Initial Review

Individual settings are reviewed on an annual basis.

No more than 30% of a provider's settings may be reviewed within a 60-day period.

Exit Meeting/ Reconsideration Opportunity

Review concludes within 15 days of start date

Summary of Preliminary Findings presented at Exit Meeting with opportunity for reconciliation. 

Report of Findings Issued to Provider

A single report is completed for each service setting.

Final electronic reports posted for each review no later than 15 calendar days from the date of the start of the review.

Report includes a list of all participant records reviewed, with identifiers for individual Waiver and service type authorized.

Appeal

Provider may formally appeal and citations that remain in dispute within 15 days after Report of Findings is issued.

Contractor will review appeal and provide recommendation to SCDDSN.

Upon final determination by SCDDSN, Contractor will amend the Report of Findings, as necessary, within 72 hours.

Plans of Correction

Plan of Correction required for all citations.

Within 15 days of receipt of the specific Report of Findings from the Contractor, the provider will submit a Plan of Correction which addresses the findings in each participant record as well as systemic findings identified by the Contractor. 

The latest completion date for any correction or action will not exceed 90 calendar days following the Report of Findings.

Accept/reject Plans of Correction.

Follow-up Review

Follow-up review required to ensure successful implementation of the provider's Plan of Correction.

Timeframe for follow-up reviews should correspond to the type of citation and length of time needed for remediation, but shall be within 120 calendar days from acceptance of the provider's Plan of Correction.

Report of Findings, Plan of Correction, and Appeal process will follow, similar to the initial review process.

If the provider is unable to demonstrate remediation, a second follow-up is required.