RCPA - Rehabilitation and Community Providers Association


County Contracting and ITQ
February 6, 2003

Information provided as HCSIS Bit by OMR

County Contracting Clarification
The Invitation to Qualify (ITQ) Process is a voluntary process until regulations are published as final. ITQ qualification criteria cannot be used as necessary criteria for a county to contract with a provider unless both parties agree. Furthermore, lack of ITQ qualification cannot be used to sanction a provider. However, if the provider has failed to deliver services in accordance with the individual's service plan (ISP), the service they are providing can be de-authorized. ITQ will be part of provider qualification after regulations are established.

According to CMS, counties are legally required to contract with any qualified provider chosen by one or more individuals enrolled in a Waiver. The criteria for a qualified provider are those established in the Medicaid Waiver Applications (Consolidated and Person/Family Directed Support). For example, the qualifications as currently established in the approved Consolidated and Person/Family Directed Support waiver applications for respite are as follows: 18 years of age, completion of necessary pre-in service training based on individual service plan, agreement to carry out the responsibilities based on the individual service plan and a criminal history/child abuse clearance.

As in previous years, counties should use Bulletin #00-00-09 - Service Preference in Medicaid Waivers for Individuals with Mental Retardation (esp. section on pages 14-15 called Provider Choice and Access in Medicaid Waiver) which provides information on the individuals' rights to the provider of their choice, and under what grounds the county is authorized to deny the choice of a qualified provider. Title 55 Pa Code, Chapter 4300.139 should also be used when creating contracts. This section provides information on the required contracting requirements. The rate-setting guidelines and new service definitions (as appropriate per the roll out schedule) should also be used. The Supplemental Grant Agreement will not be re-written until the amendments (primarily service definitions) are approved and HIPAA codes are finalized. Until all of these processes are settled, counties should contract as usual based on Medicaid law, the 4300 regulations, and the Service Preference bulletin.

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