HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471)

What this rule requires your agency to do

• 1All verification screenings required by federal and state law must be complete before enrollment is finalized; the enrollment effective date cannot be prior to the required verification screening date; QSPs are not paid with public funds until enrollment requirements are fulfilled and a current authorization is received from the Case Manager (Enrollment/Reimbursement Limitations).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 2Environmental Modification service may only be provided by a Department-approved QSP; building contractors, electricians, and plumbers must hold current ND licenses, carry liability insurance, be bonded, maintain good standing with Workforce Safety Insurance, and submit registration/license/insurance documentation with the QSP request (Environmental Modification standards).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 3No outstanding debts can be owed to the Department, and documentation of competency or professional licensure/certification (RN, LPN, CNA, physician, PA, NP, PT, or OT) must be current and up to date (Family Home Care excepted) (Standards 5-6).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 4Family home care and family personal care providers must have an eligible client identified by the HCBS Case Manager before enrollment is completed (Standard 7).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 5Bureau of Criminal Investigation background checks and fingerprint screening must be done for Adult Foster Care and Respite providers in an AFC home per Admin. Code 75-03-21-08(1)(h) and NDCC 50-11-02.4, 50-11-06.8, and 50-11-06.9 (Standard 8).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 6QSP enrollment end date is no longer than 24 months from enrollment; a break in renewal status greater than 30 days from the closed date requires a complete new application; QSPs with no billing activity within 12-15 months receive a 30-day stop notice and are stopped if no valid reason for inactivity is provided (Renewal / Closure for Inactivity).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 7Per N.D. Admin. Code 75-03-23-08(1)(n),(2)(o),(p), QSPs must have been actively billing in the past 12 months or have a valid reason for inactivity to renew, or they may be closed for inactivity (Standard 4).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))
• 8A Qualified Service Provider must be 18 years of age, meet the standards of 42 CFR Part 455 (Medicaid Program Integrity), and meet the provider standards and agreements under the N.D. Admin. Code and CFR (Standards 1-3).(HCBS Service Chapter 525-05-45 - Standards for Qualified Service Provider(s) / Provider Enrollment (Manual Letter #3471))