CLEARWATER COG

Provider Compliance

Clearwater COG

Provider Compliance Reviews

All Medicaid waiver providers are required to participate in a Provider Compliance Review during their period of certification. Compliance reviews ensure standards for services that comply with state and federal regulations to ensure the health, safety, and welfare of the people who participate in DODD programs. They are conducted by DODD or county board of developmental disabilities staff.

Clearwater COG conducts provider compliance reviews Medicaid waiver providers on behalf the COG’s seven County Boards of Developmental Disabilities. In order to ensure consistency, a standardized review process is used from the DODD Office of System Support and Standards (OSASS).
Clearwater COG

Types of Provider Compliance Reviews

Routine Compliance Review
Can occur at any time based on credible information
Special Compliance
Review
Can occur at any time based on credible information
Pertaining to the health, safety, or welfare of an individual
Complaints of allegations
Based on an MUI that may indicate failure to comply with applicable requirements
Adverse outcomes identified by other entities such as the Ohio Department of Health (ODH) or the Ohio Department of Medicaid (ODM)
Does not affect the routine review schedule
New to the
System Review
All newly certified providers will have a provider compliance review within the first 9 months of the provider billing for services.
Provider Compliance

Review Process

    • All compliance reviews will be conducted using the review tools and forms developed by DODD.

    • A compliance summary report will be completed by the reviewer and include the following elements:
      • Results of review areas
      • Citations (if applicable)
      • Rule reference for citations
    • Plan of Correction Verification – a follow-up, performed either on-site or as a desk review to ensure that the provider has implemented the Plan of Correction submitted in response to a compliance review.
    • Appeal of Citations– Providers have the right to appeal citations within 14 days of citation notification. 
    Additional information and tools can be found at the below link to DODD Office of System Support and Standards (OSASS).
    Adverse Outcomes

    Medicaid Fraud

    The Ohio Department of Developmental Disabilities is committed to identifying and eliminating fraud. We view it as our collective responsibility to safeguard the limited resources available to Ohio Medicaid recipients.
    Adverse Outcomes

    Suspension, Revocation and Abeyance

    Clearwater COG and the Department of Developmental Disabilities is committed to educating providers of the standards that must be followed and assisting them in maintaining compliance with rules through technical assistance and support. However, in some cases when good cause exists, the Department may initiate sanctions against a provider. Suspension of new services or revocation proceedings of a provider’s certification(s) or license(s) may be initiated if the Department finds one or more of the following:
    The Clearwater Council of Governments is committed to collaborating with our partners to enhance people’s lives one system, one community and one person at a time.

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