Site visits are conducted to verify that information submitted is accurate and to determine compliance with federal and state enrollment requirements. AHCCCS conducts pre-enrollment and post-enrollment site visits of providers that are included in the “moderate” or “high” risk levels in Medicaid (PEPM102 Risk Levels). All providers are required to allow CMS, its agents, its designated contractors, or AHCCCS to conduct both announced or unannounced on-site inspections of all provider locations. Failure to allow CMS, its agent, its designated contractors, or AHCCCS on-site to conduct an announced or unannounced inspection may result in the denial of an enrollment application or termination of enrollment.
Site visits may be combined with other site visit activity so long as the verification activity for screening and enrollment is documented separately. Other site visit activities include, but are not limited to visits for State Licensing, Survey and Certification, and Clinical Laboratory Improvement Act requirements.
See PEPM112B for site visit requirements for physical therapists in Private Practice.
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Term |
Definition |
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Clinical Laboratory Improvement Act (CLIA) |
Sets standards and issues certificates for clinical laboratory testing. |
Site visits are documented using a Site Visit Questionnaire. A site visit is valid for 12 months; however, AHCCCS has the option to conduct a site visit at any time.
When a site visit is required for a provider located outside of Arizona, a virtual site visit is allowed. The method must use video conferencing technology, such as Skype, FaceTime, or Google Meets. Pictures are not sufficient proof for a site visit. When a virtual visit is completed, it is documented as a virtual visit on the site visit questionnaire.
If a provider does not allow a site visit, AHCCCS will terminate or deny enrollment unless AHCCCS determines in writing that termination or denial of enrollment is not in the best interests of the program.
42 CFR 424.518
42 CFR 455.416(f)
42 CFR 455.432
42 CFR 455.450