R414-516-9. Exceptions and Holdings

  (1) A program that does not earn the minimum required QI points during a calendar year shall:

  (a) earn the number of QI points not achieved from that calendar year in addition to the required QI points the subsequent calendar year; and

  (b) submit to the Division a plan of correction that details how the program will come into compliance with the QI Program.

  (c) A plan of correction must be mailed electronically to the correct address found at https://health.utah.gov/stplan/longtermcarenfqi.htm.

  (2) The Division shall remove from the UPL Seed Contract, a program that fails to earn the minimum QI points for a second consecutive year as required by Subsection R414-516-9(1)(a).

  (a) Once the Division determines that the program failed to meet QI program qualifications, the Division shall send the program a notice of failure to meet the requirements.

  (b) The program shall have the opportunity to appeal the determination in accordance with Rule R410-14, or shall waive the right of appeal.

  (c) If the program does not file an appeal or the Division's determination is upheld, the Division shall amend the UPL seed contract to remove the program effective the last day of the quarter in which the determination was made.

  (3) If a program that has been removed from the UPL Seed Contract desires to be added back to the contract prospectively, the program shall demonstrate compliance to Subsection R414-516-3(1)(c) for one full year ("trial period") after the effective date of the removal.

  (a) The program shall submit to the Division within 30 days of the trial period:

  (i) the current compliance form; and

  (ii) documentation of compliance with all QI programs in which points were earned.

  (b) If the Division determines that the program was compliant during the trial period, the Division may add the program back to the UPL Seed Contract effective the first day of the quarter following the date compliance was determined.

  (4) The Division may audit a program at any time to ensure compliance.

  (a) The Division shall provide notice that indicates the period of the audit and the QI programs being audited.

  (b) When an audit is performed, all documentation requested by the Division shall be postmarked or demonstrate proof of delivery to the Division within 10 business days of the request.

  (c) Failure to submit the requested documentation in a timely manner shall result in the program forfeiting the QI points for the specific QI program category being audited.

  (d) If an audit is completed, as applicable, the findings of the audit shall supersede the program's reported QI points.

  (e) The program shall have the opportunity to appeal the determination in accordance with Rule R410-14, or shall waive the right of appeal.