STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

Aging and Long-Term Support Administration

Home and Community Services Division

PO Box 45600, Olympia, WA 98504-5600

H13-056 – Policy/Procedure

September 5, 2013
TO: / Area Agency on Aging (AAA) Directors
Developmental Disabilities Administration (DDA) Regional Administrators
Home and Community Services (HCS) Division Regional Administrators
FROM: / Bea Rector, Director, Home and Community Services Division
Don Clintsman, Deputy Assistant Secretary, Developmental Disabilities Administration
SUBJECT: /
CLARIFICATION: Changes in Contractor Intake Form and Process for W-2 Providers (Individual Providers of Personal Care and DDA Respite Care Services)
Purpose: / To inform field staff of new pre-qualification requirements for new and renewal W-2 contractors prior to contracting. W-2 contractors include only individual providers (IPs) who provide personal care and/or DDA respite care services.
Background: / DSHS pre-contracting requirements require completion of the HCS/AAA/DDA Individual Provider Contractor Intake form. This form is part of the intake packet that the provider completes upon an initial or renewal contract.
The revised form is attached below and is also located on the Central Contracts Services (CCS) website at: http://one.dshs.wa.lcl/FS/OSS/CCS/Pages/Forms.aspx
CMS conducted a Program Integrity Review during FFY2012. CMS found that ADS was not in full compliance with federal regulations which require ownership and control disclosures, business transaction disclosures, and screening for individuals and entities excluded from participating in Medicaid. The state must obtain certain disclosures from providers and complete screenings to ensure the state does not pay federal funds to excluded persons or entities prior to executing a contract. Additionally, federal regulations now require the state to check for the death of an individual provider, agency owner or authorized official. ADS will screen providers through the Social Security Death Master List prior to contracting in order to meet this requirement.
What’s new, changed, or
Clarified / I.  Provider Disclosures and Screenings:
Individual Providers of Personal Care and DDA Respite Care Services are required to complete the revised HCS/AAA/DDA Individual Provider Contractor Intake Form. This form will capture the required disclosures. Contract staff must have all new and renewing IPs screened through the Social Security Death Master List and the federal exclusion lists below prior to finalizing a contract. The required federal exclusion lists currently are:
§  List of Excluded Individuals/Entities (LEIE) administered by the US Department of Health and Human Services, Office of the Inspector General (HHS-OIG); and
§  Excluded Parties List System (EPLS), now migrated to the System of Award Management (SAM), administered by the US General Services Administration.
The two current HCS/AAA and DDA Individual Provider Contractor intake forms are being replaced by one form that will be used by HCS/AAA/DDA for all Individual Providers who provide personal care and DDA respite. This revised IP Contractor Intake form contains fields required for both Medicaid disclosure and the IP Collective Bargaining Agreement.
II.  Preparation for release of ProviderOne Phase 2
The ProviderOne payment system will replace the current Social Service Payment System. The conversion of one system to the other will be reliant on information transferred from the Agency Contracts Database (ACD) to ProviderOne (P1) upon go-live of Phase Two, currently scheduled for 2014.
ACTION: / Effective immediately HCS/AAA/DDA staff will:
·  Use the new Contractor Intake form for initial and renewal contracts for Individual Providers.
·  Input the information from the new form into the ACD.
Note: HQ staff will run a report in September which will include all current ADS LTC/DDA providers, to be screened against the required validation lists. HQ staff will contact HCS/AAA/DDA staff if any action is needed regarding a provider’s contract.
Effective 10/1/2013: HCS/AAA/DDA staff must receive results of validation screening for any new or renewal provider information input into the ACD prior to completing the contracting process.
·  HCS/AAA/DDA staff will select the Intake/Disclosure Form dropdown on the “Checks” screen, and enter the date the provider information is entered into ACD. Entering a date into this field will notify HQ staff to screen the provider against the required validation lists.
·  HQ will run a report twice a week to check for provider information to screen.
·  HQ will conduct required screenings for providers, verify all potential hits for accuracy, and respond to regional staff via email if the provider fails any validation checks. HQ will indicate screening results by entering text such as “Validation Pass” or “Fail” on the “Checks” screen in ACD.
·  Prior to having the contract signed by HCS/AAA/DDA and placing into “Signed” status in ACD, HCS/AAA/DDA staff will verify that the new or renewing provider has passed the required screening by looking for the “Intake/Disclosure Validation Results” entry on the “Checks” screen in ACD.
I. Instructions for Provider Disclosures and Screenings:
1.  Field Staff will:
a.  Use the HCS/AAA/DDA Individual Provider Contractor Intake form (revised April 2013) for all IPs seeking initial or renewal contracts for provision of in-home personal care services and/or DDA respite care services.
1)  Note: this form does not include I-9 related information. It is the responsibility of the client to have their IP/employee complete and retain the I-9. See DSHS form #11-055. “Acknowledgement of My Responsibilities as the Employer of My Individual Provider”.
b.  Ensure the provider returns the completed HCS/AAA/DDA Individual Provider Contractor Intake form. Providers who fail to submit this information cannot obtain a contract with ADS.
c.  Input the information gathered on the HCS/AAA/DDA Individual Provider Contractor Intake form into the ACD Contractor Screen as follows:
1)  For new Individual Providers:
·  Create the new provider record in the ACD.
·  The ACD will populate the “staff” screen with the provider’s Social Security Number.
·  Input the Date of Birth (DOB) on the “staff” screen.
Note: If a prior version of the intake form is used, locate the DOB on the Driver’s License or State ID, or the background check form.
·  After 10/1/2013, enter the new record on the “Checks” screen, select “Intake/Disclosure Form” and enter the date the new record is created.
2)  For IP renewals:
·  When the contract is renewed, update the provider record with any corrected information and the date the new IP Contractor Intake form was signed.
·  Edit the “Staff” screen to add the DOB and ensure the SSN field is populated.
·  After 10/1/2013, enter the new record on the “Checks” screen, select “Intake/Disclosure Form” and enter the date.
d.  Maintain the completed HCS/AAA/DDA Individual Provider Contractor Intake form in the Contract file.
e.  After 10/1/2013, verify the provider’s validation was completed and approved by ADS Headquarters Contract Staff (see ADS Headquarters Contract Staff actions outlined in section 2 below). All verification of provider’s validation can be found on the ACD Contractor “Check” screen.
1)  If the provider passes the screen completed by HQ contract staff, continue with the contracting process.
2)  If the provider fails the screen completed by HQ contract staff, proceed with the existing contract denial and termination process including but not limited to:
i.  Termination of all open authorization(s);
ii.  Termination of active contract(s) for default;
iii.  Closure of the SSPS provider file using a SSPS Status 4.
2.  After 10/1/2013, ADS Headquarters Contract Staff will:
a.  Run an ACD report twice weekly to identify new or renewing providers.
b.  Screen the provider on the following databases to ensure they are not listed as a Medicaid excluded provider:
·  Social Security Death Master List;
·  List of Excluded Individuals/Entities (LEIE) administered by the US Dept. of Health and Human Services, Office of Inspector General (HHS-OIG); and
·  Excluded Parties List System (EPLS), now migrated to the System of Award Management (SAM), administered by the US General Services Administration.
Note: The Health Care Authority will complete monthly batch screenings of current individual providers using LEIE.
c.  Indicate in the ACD under Contractor “Checks” when validation is complete and the results of the validation (pass or fail);
d.  Notify the office initiating the contract by e-mail if the provider failed the validation review;
e.  Ensure all validation results are complete and noted in the ACD within 5 working days from date of review;
f.  Maintain a list of all IPs who fail the Social Security Death Master list and federal exclusion list screens;
g.  Provide all required notification to the Health Care Authority and the Office of the Inspector General;
h.  Monitor the ACD for non-input of new requirements.
II. Instructions to Prepare for Release of ProviderOne Phase 2
Field staff will:
a.  Create New or Edit existing “Contractor” information in the ACD:
·  Complete new or update information to all required ACD fields for the contractor and enter date the intake form was signed by the provider.
·  Save the provider record/edits.
·  Enter the provider’s Preferred Language in the new mandatory field. This information can be found on the new IP Contractor Intake form.
Note: An exception to entering the Preferred Language will be granted for 30 days from the date of this MB and only for contract packets that were sent to providers prior to the MB date. In these circumstances select “undetermined” in the Preferred Language field.
Related
REFERENCES: / 42 CFR 455.104; 42 CFR 455.105; 42 CFR 455.106
ATTACHMENT(S): / Intake Form and Instructions:
http://one.dshs.wa.lcl/FS/OSS/CCS/Forms/HCS%20AAA%20DDA%20Individual%20Provider%20Intake%20(Aug%202013).doc
ACD Version 4.2 Release Notes:
ACD Version 4.2 User Manual Update:
CONTACT(S): / Christy Hoosier, ADS HQ Contracts Manager
(360) 725-3209

Stacy Graff, ALTSA Individual Provider Program Manager
(360) 725-2533

Debbie Roberts, DDA Program Manager
(360) 725-3525

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