Ala. Admin. Code r. 560-X-53-.14

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-53-.14 - Federal And State Monitoring

(1) Annual reviews of a PO will be conducted by AMA and CMS to ensure compliance. Onsite visits will be conducted every two years at a minimum. The scope of the reviews includes, but not limited to, the following:

(a) Onsite visits, including but not limited to

1. Review of Participants' charts;

2. Interviews with staff, contractors, Participants, caregivers;

3. Observation of program operations (marketing, services, enrollment and disenrollment procedures, grievances, appeals, etc);

(b) Comprehensive assessment of the PO's fiscal soundness;

(c) Comprehensive assessment of PO's ability to furnish services to Participants;

(d) Any other areas determined necessary by AMA and/or CMS.

(2) A PO will be informed of any deficiencies found during a review and must take action necessary to correct the identified deficiencies. Failure by the PO to correct deficiencies my result in sanctions or terminations, as specified in 42 CFR 460 Subpart D. The effectiveness of the corrective actions will be monitored by AMA or CMS.

(3) AMA and CMS will notify the PO of the final results of the review and any recommendations for changes to the program. The results are also made available to the public upon request. Upon receipt of the results and recommendations, the PO must post a notice of the availability of the results and make them readily accessible.

Ala. Admin. Code r. 560-X-53-.14

New Rule: Filed November 10, 2011; effective December 15, 2011.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 4 2 CFR 460 Subpart K.