24.12 Exceptions to Contracts

24.12.1 Providers Without a Contract

Contracts are the required instrument to purchase most goods or services. Before creating a service record, check ReHabWorks to verify whether a contract is required.

If a contract is required, case-by-case exceptions to a contract requirement may be approved only in situations where the exception is:

  • in the best interest of the CRS program;
  • in the best interest of the CRS consumer;
  • necessary and appropriate;
  • in accordance with the consumer’s plan; and
  • in accordance with state or federal laws.

The CRS program manager reviews exceptions.

24.12.2 Process for Exceptions to Contracts

The following process applies to all contracts except for hospital contracts. For more information about exceptions to hospital contracts.

Counselor

  1. documents a contract-exception request in an email or memo that describes the consumer's need for a specific contracted good or service. (The request explains that a non-contracted vendor is needed to best serve the consumer in achieving his or her plan objective.); and
  2. sends the contract exception request email or memo to the manager for review and approval.

Manager

  1. reviews and concurs with the request or denies the contract exception request; and
  2. sends the requested documentation to the CRS program manager for review and concurrence or denial.

CRS Program Manager

  1. reviews and concurs with or denies the request; and
  2. sends the request documentation to the appropriate executive staff for review and approval.

Executive Staff

  1. reviews and approves or denies the request;
  2. make final approval; and
  3. sends the approved exception to the CRS program manager.

CRS Program Manager

  1. returns the approval through the chain of command to the counselor.

If at any time the request for a contract exception is denied, the document is returned through the chain of command to the caseload carrying staff member.

Hospitals without CRS Program Contracts

If a consumer needs a medical service at a hospital that does not have a CRS program contract, the assigned medical service coordinator must contact the CRS central office program manager to negotiate a payment rate for the medical service. A DARS3423, Exception to Contracted Hospital Purchase must be completed and submitted through the CRS program manager.

24.12.3 Exceptions to Hospital Contracts

Hospital contracts allow for payments below the contracted rate or in addition to the contracted rate when the consumer's circumstances warrant. See "Exceptions to payment rate limits" in the Chapter 27: Hospital and Ambulatory Surgery Center Services for instructions including use of DARS3422, Reduced Payment Agreement.

24.12.4 Process for Documenting Modifications to Contracts

When the caseload carrying staff member's manager reviews and concurs with an exception to a policy regarding a service provided under a contract, such as changes in the service description so that the service is individualized for a specific consumer, approval must be recorded on the DARS3472, Contracted Service Modification Request.

The DARS3472, Contracted Service Modification Request, must be:

  • signed by the Program Executive; and
  • countersigned by the contractor.

A copy of the completed DARS3472 must be retained in the consumer file.

The counselor forwards a copy of the completed DARS3472 to the contract manager.

Exceptions to Contracted Fees

Fees in excess of the contracted fee for a specific service are not allowed and managers may not authorize an exception.