Frequently Asked Questions (FAQs):
Delmarva Foundation is a Quality Improvement Organization (QIO-like) working in partnership with the State of Florida’s Agency for Health Care Administration (AHCA) and the Agency for Persons with Disabilities (APD). Our number one goal in the state of Florida has always been and will continue to be improving the quality of supports for Florida citizens with developmental disabilities. The values we support and actively promote are rights, choice, full inclusion, health and safety, respect and dignity, and the person’s satisfaction with all services and supports.
The services reviewed by Delmarva Foundation are Life Skills Development 1 (Companion), Life Skills Development 2 (Supported Employment), Life Skills Development 3 (Adult Day Training), Behavior Analysis, Behavior Assistant, Residential Habilitation (Standard, Behavior Focus, and Intensive Behavior), Personal Supports, Respite (Under 21), Waiver Support Coordination/CDC+ Consultant, Special Medical Home Care, and Supported Living Coaching. Delmarva Foundation also conducts reviews with Consumer Directed Care Consultants and Representatives.
You will receive a notification letter from Delmarva Foundation informing you your review will take place sometime within the next 90 days. You will receive a call up to 30 days in advance from the Quality Assurance Reviewer who will work with you to schedule your review.
As soon as you are aware of a conflict, you should contact your reviewer to discuss next steps. Providers who are not present at the time of a scheduled review are scored non-compliant. Non-compliance results in a score of 0% for the review. Agency providers should assure availability of a backup person to participate in the review and present necessary documentation including personnel files, and individual and administrative records.
The Delmarva Discovery Review Tools can be located on the www.dfmc-florida.org website under the Resource Center or directly by following this link: https://www.dfmc-florida.org/Public2/resourceCenter/providers/discoveryReviewTools/index.html.
Delmarva Foundation receives provider information and claims data from AHCA on a monthly basis. Providers can update or change their contact information via the Florida Medicaid Fiscal Agent Provider Enrollment Unit at: 1-800-289-7799, 8AM - 5PM ET, Monday – Friday portal.flmmis.com/FLpublic/ (see Provider Support). When you receive a notification letter for an upcoming review, the phone number Delmarva Foundation has on record is included. If this is incorrect, please contact us at 866-254-2075 to update. Delmarva Foundation records are updated for the current year only. You would still need to complete updates with AHCA.
No. The Reconsideration Request must be made in writing and received within 30 days of the mailing of the annual PDR report. If the request is not submitted within the 30 days, it will not be processed and the request will be deemed ineligible. You have the option of submitting the Reconsideration Request by hand delivery, mail or by secure fax to the Tampa or Tallahassee address/Right Fax number located below. Complete instructions on how to request for reconsideration can be found at the end of your report. Upon receipt, your Reconsideration Request will be entered into a tracking system to ensure Delmarva Foundation completes the Reconsideration Report within 30 days of receipt of your request. The fax number is toll-free at 1-888-877-5526.
No. You do not need to send this information to Delmarva Foundation. Remediation activities are facilitated by your Regional APD office. For a list of APD Regional offices, please visit www.apdcares.org.
Delmarva Foundation does not have a role in repayment. Remediation activities are completed with AHCA and your Regional APD office.
For a list of approved training entities or upcoming training events, please visit the APD website at https://apd.myflorida.com/providers/training/web-based.htm.
Providers will appear on the Public Reporting Website once Delmarva Foundation receives claims data from AHCA for that provider. Provider performance information is available for providers who have received a PDR from Delmarva Foundation in the past 18 months. Performance scores reflect waiver rule compliance based upon the number of standards reviewed during the PDR.
Please visit APD for eligibility requirements at www.apdcares.org.
The review will be for the 12 months prior to the month of your review. Therefore, if you are being reviewed in October 2017, the reviewer will be reviewing all services rendered during the prior October 2016 –September 2017.
Review schedules vary from year to year and are not always held in the same month as the prior year. The schedule for reviews is developed based upon the number and location of eligible providers in a given year.
The review covers the prior 12 months. Therefore, if you are being reviewed in October, the Quality Assurance Reviewer will be reviewing all services rendered from October of the previous year through-September of the current year. Even if you are no longer rendering the service, it is still eligible for review because it was rendered and billed for within the 12-month review period.
Effective 1/2015, if you are a Waiver Support Coordinator you will have one PDR per APD Region. If you are a provider of the other Medicaid Waiver services, you will have one PDR per APD Area.
No, Delmarva Foundation cannot send the reports through electronic mail. Reports contain protected health information (PHI) therefore, they are mailed to providers.