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Viewing: Recruitment and Application to become a Provider of Behavioral Health Services, 01-111

Current Status: Active PolicyStat ID: 1040338

Recruitment and Application to become a Provider of Behavioral Health Services, 01-111

FULL IMPLEMENTATION DATE – October 1, 2014

APPLICABILITY

Providers of Behavioral Health Services

POLICY

DBHDD accepts and reviews provider applications for the provision of behavioral health services delivered by three tiers of providers, see Community Behavioral Health Provider Network Structure, 01-199.  A qualifying process is accomplished through the use of an initial pre-qualification process review, a subsequent application review, and one or more site visits. Recruitment cycles occur two times during each State fiscal year (FY) on a schedule set forth by DBHDD and attached to this policy as Attachment A: Behavioral Health Provider Recruitment Cycle Schedule.  Successful completion of the pre-qualification and the application process results in DBHDD requesting a review of the provider's application by the Department of Community Health (DCH). If approved by DCH, the provider is notified of the approval and the Medicaid provider number is included.  If denied by DCH, the provider is notified along with the appeal rights. DCH holds the final decision regarding the approval or denial of an application and the issuance of a Medicaid provider number.

Please note:

  • DBHDD may close an applicant's Letter of Intent or deny an applicant's application if the applicant or the applicant's principals, officers, managers, or managing employees have a history of termination or suspension of a contract or letter of agreement with DBHDD for any health or safety concern.  In such a case, the applicant will be denied enrollment for a minimum of one year from the date of the last termination or suspension, or for the period of time required by CMS regulations and any other applicable law or regulation, whichever is longer.
  • DBHDD may close an applicant's Letter of Intent or deny an applicant's application if the applicant or the applicant's principals, officers, managers, or managing employees have a history of termination or suspension of a contract or letter of agreement with any other government agency or entity (whether in Georgia or in any other state) for any health or safety concern. In such a case, the applicant will be denied enrollment for a minimum of one year from the date of the last termination or suspension, or for the period of time required by CMS regulations and any other applicable law or regulation, whichever is longer.
  • DBHDD may disqualify an applicant from participation in the process due to material misrepresentation or falsification of information.
  • DBHDD reserves the right to utilize a procurement process (e.g. Request for Proposal [RFP]) process for any behavioral health services. Providers selected through the procurement process may not be subject to this policy.
  • DBHDD may elect at any time to revise this policy.
  • Changes to this policy, or any of the attachments, will be announced on the Department's website: www.dbhdd.georgia.gov.

DEFINITIONS

Applicant: For the purposes of this policy, the term "applicant" refers to a Corporation, Limited Liability Corporation (LLC) or other single entity with the legal authority to make application to become a provider of Behavioral Health Services as allowed by policies set forth by DBHDD and the Department of Community Health. 

Applicant Forum: An interactive informational session held prior to the beginning of each open enrollment cycle that will allow applicants to discuss the Pre-Qualifiers.

Behavioral Health Services: Please see list of available services in Attachment B: Letter of Intent.

Community Behavioral Health Rehabilitation Services (CBHRS): A group of behavioral health services that are part of the Federally approved Georgia State Medicaid Plan. CBHRS services are paid by Medicaid when they are delivered by approved providers to eligible recipients. These services are also referred to as Medicaid Rehabilitation Option (MRO). Requirements for CBHRS can be found in Provider Manual for Community Behavioral Health Providers, 01-112.

Clinical Director: Clinical Directors for Tier 1 and Tier 2 providers must be a full-time employee of the applicant, independently licensed in Georgia, and must have at least 2 years of experience in behavioral health service delivery. He or she is responsible for the following within the organization:

    • The clinical review and management of individual services
    • Participation in the development, implementation and ongoing assessment of programs
    • Assigning caseloads, providing supervision and/or ensuring adequate supervision is occurring
    • Meeting with supervisory clinical staff to direct and review work
    • Ensuring that all facility policies and regulations are upheld and fulfilled as it pertains to patient care
    • The regular training and evaluation of staff members
    • Ensuring that clinical practice is in line with evidence based therapeutic models.

Details about Tier 1 staffing requirements are found in CCP Standard 10, Required Staffing, 01-210.

Tier 2: Applicants requesting the Core Services Benefit Package must employ a full-time employee for this position. Due to the staffing requirement and responsibilities of the Clinical Director, the individual in this position may not function in any other Executive/Management/Leadership capacity within the organization.  For instance, the CEO may not also be the Clinical Director.

Tier 3: Applicants requesting specialty services must comply with staffing requirements as outlined in the specific service definition(s) as per Provider Manual for Community Behavioral Health Providers, 01-112. In addition, each service must maintain support, via staff or contractual relationship, from a licensed clinician to provide service review, service monitoring and assistance in directing an appropriate course of treatment. The specific service definition notes the type of employment relationship (i.e., contract, full-time, part-time, etc) required for clinical review. 

Entity: An organization (such as a corporation or LLC) that has filed documents with the Secretary of State of Georgia or of another state such that it is recognized by a state government as having a legal identity distinct from the identity of its members, owners, principals and employees.

External Review Organization: An agency contracted by DBHDD to provide service authorizations, provider audits and data collection regarding the Behavioral Health Provider Network and services.

Invitation Letter: A letter extending an invitation to submit application to any Provider Agencies that met all the required Pre-Qualification criteria.

Letter of Intent to Provide Services Form: A form letter provided by DBHDD (Attachment B: Letter of Intent) which must be completed by the applicant outlining their intent to become a provider of behavioral health services.

Medicaid Rehabilitation Option (MRO): A group of behavioral health services that are part of the Federally approved Georgia State Medicaid Plan. MRO Services are paid by Medicaid when they are delivered by approved providers to eligible recipients. These services are also referred to as Community Behavioral Health Rehabilitation Services (CBHRS). Requirements for CBHRS can be found in Provider Manual for Community Behavioral Health Providers, 01-112.

New Site Inspection Checklist: A required provider self survey form regarding the therapeutic and safety environment of the designated service delivery site.

Nonprofit Organization: An organization qualified and approved as a tax-exempt organization under section 501(c) (3) of the Internal Revenue Code.

Pre-Qualifiers: Items listed in this policy that are required to be submitted and approved before the applicant is invited to submit an application.

Provider: For the purposes of this policy, the term "provider" means an organization approved to serve individuals with mental illness and/or substance use disorder, where those services are financially supported in whole or in part by funds authorized through DBHDD.

Recruitment Cycle: A six (6) month cycle of recruitment, pre-qualification determination, and application review process, as set forth in Attachment A: Behavioral Health Provider Recruitment Cycle Schedule.

Status Report: Document submitted to the applicant outlining the status for each application requirement.

PROCEDURES

  1. Announcement of Provider Recruitment 
    The Office of Provider Network Management announces the Recruitment of Providers within the month prior to the beginning of each twice-yearly recruitment cycle. The announcement is distributed to all enrolled providers and is posted on the DBHDD website at www.dbhdd.georgia.gov.
  2. Informational Session for Applicants 
    The Office of Provider Network Management hosts an Applicant Forum prior to the beginning of each recruitment cycle period to meet with interested providers considering application. The Applicant Forum supplies information concerning the Pre-Qualifiers, DBHDD Application, DCH (Medicaid) Application and other pertinent policy requirements.
  3. Process for Qualifying Applicants  
    DBHDD utilizes a Pre-Qualification determination process to review applicants of behavioral health services. Applicants who meet the Pre- Qualifiers receive an invitation to complete and submit both the DBHDD Provider Application and the DCH Medicaid Provider Application.

PRE-QUALIFICATION ELEMENTS

Note: All documents submitted to DBHDD must be typed. Handwritten documents or forms completed in handwriting will not be accepted.

  1. Pre-Qualifiers for all NEW Applicants
    1. Letter of Intent (Attachment B). The applicant must submit a fully completed Letter of Intent.
    2. Résumé and Professional License for the Clinical Director, if applicable.
    3. Current résumé(s) of the Owner(s) of the applicant organization.
    4. Current résumé(s) of the applicant's CEO/Director, if different from the Owner.
    5. Copy of the current Georgia Secretary of State (SOS) Registration. For more information visit the Secretary of State website at http://sos.ga.gov/.
    6. Copy of "DBA" or trade name Registration filed with the Clerk of the Superior Court of the county of the organization's domicile, if the applicant operates or will operate under a trade name or "DBA". The copy should show the stamp of the Clerk of Superior Court showing the date on which the Registration was filed and the Clerk's recording information. For more information see Georgia Code O.C.G.A. 10-1-490.
    7. Evidence of Delivering Community-Based Behavioral Health Services
      Applicant must provide evidence that the applicant (not individual personnel affiliated or associated with the applicant) has provided community-based behavioral health services that are the same or similar in definition (see minimum list of services below for Tier 2 applicants) to those being requested for a minimum of one year immediately prior to submission of Pre-Qualifiers. The evidence submitted must be:
      1. A copy of a fully executed, verifiable contract with an organization that has the authority to enter into such an agreement, and
      2. Documentation that the services described in the contract were delivered. Volunteer work is not acceptable.
    8. Contracts submitted must demonstrate a contractual relationship with one of the following types of organizations:
      1. An Insurance company for Behavioral Health Services; or
      2. An entity licensed by the State of Georgia or the government of another state to provide Behavioral Health services; or
      3. A government agency of the State of Georgia or a government agency of another state.
        The contract must:
      4. Include a description of each service listed in the contract; and
      5. Clearly identify the specific population served for each service listed; and
      6. Include the reimbursement rates and mechanism for each service listed.
        Documentation to verify that the services described in the contract were delivered must meet the following minimum criteria:
      7. Describes the specific service provision during the term of the contract being submitted as verification of service delivery; and
      8. Describes staff (i.e., title and credentials) employed for each service during contract period being submitted as verification of service delivery.
    9. Three Professional Reference Letters
      1. The applicant must provide three (3) professional reference letters that are signed and on professional letterhead from individuals or organizations that have had experience with the applicant (not with employees, owners or principals of the applicant), and can validate that the applicant has provided Community Behavioral Health services that are the same or similar to those requested in the LOI. The person or organization providing the reference must be able to personally attest to the credibility and quality of the applicant’s services.
      2. Professional reference letters must be dated within one (1) year of LOI submission. The person or organization providing the reference must not be a current or former employee, officer, or principal of the applicant, and must not have an ownership interest in the applicant. If the person or organization providing the reference is a legal entity other than a natural person (such as a corporation or LLC), then that entity must not have an officer, principal, or ownership interest holder who is also an employee, officer, principal or ownership interest holder of the applicant. The letters must include contact information.
      3. Providers who hold (or previously held) a contract with another state government agency must submit contact information for that government agency's Contract Manager, who provided the oversight of the contract along with a copy of the contract. Information regarding the result of performance measures required in the contract must be included.
    10. Copy of Current City or County Business License or Permit
      A business license or permit must be submitted for each location in which the applicant operates or intends to operate at the time of LOI submission.
    11. Copy of Current Drug Abuse Treatment and Education Program (DATEP) License
      If applying for the Core Services Benefit Package or Substance Use Disorder Specialty Services, a DATEP License is required and must be submitted for each location at the time of LOI submission.
    12. Accreditation
      1. Applicants must provide a copy of accreditation certificate for Community Behavioral Health Services from one of the following four accrediting bodies:
        • Council on Accreditation (COA)
        • Commission on Accreditation of Rehabilitation Facilities (CARF)
        • The Council on Quality and Leadership (CQL)
        • The Joint Commission (TJC)
      2. All accreditation documents must list the type of service the agency is accredited to provide and the address of the service site(s), and must indicate that the agency is currently providing the services listed.
      3. A three (3) year accreditation is required. New applicants must submit the full accreditation survey report. Details revealed in this report may impact the status of the on-going LOI and application review.
    13. A 12-month pro-forma (projected) operating budget which outlines and includes at a minimum, the following expenses professional fees (if applicable), employee salaries and other employee costs, facility costs, transportation (if applicable), service contracts (if applicable), administrative costs, other support services (if applicable), etc. Pro-Forma budgets must also identify all projected revenue and revenue sources based on the type of services and the number of individuals projected to be served.
    14. IRS Exempt Status Determination
      Non-profit applicants must submit Internal Revenue Service exempt status determination letter and the most recent calendar year Internal Revenue Service Return of Organization Exempt Form Income Tax (IRS Form 990).
    15. Additional Requirements for Tier 2 Applicants
      In addition to the evidence outlined in Section A, CMP applicants requesting the Core Services Benefit Package must demonstrate experience delivering all the services listed in the Core Benefit Package to individuals with Mental Health (MH) and Substance Use Disorder (SUD) issues. At a minimum, the applicant must demonstrate a minimum of one year of prior experience providing ALL of the following services:
      • Behavioral Health Assessments
      • Psychological Testing
      • Diagnostic Assessments
      • Crisis Intervention
      • Psychological Treatment with Medical Doctor (MD)
      • Nursing Services
      • Case Management
      • Community Support Individual (CSI)
      • Individual Counseling
      • Group Counseling
      • Family Counseling
    16. It is not permitted under DBHDD Contracts, Letters of Agreement or Provider Agreements for enrolled providers to sub-contract or establish extended relationships with another organization to subcontract the entirety of an approved service or set of services such as Core Services Benefit Package. This relationship is not approved and does not qualify the applicant for the opportunity to meet the one year experience requirement.
  2. Pre-Qualifiers for EXISTING approved DBHDD Behavioral Health Providers adding a New Service or New Site.  Note: Tier 1 Comprehensive Community Providers (CCPs) are not required to submit LOIs.
    1. Letter of Intent (Attachment B):
      The applicant must submit a fully completed Letter of Intent.
    2. Audit Scores:
      Existing DBHDD Behavioral Health (BH) providers applying for additional services or sites must submit their two most recent External Review Organization (ERO) audit scores. Only providers who have achieved a score of 80% or greater in both audits will be considered.
    3. Résumé and Professional License for the Clinical Director (if applicable).
    4. Copy of the current Georgia Secretary of State Registration.
    5. Copy of current City or County Business License or Permit
      A business license or permit must be submitted for each location in which the applicant operates or intends to operate at the time of LOI submission.
    6. Drug Abuse Treatment and Education Program (DATEP) LicenseIf applying for the Core Services Benefit Package or Substance Use Disorder Specialty Services, a DATEP License is required and must be submitted for each location at the time of LOI Submission.

REVIEW PROCESS

  1. Letter of Intent (LOI)
    1. The Letter of Intent and Pre-Qualifiers must be postmarked in accordance with dates in the Behavioral Health Provider Recruitment Cycle Schedule (Attachment A) via US Postal Service certified return receipt requested, FedEx, or UPS.
    2. Information must arrive in a hard copy format that is typed, organized and in a notebook.  Each section must be tabbed, labeled and organized. Handwritten documents will NOT be accepted. Pre-Qualifiers that are not submitted as specified in this policy will not be processed.
    3. Within five (5) business days of receipt of the Pre-Qualifiers, the Office of Provider Network Management (PNM) sends an acknowledgment of receipt to the contact person listed on the LOI.  This will be sent via email.
      Note: If any document is missing, the LOI is considered incomplete and will not be accepted or reviewed. The provider will be informed via email that the LOI is closed.
    4. Within thirty (30) calendar days of receipt of the Pre-Qualifiers, the Office of PNM sends a Status Report to the contact listed for the applicant with notification of any deficiencies in the submitted Pre-Qualifiers. 
    5. The applicant is allowed five (5) business days from the date of the Status Report to submit the corrections via US Postal Service certified return receipt mail, FedEx, or UPS delivery.
    6. Within fifteen (15) business days of receipt of these corrections, the Office of PNM informs the applicant of the status of the LOI and Pre-Qualifiers. If the LOI and Pre-Qualifiers are complete, an Invitation Letter via email correspondence is extended, inviting the applicant to submit both the DBHDD and DCH Medicaid applications. If the pre-qualifiers are not complete, the applicant is informed that the LOI is closed and no further review will occur.
    7. Additional Important Information:
      1. Applicants must meet ALL applicable Pre-Qualifiers to be invited to move forward in the process. Any incomplete or deficient Pre-Qualifiers may result in a determination that the request is not approved.
      2. The applicant's email address specified in the Pre-Qualifiers must be valid and able to accept emails from DBHDD as this will be the main form of communication. It is the responsibility of the applicant to ensure that emails from DBHDD are accepted by their email system and do not go to the "spam" mailbox. Upon receipt of email notification from DBHDD, applicants must return a reply of email receipt.
      3. DBHDD reserves the right to request any additional information deemed relevant to the qualification process
      4. All information sent to DBHDD as any part of the application process must be received via US Postal Service certified return receipt requested, FedEx, or UPS delivery. No hand delivered information will be accepted. All information must be submitted to this address:

            Office of Provider Network Management
            Department of Behavioral Health and Developmental Disabilities
            2 Peachtree St., NW, Suite 23-247
            Atlanta, GA 30303
  2. Invitation to Apply
    1. Invitation Letter
      Applicants and the respective Regional Office(s) are notified of successful completion of the Pre-Qualifiers via the Invitation Letter which invites the applicant to move forward in the process. This Invitation Letter is sent via email correspondence and it includes the following:
      1. DBHDD Application
      2. DCH (Medicaid) Application submission instructions
      3. Behavioral Health Services Site Inspection Form (Attachment C) to be used for self-survey and Regional Office Site Visit verification
  3. Application Submission
    Applications must be postmarked and sent via US Postal Service certified return receipt requested, FedEx, or UPS within 30 calendar days of the Invitation Letter date. If received postmarked after the 30th calendar day, the application is not processed and applicant is notified. Information must arrive in a hard copy format that is typed, organized and in a notebook. Each section must be tabbed, labeled and organized. Handwritten documents will NOT be accepted. Applications not submitted as requested in this policy will not be processed. All information must be submitted to this address:
      
        Office of Provider Network Management
        Department of Behavioral Health and Developmental Disabilities
        2 Peachtree St., NW, Suite 23-247
        Atlanta, GA 30303
        
  4. Within five (5) business days of receipt of the application, the Office of Provider Network Management (PNM) sends an email notification of receipt to the contact person listed on the application.
  5. Within thirty (30) days of receipt of application, the PNM sends a Status Report outlining any and all deficiencies via email correspondence to the contact person listed on the application with required response confirmation.
  6. The applicant is allowed fifteen (15) days from the date of the Status Report to submit the corrections via US Postal Service certified return receipt mail, FedEx, or UPS delivery.
  7. Within fifteen (15) days of receipt of the corrections, PNM submits notification via email correspondence to the applicant notifying the applicant of the completion of the review by PNM. This notification includes information on contacting the Regional Office to schedule the site visit. The site visit must be scheduled within thirty (30) days of notification. See Behavioral Health Services Site Inspection Form (Attachment C).
  8. Once a site visit is successfully completed by the Regional Office and notification is submitted to PNM, the DCH application is forwarded to DCH for their review.
  9. DCH submits a formal notification to the provider agency outlining their decision and the appeal rights.
    1. If approved, DCH issues a new provider number for a new site and services, or adds the new service(s) to an existing provider number. The applicant receives notification from DCH.
    2. If application is denied by DCH, the applicant is notified by DCH.
  10. After notification from DCH that the application was approved, PNM notifies the DBHDD Office of Financial Services, requesting the generation of the appropriate Contractual agreement or amendment.
  11. A new provider is authorized to deliver services only with a fully executed Letter of Agreement, Provider Agreement, or Contract with DBHDD.
  12. Additional Important Information
    1. Any incomplete applications as well as those not received within the correction period will result in closure of application and notification will be submitted to the DCH that the applicant was unsuccessful. 
    2. The counties of service requested in the application may not exceed a 50 mile radius from the requested service delivery location. Only counties that are approved are eligible for service.

REFERENCE MATERIALS

Department of Behavioral Health and Developmental Disabilities: http://www.dbhdd.georgia.gov/

Georgia Department of Community Health:     
Georgia Web Portal:  https://www.mmis.georgia.gov/portal/default.aspx
Healthcare Facility Regulation: http://dch.georgia.gov/healthcare-facility-regulation-0

RELATED POLICIES

Provider Manual for Community Behavioral Health Providers, 01-112

Community Behavioral Health Provider Network Structure, 01-199

Comprehensive Community Provider (CCP) Standards for Georgia’s Tier 1 Behavioral Health Safety Net, 01-200

CCP Standard 10, Required Staffing, 01-210

Attachments:
Approver Date
Joetta Prost, Ph.D.: DBHDD Policy Director 10/16/2012
Judy Feimster: Director, Provider Network Management 10/16/2012
Joetta Prost, Ph.D.: DBHDD Policy Director 10/22/2012
Joetta Prost, Ph.D.: DBHDD Policy Director 8/25/2014
Judy Feimster: Director, Provider Network Management 8/26/2014
Joetta Prost, Ph.D.: DBHDD Policy Director 8/26/2014