Compliance with Statewide Transition Plan Alignment with CMS HCB Setting Regulation Requirements (42 CFR Sections 441.301 (c) (4) - (6); Section 441.302 and 441.530)
As a provider of NC Innovations – Residential Supports, Day Supports, and Supported Employment or CAP/DA/CAP CHOICE – Adult Day Health Services and Coordinated Caregiving, an HCBS provider self-assessment must be completed as follows:
*Note, providers are no longer required to submit a provider self-assessment for any new Supported Employment work sites. Supported Employment should only be provided in competitive, integrated settings and therefore, new Supported Employment work sites should meet such requirements.
Assessments must be submitted, to the appropriate LME-MCO/Local Lead Agency electronically.
The assessment, unless otherwise noted by responses to Section I - Question 1, must be completed in detail and entirety.
SPECIAL NOTE FOR SECTION II AND SECTION III:All elements for each characteristic must be met for the response to be Yes. Evidence of support should be maintained, by the provider, in circumstances where element(s) of a characteristic is/are met, but a plan of action/correction is required for any element(s) that is/are not met. This will ensure monitoring only occurs for the area(s) that is/are out of compliance.
I certify that the above information is true and correct. I further understand that any false or misleading information may be cause for denial or termination of participation as a Medicaid Provider.
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