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How does a state comply with the qualified provider assurance?

A state establishes processes to monitor and verify that providers meet required licensure, certification or other standards. The state will monitor whether:

  • Providers meet the applicable licensure or certification standards (if any) for the type of service provided.
  • Providers meet any other required standards (e.g. staffing ratios, training, administrative structure etc).
  • Background checks were conducted, if required.
  • Other training requirements for non-licensed/non-certified personnel were met.

A state will typically use data from a number of different sources to provide evidence for this assurance.

  • Data from a state’s Licensure and Certification Agency.
  • Review of case management agency records.
  • Review of provider agency records.
  • Review of a sample of participant records.

Some states also use consumer surveys to determine if consumers are satisfied with how well workers are performing their jobs.

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