LEAs are required to comply with all state and federal laws regarding documentation and record retention. Refer to 55 Pa. Code § 1101.51, 45 CFR Parts 160, 162, and 164, and the Health Insurance Portability and Accountability Act of 1996.
Every LEA that participates in the SBAP is responsible for its compliance with the program requirements. Regular self-audits are an important tool for supporting each LEA’s efforts to maintain compliance with program requirements.
Additional external reviews are conducted to ensure compliance with regulations and help support best practices, such as:
Quality Assurance Reviews (QAR),
which are intended to offer individual support for an LEA in its participation in the program and to allow for direct sharing of information.
Oversight & Monitoring Reviews,
which review documentation maintained to support annual cost settlement reimbursement. This could include direct service provider credentialing, financial invoices, ratio calculations, and other documentation used to support annual cost settlement.
Bureau of Program Integrity (BPI) Reviews,
which review paid MA claims, tracing back through service level documentation and other required documents, such as Parental Consent Forms, Medical Practitioner Authorization Forms, IEPs, and more.