Section R6-6-2107. Selecting a Provider – Individual Consumers

A.      A consumer or the consumer’s representative shall select pro- viders of service from the Qualified Vendor Directory and Individual Independent Provider list or by requesting that the Division post to its web site a Vendor Call for Services.

B.       The Department shall provide a consumer or the consumer’s representative with an opportunity to select a provider at any time that:

1.        A consumer who is new to the service system is seeking a provider,

2.        There is a change in provider requested in the ISP at the time of the annual ISP review,

3.        The consumer’s needs change and the current provider or providers are no longer able to meet the consumer’s needs,

4.        The consumer or the consumer’s representative requests a change pursuant to R6-6-2109(C), or

5.        The current provider is unable or unwilling to continue to meet the needs of the consumer.

C.      The Division shall confirm that the program plan for the pro- vider selected from the Qualified Vendor Directory or Inde- pendent Individual Provider list will meet the needs of the consumer as defined in the consumer’s ISP.

D.      For providers to be selected through the Vendor Call for Ser- vices process, the Division shall post a Vendor Call for Ser- vices to the Division’s web site that includes a list of the service needs of a consumer based on the consumer’s ISP, identification of any special accommodations needed by the consumer or specific group of consumers and the consumer’s desired time-frame for delivery of the services.

E.       The Division shall notify Qualified Vendors and Individual Independent Providers via the list serv when the consumer or the consumer’s representative have requested that the Vendor Call for Services process be used to identify potential provid- ers and the Vendor Call for Services has been posted to the Division’s web site.

F.       The Division shall include only individual consumer non-iden- tifying information in the Vendor Call for Services.

G.      A Qualified Vendor shall submit to the Division, within the time-frame indicated in the Vendor Call for Services, a Vendor Call Response indicating the Qualified Vendor’s availability to provide the needed service or services, a description of how the Qualified Vendor would meet the special accommodations described in the Vendor Call for Services, and any other infor- mation described in the Vendor Call for Services to select a provider of service.

H.      The Division shall review and evaluate the Vendor Call Responses and identify those responses that meet the needs described in the consumer’s ISP.

I.        The Division shall notify the responding Qualified Vendors within 14 days after the due date for Vendor Call Responses as to whether the response meets the needs of the consumer.

J.        The Division shall provide the consumer and the consumer’s representative with a list of those providers that, based on the Vendor Call Response submitted, can meet the needs of the consumer.

K.      The consumer or the consumer’s representative shall select any Qualified Vendors from the list provided by the Division or may select an Individual Independent Provider.

L.       If a consumer or the consumer’s representative refuses or fails to select a Qualified Vendor from the list, the Division shall make the selection based on a random automatic assignment methodology. The Division shall include the following criteria in the automatic assignment process:

1.        Continuity of care,

2.        Least disruption to established daily routines of the con- sumer, and

3.        Least disruption to the consumer’s receipt of other ser- vices and supports.

M.     Before a final selection, the Division may require Qualified Vendors to meet with the consumer or the consumer’s repre- sentative. The Division shall provide a minimum of 48 hours notice when scheduling the meeting.

N.      A Qualified Vendor may withdraw its response to a Vendor Call for Services anytime prior to the consumer, the con- sumer’s representative or the Division selecting a Qualified Vendor.

O.      Once a consumer, the consumer’s representative or the Divi- sion has selected a Qualified Vendor, the Qualified Vendor may not refuse to provide the authorized services for the con- sumer based on the difficulty of supports needed by the con- sumer.

P.       If the Qualified Vendor determines, subsequent to its selection, that it cannot meet the consumer’s needs, the Qualified Vendor may request an informal review by the Division.

1.        The party  requesting a review shall submit a written request to the Division District Program Manager.

2.        The Division District Program Manager shall review the facts and provide the final decision in writing to the Qual- ified Vendor within 21 days of the request for a review from the Qualified Vendor.

3.        If the District Program Manager rejects the Vendor’s request, the District Program Manger shall provide the Qualified Vendor with the reason for the decision.

4.        A Qualified Vendor who disagrees with the decision of the Division District Program Manager may file a griev- ance as provided by R6-6-1801 et seq. and R6-6-2201 et seq.

Historical Note

New Section made by exempt rulemaking at 9 A.A.R. 170, effective February 1, 2003 (Supp. 03-1). R6-6- 2107(P)(4) reference to R6-6-2001 corrected to R6-6- 2201 at request of the Department, Office File No. M10- 461, filed December 6, 2010 (Supp. 10-1).