Header:
CALIFORNIA CODE OF REGULATIONS
TITLE 17. PUBLIC HEALTH
DIVISION 2. HEALTH AND WELFARE AGENCY--DEPARTMENT OF DEVELOPMENTAL SERVICES REGULATIONS
CHAPTER 3. COMMUNITY SERVICES
SUBCHAPTER 2. VENDORIZATION
ARTICLE 2. VENDORIZATION PROCESS
Date:
03/20/2014
Document:
ยง 54326. General Requirements for Vendors and Regional Centers
(a) All vendors shall:
(1) Be prohibited from transferring vendorization of their service to another person or entity;
(2) Provide access to regional center and/or Department staff, on an announced or unannounced basis, for the purposes specified in the Welfare and Institutions Code, Section 4648.1;
(3) Maintain records of services provided to consumers in sufficient detail to verify delivery of the units of service billed:
(A) Such records shall be maintained for a minimum of five years from the date of final payment for the State fiscal year in which services were rendered or until audit findings have been resolved, whichever is longer. This requirement may be satisfied by retaining an electronic record of the information in the record, if the record reflects accurately the information set forth in the record at the time it was first generated in its final form as an electronic record or otherwise, and the electronic record remains accessible for later reference.
(B) Records must include for each consumer the information specified in Section 50604(d)(3)(A), (B), (C), (D), (E) or (F), as applicable.
(C) Data, as specified in Section 50604(d)(3)(A), (B), (C), (D), (E) or (F), as applicable, for the billing period shall be submitted to the regional center with the billings/invoices.
(4) Make available any books and records pertaining to the vendored service, including those of the management organization and disclosure information required in Section 54311, if applicable, for audit, inspection or authorized agency representatives. This shall also include only those portions of any personnel records that are necessary to en-sure staff qualifications comply with the requirements contained in Section 56724, and Section 56770 or 56792 of these regulations, if applicable, in order to comply with the monitoring of program standards pursuant to the Welfare and Institutions Code, Section 4691(f);
(5) Utilize and be bound by Title 17, Sections 50700 through 50767, and the Welfare and Institutions Code, Section 4648.2, should the vendor elect to appeal any audit findings;
(6) Comply with the provisions contained in the Fair Labor Standards Act (29 U.S.C., Sections 201 through 219);
(7) Not discriminate in the provision of services to consumers on the basis of race, religion, age, disability, sex, or national origin of the consumer, or his/her parents, guardian, or conservator;
(8) Be vendored separately for each type of service provided, as specified in Sections 54342 through 54356 of these regulations unless the regional center waives separate vendorization pursuant to Section 54342(a)(37) or 54342(a)(78)(A);
(9) Provide certification consistent with the Public Contract Code, Sections 10410 and 10411, that the vendor and the agents or employees of the vendor, in the performance of the contracts, are independent contractors and are not officers or employees of the State of California;
(10) Bill only for services which are actually provided to consumers and which have been authorized by the refer-ring regional center. When the vendor is receiving payment for a consumer from the Department of Rehabilitation and/or the Department of Health Services for a portion of the program day, and the vendor's rate of reimbursement is based on costs reported pursuant to Section 57422(c)(2), the vendor shall only bill the prorate share of the daily rate.
(11) Not bill for consumer absences for nonresidential services. The Department shall authorize payment for absences which are the direct result of situations and/or occurrences for which a State of Emergency has been de-clared by the Governor. If payment for absences due to a State of Emergency is authorized by the Department, the vendor shall bill only for absences in excess of the average number of absences experienced by the vendor during the 12-month period prior to the month in which the disaster occurred;
(12) Agree to accept the rate established, revised or adjusted by the Department as payment in full for all author-ized services provided to consumers and not bill the consumer nor the consumer's family, conservator, guardian or authorized consumer representative for a supplemental amount regardless of the cost of providing the authorized service. This shall not preclude the vendor from billing the consumer or consumer's family for services provided which were authorized by the consumer or family and which were not authorized by the regional center;
(13) Comply with all applicable staffing ratio requirements;
(14) Be prohibited from being vendored by more than one regional center for the same service at the same loca-tion; and
(15) Comply with conflict of interest requirements as determined by the criteria established by Title 17, Sections 54500 through 54525 and the Welfare and Institutions Code, Sections 4626 through 4628.
(16) Sign the Home and Community-Based Services Provider Agreement (6/99), if applicable pursuant to Section 54310. If the Home and Community-Based Services Provider Agreement (6/99) is required and has not been signed, the regional center shall:
(A) For new applicants requesting vendorization, deny vendorization pursuant to Section 54322(c); or
(B) For existing vendors, notify in writing, the vendor and utilizing regional center(s), if any, that the signed Home and Community-Based Services Provider Agreement (6/99) is required and that payment of the vendor's rate will be suspended, the effective date of the suspension, and that payment shall remain suspended until the signed Home and Community-Based Services Provider Agreement (6/99), is received.
(1) The effective date for suspension of payment of the vendor's rate shall be 15 days from the date of the letter notifying the vendor that payment will be suspended.
(2) If the signed Home and Community-Based Services Provider Agreement (6/99), is submitted within the time specified, no further action will be taken.
(3) If the Home and Community-Based Services Provider Agreement (6/99), is submitted after the date when payment of the vendor's rate has been suspended, the vendoring regional center shall notify the vendor and utilizing regional center(s) that payment of the vendor's rate is reinstated as of the date payment was suspended.
(17) Notify the vendoring regional center of any additions or changes in the information disclosed on the DS 1891 (7/2011) and submit the information pursuant to requirements of Section 54311(c).
(18) Notify the vendoring regional center of:
(A) Any conviction for any felony or misdemeanor, within the previous ten years, involving fraud or abuse in any government program, or related to neglect or abuse of an elder or dependent adult or child, or in connection with the interference with, or obstruction of, any investigation into health care related fraud or abuse, or that has been found liable, within the previous ten years, in any civil proceeding for fraud or abuse in any government program;
(B) Any settlement in lieu of conviction involving fraud or abuse in any government program within the previous ten years; or
(C) Any loss of license, certificate or credential, or failure to maintain any valid licenses, certificates or credentials required for the performance or operation of the vendored service.
(b) The vendor shall maintain a written description of its organizational structure and operations at the vendor's business office in accordance with the following:
(1) All descriptions shall include:
(A) An identification of the legal entity serving as the governing body or board of directors;
(B) The policies of operation that are established by the governing body or board of directors; and
(C) A diagram depicting the relationships among organizational units and titles of persons responsible for those units.
(2) In addition to the information specified in (b)(1) above, if the vendor:
(A) Operates more than one service, the description shall also include:
1. The names, addresses and vendor numbers of the other services; and
2. Whether any of the services share staff or facility space.
(B) Has a management organization, the description shall also include a diagram depicting the relationships among the management organization, the vendor, and any other services under the management organization.
(c) Regional centers shall submit the information specified in subsection (a)(3)(C) above to the Department on a monthly basis, and no later than 30 days after the end of the previous month.
(d) Regional centers shall not:
(1) Use purchase of service funds to purchase services for a minor child without first taking into account, when identifying the minor child's service needs, the family's responsibility for providing similar services to a minor child without disabilities. In such instances, the regional center must provide for exceptions, based on family need or hard-ship.
(2) Use purchase of service funds to purchase services for those executive/management services, legal services for the benefit of the regional center, service coordination, and administrative service and support functions that are funded through the regional center operations budget. Funding of specialized clinical and diagnostic assessment ser-vices and other services for the benefit of a consumer through purchase of service funds is permissible.
(3) Charge vendors or consumers for providing representative payee services.
(4) Except as specified in Section 54324 of these regulations:
(A) Refer any consumer to an applicant until the vendor application is approved; or
(B) Reimburse a vendor for services provided before vendorization.
(e) Compliance with the standards and requirements specified in these regulations does not exempt a vendor from compliance with existing statutes and regulations or with any other applicable standards or requirements promulgated by the controlling agencies for the service provided by the vendor.
(f) Regional centers shall take routine action to ensure that vendors have no convictions and have not been found liable as described in (a)(18)(A) above, have not entered into any settlement agreements in lieu of convictions involving fraud or abuse in any government program as described in (a)(18)(B), and are serving consumers with the valid licenses, certificates or credentials required for the performance or operation of the vendored service.
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