After a failed PDR: the Plan of Remediation

Your Provider Discovery Review ends with a report, not a verdict. Qlarant mails the PDR report within 45 days of completing the review, scoring each standard Met or Not Met — health-and-safety standards weigh 3 points, person-centered and billing standards 2, the rest 1, and each alert type subtracts 5 points (up to 15). What you do in the weeks after that envelope arrives determines whether findings become a fixed process or a provider-agreement problem.

If the report cites potential billing discrepancies you believe are wrong, you have exactly one shot: a written reconsideration request that Qlarant must receive within 30 days of the report's mailing date. One request per PDR, every supporting document submitted at once — and documentation you didn't make available during the original review is not accepted. That last rule is the quiet killer: reconsideration can't fix what your files didn't contain on review day. Reconsideration applies only to billing-discrepancy standards; other findings go straight to remediation.

For cited deficiencies, APD requests a Plan of Remediation (POR) — the Handbook's term for your written corrective plan, agreed with APD and submitted to your Regional APD office (not Qlarant). Two things about it are widely misunderstood. First, there is no universal deadline: your correction timeframe is specified in the findings documentation itself, so the dates in your report are the law of your case. Second, the stakes are contractual — the Medicaid Waiver Services Agreement provides that failing to correct noted deficiencies within the stated timeframes may result in termination of the agreement. A POR is not paperwork to file and forget; it's commitments with dates.

A workable POR names each finding, the root cause, the fix, the person responsible, the completion date, and — the part reviewers look for next year — how you'll keep it fixed. If the finding was a missing training or an expired document, “we uploaded it” is remediation; “our system now tracks every expiration and warns us at 30/60/90 days” is prevention.

The worst PDR outcomes are usually process failures, not care failures. Per Qlarant's operational manual: if you don't respond to two scheduling attempts, APD gives you 3 business days — then you're scored Not Met in every area. Records not made available in the designated timeframe score Not Met across the record review. No-show a scheduled review and after 30 minutes the same happens. And on a desk review, you get 7 calendar days and one electronic submission — nothing added afterward is accepted. Answer the phone, hit the windows, and your remediation will be about findings, not forfeits.