DDS Provider Certification
Provider Certification is defined as the written authorization issued by the Commissioner to a qualified provider to deliver support services to individuals. Certification is achieved and maintained by the qualified provider by participating in and meeting the expectations of the department’s quality system in the area of level of care determinations, individual plans and service delivery, outcome achievement, provider qualifications, individuals’ health and welfare, compliance with financial requirements, and implementing quality improvement plans to address issues identified by department staff or the provider organization.
Generally, Qualified Providers who currently provide the following services; Day Support Option, Sheltered Employment, Individual Supported Employment, Group Supported Employment, Community Living Arrangements, Respite, Continuous Residential Support, Individualized Home Supports (Supported Living, Independent Living) and certain Individualized Supports, will be given an initial Certification on July 1, 2010. In the future, additional service types may be added to the DDS Certification process.
No additional action is required by providers for this to occur. This initial Certification will be valid until the provider’s next Regional Provider Performance Review, at which time a recommendation regarding Certification renewal will be made by Resource Management to Quality and Systems Improvement. Resource Management will make a recommendation as follows:
- Certified status indicates that the Provider has achieved all expectations outlined in the Regional Provider Performance Review Certification Checklist.
- Conditional status indicates that the Provider has not met all of these expectations. Conditional status will be issued at the time of being placed on Enhanced Monitoring and will continue until the provider is off enhanced monitoring for a minimum of 30 days. Conditional status also may be used to identify performance issues requiring remediation prior to issues rising to the level of Enhanced Monitoring.
Resource Management Certification recommendations will be identified and sent to Quality and Systems Improvement. Quality and Systems Improvement will review and then make recommendations regarding Certification to the Commissioner for final authorization. Providers will be notified of Certification status in writing.
During a Certification period, if provider issues arise, monitoring processes may be implemented. These include additional visits by Quality and Systems Improvement, Resource Management and Case Management and Enhanced Monitoring. These processes will continue until quality improvement occurs. Lack of acceptable progress may result in the issuance of a Conditional Certification. All Conditional Certifications will remain in effect until the provider’s next Regional Provider Performance Review, at which time a recommendation regarding Certification status will be made by Resource Management to Quality and Systems Improvement.
Although Certification status may be a Conditional designation, Provider Performance Reviews will continue to occur on an annual basis.