ROBERT L. EHRLICH, JR., Governor                            S.B. 819

(3) IF AN INDIVIDUAL ELIGIBLE FOR THE COMMUNITY CHOICE
PROGRAM REQUIRES SPECIALTY MENTAL HEALTH SERVICES, THE INDIVIDUAL
SHALL ELECT TO RECEIVE SPECIALTY MENTAL HEALTH SERVICES FROM AN
APPROVED MENTAL HEALTH PROVIDER UNDER A SEPARATE ARRANGEMENT, AND
PAYMENT FOR SPECIALTY MENTAL HEALTH SERVICES PROVIDED TO THE
INDIVIDUAL SHALL BE MADE DIRECTLY TO THE MENTAL HEALTH PROVIDER BY THE
DEPARTMENT UNDER THE MEDICAID-ESTABLISHED RATE FOR SPECIALTY MENTAL
HEALTH SERVICES.

(K) (1) EACH COMMUNITY CARE ORGANIZATION SHALL MEET ALL
REQUIREMENTS FOR CERTIFICATION BY THE DEPARTMENT.

(2) EACH COMMUNITY CARE ORGANIZATION SHALL:

(I)      HAVE A QUALITY ASSURANCE PROGRAM, SUBJECT TO
APPROVAL BY THE SECRETARY, WHICH SHALL:

1. PROVIDE FOR AN ENROLLEE GRIEVANCE SYSTEM,
INCLUDING AN ENROLLEE HOTLINE;

2.       PROVIDE FOR A PROVIDER GRIEVANCE SYSTEM,
INCLUDING A PROVIDER HOTLINE;

3.       PROVIDE FOR AN ENROLLEE SATISFACTION SURVEY; AND

4.       PROVIDE FOR A CONSUMER ADVISORY BOARD TO
RECEIVE REGULAR INPUT FROM ENROLLEES AND SUBMIT AN ANNUAL REPORT OF
THE ADVISORY BOARD TO THE SECRETARY;

(II)     SUBMIT SERVICE-SPECIFIC DATA IN A FORMAT SPECIFIED BY
THE SECRETARY;

(III)   INCLUDE PROVISIONS FOR CONSUMER DIRECTION OF
PERSONAL ASSISTANCE SERVICES;

(IV)    ENSURE NECESSARY PROVIDER CAPACITY IN ALL GEOGRAPHIC
REGIONS WHERE THE COMMUNITY CARE ORGANIZATION IS APPROVED TO OPERATE;

(V)     BE ACCOUNTABLE, AND HOLD ITS SUBCONTRACTORS
ACCOUNTABLE, FOR MEETING ALL REQUIREMENTS, STANDARDS, CRITERIA, OR
OTHER DIRECTIVES OF THE DEPARTMENT AND UPON FAILURE TO MEET THOSE
STANDARDS, BE SUBJECT TO ONE OR MORE OF THE FOLLOWING PENALTIES:

1. FINES;

2.       SUSPENSION OF FURTHER ENROLLMENT;

3.       WITHHOLDING OF ALL OR PART OF A CAPITATION
PAYMENT;

4.       TERMINATION OF A CONTRACT;

5.       DISQUALIFICATION FROM FUTURE PARTICIPATION; AND

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