Family and Children's Medicaid MA-3225 APPLICATION PROCESSING - CORRECTIVE ACTION PROCEDURES

V. LOCAL CORRECTIVE ACTION PROCEDURES FOR COUNTY DSS NON- COMPLIANCE

A. Requirements for Establishing a Local Corrective Action Team

A Local Corrective Action Team may be convened when:

1. The county DSS is out of compliance with processing thresholds in either APT or PPT on report cards in any category for three consecutive months, or, five months out of any twelve consecutive months. The APT compliance thresholds are 90 days for MAD applications and 45 days for other applications. The PPT compliance thresholds are 90% for Level II and III DSS's and 85% for Level I DSS's.

2. The county DSS fails to meet the 80% threshold for each category of denials, withdrawals, inquiries, or discouragement.

3. The county DSS fails to take corrective action within 30 calendar days as required by results of monitoring.

B. Exceptions to Holding a Local Corrective Action Team

A corrective action team will not be required when:

1. All failures are attributable to DDS.

2. It is determined by the MPR and the Assistant Director for Recipient and Provider Services (or designee) that the reason(s) for non-compliance have been or are being corrected by the DSS.

3. Budgetary constraints do not allow travel for the purpose of convening the corrective action team; however, conference calls will be considered.

REISSUED 03/01/08 – CHANGE NO. 08-08

(V.B.3.)

NOTE: A written corrective action plan may be requested from the county prior to accumulation of enough failures to warrant holding a corrective action team. The MPR will work with the county to achieve compliance and avoid the need for a corrective action team.

C. Notification

When a corrective action team must be convened, the Assistant Director for Recipient and Provider Services (or designee) will notify the DSS Director and convene the team within ten work days of notice that the DSS is subject to a local corrective action team. A date to hold the local corrective action team will be agreed upon by the two parties.

D. County Director Responsibilities

Upon receipt of notification to convene a corrective action team the county director must:

1. Determine the site for the meeting and send a letter to each Local Corrective Action Team member. The letter must include the purpose of the meeting and indicate the problem area(s). The letter may include an analysis of the problem(s) if one has been previously completed.

2. The county director or designee must prepare a summary of the problems for the corrective action team meeting and complete an analysis and report of actions taken to date to correct the problems.

E. Members of the Local Corrective Action Team

The Local Corrective Action Team will include:

1. The MPR and any additional state staff identified by the Assistant Director.

2. The DSS Director and any additional staff identified by the DSS Director.

3. The county manager or the chair of the board of county commissioners.

4. A member of the general public who is concerned about health care availability for low income citizens.

5. The social services board chairman or other board member.

6. An independent management consultant at the option and expense of the county.

F. Powers of the Local Corrective Action Team

1. The local corrective action team has broad powers and may design any remedy reasonable and necessary to bring the DSS into compliance with application processing requirements. This includes but is not limited to:

a. Employing additional staff.

(V.F.)

b. Altering office procedures (such procedures must be consistent with federal and state regulations, laws and Department rules and policies).

c. Purchasing office equipment.

d. Retaining private consultants.

e. Reopening of cases and/or ordering retroactive relief to applicants harmed by violation of processing requirements.

2. The team will establish a corrective action plan within forty calendar days of notice that a local corrective action team was required, and a date for compliance with the plan shall be set. The date by which the compliance thresholds shall be met will be based upon the extent of the problem. Report card compliance must be achieved within three months after the date the compliance plan was required to be established.

3. Failure to take corrective action or meet compliance thresholds by the date established shall result in referral to the State Corrective Action Team unless the State Corrective Action Team grants an extension of time, not to exceed three months.

G. Format of Meetings of the Local Corrective Action Team

1. The Assistant Director for Recipient and Provider Services (or designee) will chair the meeting and describe the issues and purpose of the meeting.

2. The county director or his designee will have primary responsibility to present an analysis of problem(s) and action(s) taken to date.

3. The team members will discuss the analysis of the problem(s), causal factors, results of actions taken to date, and alternatives for additional actions that may be needed.

4. The team will then formulate its corrective action plan and establish timeframes for completion.

5. The plan adopted by the local corrective action team may include a request for an extension of time from the State Corrective Action Team. Requests for extensions should not be routine and should be reserved for those instances where corrective action measures will take more than three months to achieve compliance (i.e. hiring and training staff, etc.).

6. The DSS Director will make a request for an extension of time in writing to the Assistant Director for Recipient and Provider Services who will forward the request to the chairperson of the State Corrective Action Team. The request must include justification for the request for extension and a copy of the county corrective action plan, including threshold compliance data and other pertinent information.

(V.)

H. Written Corrective Action Plan

The DSS director will prepare the agreed upon plan for approval by the local team members. The DSS director and chairman of the Social Services board will sign the plan. It will be submitted to the Assistant Director for Recipient and Provider Services within

40 calendar days from the date the notice of requirement for a local corrective action team was required.