SAMPLE POLICY WORK

h. Implementation Checklist The following checklist is provided for internal use to ensure that every aspect of the Level of Care Assessment process is executed in accordance with established policies and regulatory mandates:

Task

Responsible Party

Frequency

Verification Method

Verify completion of pre-admission intake form Schedule and confirm PAE appointment Administer standardized assessment tools Compile and review complete PAE report Managerial review and final confirmation Prepare digital summary for TennCare submission Transmit documentation to TennCare Secure storage and periodic backup of records

Intake Staff

Upon initial inquiry

Review of standardized checklist

Assessment Team Coordinator Licensed Clinical Staff

At each referral

Appointment logs and confirmation receipts Recorded test scores and clinical notes Digital record review, initial approval check Final approval signatures and audit logs Submission receipt and secure transmission log Confirmation emails and transmission reports System audit reports and backup logs Audit reports, discrepancy resolution records Updated documentation and revision history

During each Evaluation

Eligibility Specialist

Per evaluation Per evaluation

Director of Care Services

Compliance Liaison

Post-final evaluation

IT/Compliance Team

Per regulatory cycle

IT and Records Management

Ongoing

Conduct quarterly internal audits

Compliance and Regulatory Affairs Team

Quarterly

Update procedural guidelines based on feedback

Policy Coordinator

Annually or as needed

i. Continuous Quality Assurance and Process Improvement Simpl Care Services LLC is committed to ongoing process improvement in the administration of PAEs. Regular quality assurance measures ensure that the Level of Care Assessment remains both effective and in full regulatory compliance.