1 / 19

Coordination Between the LME-MCOs and DHSR in the Monitoring of Licensed Facilities

Coordination Between the LME-MCOs and DHSR in the Monitoring of Licensed Facilities. Presented by: Stephanie Gilliam Section Chief, Mental Health Licensure & Certification DHHS/Division of Health Service Regulation Eugene Naughton Acting Network Operations Manager

johannes
Download Presentation

Coordination Between the LME-MCOs and DHSR in the Monitoring of Licensed Facilities

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Coordination Between the LME-MCOs and DHSR in the Monitoringof Licensed Facilities Presented by: Stephanie Gilliam Section Chief, Mental Health Licensure & Certification DHHS/Division of Health Service Regulation Eugene Naughton Acting Network Operations Manager CenterPoint Human Services Representing the NC Council of Community Programs 3-15-14 Developed by the NC DHHS-LME/MCO-Provider Collaboration Workgroup February 2014

  2. 2 DHSR Role, Process and Authority • Role is to determine provider compliance with rules and statutes in licensed facilities. • Process is to conduct the following types of surveys: • Initial • Annual • Complaint • Follow-up

  3. Initial Survey The Initial Survey is a review of the policies, procedures and staffing to determine if the provider can demonstrate compliance with rules and statutes. These rules include: • Core Rules • Program specific rules • Client Rights • Confidentiality

  4. Annual Surveys Annual Surveys are conducted in all residential facilities and outpatient opioid facilities. • These surveys occur every 12-15 months and focus on whether or not the treatment needs are being met in a safe and healthy environment.

  5. Complaint Surveys Complaint Surveys: are based on an allegation related to a rule area. • Anyone can call in a complaint to the DHSR Compliant Intake Unit: 800-624-3004

  6. Frequency Grid The frequency grid can be found on the fourth tab in the Provider Monitoring workbook on the DMH/DD/SAS website: http://www.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm#tools

  7. Follow-Up Surveys Follow-Up Surveys are conducted within specific time frames to determine if deficiencies have been corrected.

  8. DHSR Authority DHSR has the Regulatory authority to levy penalties and sanctions for non-compliance. This includes: Type A1, Type A2, & Type B Violations Fines associated with these violations Suspension of admissions Revocation.

  9. DHSR Authority: Type As and Bs • Type A1 is violation of a rule or regulation that results in serious physical harm, abuse, neglect, or exploitation. • Type A2 is a violation of a rule or regulation that results in substantial risk that serious physical harm, abuse neglect or exploitation will occur. • Type B is a violation of a rule or regulation that is detrimental to the health, safety, or welfare of the individual but does not rise to the level of a Type A1 or A2 See NCGS 122C-24.1: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_122C/GS_122C-24.1.html

  10. DHSR Authority: Type As and Bs (cont) • Plan of Protection: If a Type A or Type B is identified on survey, the provider must give our surveyor a “plan of protection” before we exit the survey—to protect individuals from further harm. • Plan of Correction: A more thorough Plan of Correction must be developed and submitted by the provider after they have received our statement of deficiencies.

  11. DHSR Authority: Other Sanctions • Fines: are assessed for Type As and Type Bs based on NCGS 122C-24.1 • Suspension of Admissions • Revocation

  12. DHSR Authority: Appeals We are required by NCGS 150-B to resolve disputes informally if possible. This includes: • Informal Appeals-meeting with the Chief of the Mental Health Licensure & Certification Section, Branch Manager and Team Leader • Formal Appeals through the Office of Administrative Hearings • Settlement Discussions • Mediation • Hearings

  13. LME-MCO Role, Process, Authority • 13 The Role of the LME-MCO is to: • Ensure consumers receive treatment appropriate to their needs. • Manage their provider network

  14. LME-MCO Role, Process, Authority • Process includes: • Monitor contracts with providers • Authorize services • Monitor programs (licensed and unlicensed) for fidelity to service definition • Monitor licensed services that don’t receive annual surveys from DHSR for health and safety • Conduct Post payment reviews

  15. LME-MCO Role, Process, Authority, cont. Authority to suspend referrals, cancel contracts. May also conduct limited monitoring of non-contracted facilities, provide technical assistance to providers, and provide care coordination to consumers. No monitoring of ICF-IID

  16. Collaboration Steps • 16 • DHSR sends copies of all surveys, including any administrative actions, to the LME-MCO catchment area in which the facility resides, and to any LME-MCOs that contract with the facility or have an enrollee in that provider’s care. • The LME-MCO tracks DHSR surveys in a provider profile and uses this information to help make placement and/or contractual decisions.

  17. Collaboration Steps (cont) • The LME-MCO conducts Routine Monitoring Reviews plus post-payment reviews at a minimum ofevery two years for licensed day services, (excluding outpatient opioid and residential programs). • The LME-MCO copies DHSR when taking the following actions: • Termination of contract • Suspension of referrals • The LME-MCO conducts complaint investigations to determine compliance with service definitions.

  18. DHSR-Mental Health Licensure and Certification Section Web Site: http://www.ncdhhs.gov/dhsr/mhlcs/mhpage.html

  19. Questions Please send your questions to the Provider Monitoring mailbox: provider.monitoring@dhhs.nc.gov To expedite a response, please include the nature of your question in the Subject line.

More Related