certain service expectations are met. Qlarant reviewers check the providers’ records for written documentation demonstrating the provider addresses areas such as health and safety, choices and rights, person centered planning, progress toward support plan goals/outcomes, and meets minimum requirements to bill and does so properly.

Each provider has to maintain documentation demonstrating the assurances of health and safety for each person served. Findings specific to certain health and safety standards include areas such as identifying and reporting abuse, neglect and exploitation, and assessing and addressing identified health and safety needs and risks.

This refers to the date of the last Qlarant PDR annual review. Each provider identified as eligible for an Onsite or Desk 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 July 1st through June 30th.

Following the completion of a PDR providers will develop a Plan of Remediation (POR). The plan includes proposed corrective actions developed by the provider and agreed to by APD that addresses the improvements needed related to “Not Met” standards cited or identified by Qlarant.