Question: Does the provider have a documented Emergency Disaster Remediation: Response plan that addresses individual’s Provider will develop/modify an emergency safety and protection, communications disaster response plan addressing individual and/or operational procedures? safety and protection, communications and/or operational procedures. Yes No N/A Oversight area: Contingency planning Source Document(s): Reviewers will review policy and procedures for information on how to respond to health and behavioral emergencies and crises. This policy Compliance Standard: Provider has Waiver Assurances Appendix G-3, should include guidance on when it is appropriate procedures on how to respond to (relating to Participant Safeguards) to call 911. individual health and behavioral Submit Crisis (health, behavioral emergency emergencies and crises. and crises) Policy 18) Question: Are policies and procedures on how to respond in cases of individual Remediation: Provider will develop policies/procedures on health and behavioral emergencies and responding to individual health and crises? behavioral emergencies and crises. Yes No Source Document(s): Reviewers will review the provider’s grievance Oversight area: Grievances 55 Pa. Code Chapter 51 Sections , procedures. Waiver Assurance on Health and Welfare The procedures should include the following: Compliance Standard: A provider shall (Appendix G) Processes to resolve a grievance within develop grievance procedures to 19) 21 days. document, respond and resolve Instructions for individuals and their grievances. families regarding grievance procedures, including how to seek help in filing a grievance.
Question: Does the provider have a documented Emergency Disaster Response plan that addresses individual’s safety and protection, communications and/or operational procedures? Yes No N/A Remediation: Provider will develop/modify an emergency disaster response plan addressing individual safety and protection, communications and/or operational procedures. 18) Oversight area: Contingency planning Compliance Standard: Provider has procedures on how to respond to individual health and behavioral emergencies and crises. Question: Are policies and procedures on how to respond in cases of individual health and behavioral emergencies and crises? Yes No Source Document(s): Waiver Assurances Appendix G-3, (relating to Participant Safeguards) Reviewers will review policy and procedures for information on how to respond to health and behavioral emergencies and crises. This policy should include guidance on when it is appropriate to call 911. Submit Crisis (health, behavioral emergency and crises) Policy Remediation: Provider will develop policies/procedures on responding to individual health and behavioral emergencies and crises. 19) Oversight area: Grievances Compliance Standard: A provider shall develop grievance procedures to document, respond and resolve grievances. Source Document(s): 55 Pa. Code Chapter 51 Sections , Waiver Assurance on Health and Welfare (Appendix G) Reviewers will review the provider’s grievance procedures. The procedures should include the following: Processes to resolve a grievance within 21 days. Instructions for individuals and their families regarding grievance procedures, including how to seek help in filing a grievance.
New+Provider+Self-Assessment+and+Guidelines+2017.docx