The Waiver QA, Training, and Compliance team conducts ongoing monitorship of provider compliance with SCDHHS policies and scopes of services.
Waiver Compliance
Compliance reviewers conduct unannounced site visits to personal care, adult day health care, and private duty nursing providers. Reviewers will request a sample of staff and participant records in addition to administrative records. During the site visit, reviewers will scan any paper files and give the provider a secure drop link to upload any electronic records. Per the Administrative and Billing Manual providers have 2 hours from the request to submit any requested documents. Reviewers will allow the providers until 5:00 pm on the date of the site visit to upload any electronic records. Records will be reviewed after the site visit to ensure that they meet the scope of services. Service Scopes can be located in the Home and Community Based Services (HCBS) Manual in Section 3: Eligible Providers. Compliance review scoring and sanctioning process can be located in the Home and Community-based Services (HCBS) Provider Manual in Section 4: Quality Assurance.
- Personal Care Service Provider Checklist
- Adult Day Health Care Service Checklist
- Nursing Service Checklist
Providers can email provider-distribution@scdhhs.gov with any policy related questions. Compliance questions can be sent to LTLCompliance@scdhhs.gov Currently enrolled providers can email BOQTraining@scdhhs.gov to request training at any time.
Case Management Quality Assurance and Training
Case Management Training is conducted for new case managers on the every other month. Training is designed to assist case management agencies with ensuring new case managers understand their responsibilities for service counseling, service planning, service coordination, monitorship, and re-evaluation for waiver participants in the Community Choices, HIV/AIDs, and Mechanical Ventilator Dependent Waivers. New case managers must meet the enrollment requirements as outlined in the Case Management Scope of Services that can be located in the Home and Community Based Services (HCBS) Manual in Section 3: Eligible Providers. Case Management agencies must demonstrate that the new case manager has met the experience requirements as outlined prior to training. Providers can email CMTraining@scdhhs.gov with any questions.
- Upcoming Training Opportunities
- Past Training
External Waiver Quality Assurance
Medically Complex Children's (MCC) Quality Assurance
Reviewers conduct desk reviews of care coordination records to monitor compliance with the MCC Waiver requirements as outlined in the MCC Waiver Document. Reviewers review records in Phoenix Case Management system to ensure level of care, service planning and monitorship, and health and wellbeing waiver requirements are met.
On Demand Training