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Provider Update: January 28, 2020

To:      ADvantage Adult Day Health, Assisted Living, Case Management, and Home Care Providers, and State Plan Personal Care Providers

Subject:Quality Assurance/Improvement

This letter is to advise you of Medicaid Services Unit - Quality Assurance/Improvement (MSU-QAI) department activities for Fiscal Year (FY) 2020 (July 1, 2019 – June 30, 2020), as related to Provider Agency audits performed by the Department of Human Services, Aging Services (DHS/AS).

FY2020 annual Consumer-Focused Quality of Care audits are currently being conducted.  Effective January 1, 2020, MSU-QAI stopped conducting Case Management, Home Care & State Plan Personal Care audits onsite.  The reviews are now conducted as desk audits.  The Lead Auditor will notify your agency's CQI Contact of the upcoming audit.  Some information required for the audit is not yet available in Harmony; therefore you may be asked to fax specific documents or the auditor may need to be onsite for a short period of time in order to obtain the necessary information.  Exit Conferences will continue to be scheduled at a time convenient to all parties.

Assisted Living and Adult Day Health reviews will be conducted onsite, with continued emphasis on the final rule from Centers for Medicare and Medicaid (CMS) regarding Home and Community Based Settings. 

MSU-QAI is working to update the current audit process.  Until the process update is completed, FY2020 annual audits will not be finalized unless referral status is involved.

Finally, MSU-QAI continues to provide trainings at various locations across the state.  Although these trainings are not mandatory, we hope that you will make plans to attend.  Regional Provider Training is scheduled for April 2020.  For more information or to attend one of these trainings, please visit the ADvantage Administration website at:

Please send any questions regarding the information above through the Harmony PQ chapter.

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