Contract Compliance Activities

Administrative Compliance and Individual Services (ACIS) Reviews

DDSN contracts with a Quality Improvement Organization (QIO) to complete all Administrative Compliance and Individual Services (ACIS) Reviews. The Key Indicators of compliance for each service area are used to measure each provider’s compliance with DDSN Service Standards, Directives, and Medicaid Policy/Requirements. Administrative Indicators capture Agency-wide requirements such as staff qualifications and training, and Human Rights Committee and Risk Management Committee Reviews. Services Indicators capture the requirement for the specific service being delivered. Each of the Key Indicators’ documents will state the applicability for different types of providers. In general, Administrative Indicators apply to all providers, although there may be some indicators that only apply to particular service types.

The Provider receives a 48-hour notice for their Administrative Indicator review. This process will apply to the initial reviews and the follow-up Reviews. All new providers will be reviewed between three to six months after accepting their first waiver participant (i.e., during their 12-month probation period).

Individual Record Reviews are initiated without prior notice to the Provider Agency for Case Management, Residential Habilitation, and Day Services. The QIO begins the record review utilizing information available through the electronic record, including Therap and CDSS. The QIO will then arrange a later time to review any information that is not required to be maintained in an electronic format, unless the provider chooses to upload the documentation required for review. This process will be the same for initial reviews and follow-up Reviews. A Plan of Correction will be required for each citation. The action plan should address both the individual citation and systemic corrections.

The purpose of the follow-up review is to ensure remediation of all citations. Typically, this occurs after the Plan of Correction has been submitted and the targeted action plans have been implemented. Most follow-up Reviews occur four (4) to six (6) months after the prior review date. The QIO looks for documentation to verify any citations from the prior review have been corrected and that the provider took steps to prevent similar citations in the future. A follow-up review is limited in size and scope. The only indicators reviewed are those with prior citations. An equal number of new records will also be reviewed to ensure systemic remediation.

Administrative Compliance and Individual Services (ACIS) Review Instruments

In conducting Administrative Compliance and Individual Services (ACIS) Reviews, DDSN utilizes the following forms and documents:

MAPS Provider Guide

General Information for FY24 Provider ACIS Reviews (PDF)

ACIS Frequently Asked Questions (PDF)

FY24 Administrative Indicators (PDF)

FY24 Case Management ACIS Indicators (PDF)

FY24 Early Intervention ACIS Indicators (PDF)

FY24 Day Services ACIS Indicators (PDF)

FY24 Employment ACIS Indicators (PDF)

FY24 In-Home Supports ACIS Indicators (PDF)

FY24 Residential Habilitation ACIS Indicators (PDF)