FULL IMPLEMENTATION DATE – July 1, 2015
Providers of Behavioral Health Services
The Georgia Collaborative Administrative Services Organization (ASO), on behalf of DBHDD accepts and reviews provider applications for the provision of behavioral health services delivered by all tiers of providers, see Community Behavioral Health Provider Network Structure, 01-199. The Georgia Collaborative ASO will manage the application process for providers seeking approval by the State of Georgia. Successful completion of the pre-qualification and the application enrollment process results in the Georgia Collaborative ASO and DBHDD requesting a review of the provider's application by the Department of Community Health (DCH). DCH holds the final decision regarding the approval or denial of an application and the issuance of a Medicaid provider number. To be considered an approved DBHDD Behavioral Health provider all phases of the process must be successfully completed. Receipt of Letter of Intent (LOI) and/or Application and engagement in the review process does not imply approval as a DBHDD Behavioral Health provider.
New providers must complete a qualifying process consisting of a LOI, and an application, which includes a site visit. Recruitment cycles for new providers occur three times during each State fiscal year (FY) on a schedule set forth by the Georgia Collaborative ASO and DBHDD and published on the DBHDD website quarterly. Existing DBHDD Behavioral Health providers may submit an application for expansion of services at any time throughout the year providing they meet the requirements set forth below.
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. Changes to this policy, or any of the attachments, will be announced on the Department's website: www.dbhdd.georgia.gov.
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 each open enrollment cycle that allows applicants to discuss the LOI and Pre-Qualifiers. Attendance is required for all new providers.
Administrative Service Organization (AS0): An agency contracted by DBHDD to review provider applications, provide service authorizations, provide agency audits and data collection regarding the Behavioral Health and Developmental Disabilities Provider Networks and services.
Behavioral Health Services: Definition of services can be found in the DBHDD Behavioral Health provider manual. For a completed list of available services refer to the DBHDD website: www.dbhdd.georgia.gov.
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 and the DCH Provider Manual Part II for CBHS: https://mmis.georgia.gov.
Clinical Director: A Clinical Director is a full-time employee, independently licensed in Georgia, with at least 2 years of experience in behavioral health service delivery, 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.
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.
Details about Tier 1 staffing requirements are found in CCP Standard 10, Required Staffing, 01-210. Details about Tier 2 staffing requirements are found in CMP Standard 8, Required Staffing, 01-238 or CMP+ Standard 8, Required Staffing, 01-238a.
Applicants requesting specialty services (Tier 3) 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 Georgia Secretary of State 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. NOTE: All interested organizations must have an active filing with the Georgia Secretary of State to be considered a provider.
Invitation Letter: A letter extending an invitation to submit application to any Provider Agency meeting all required LOI Pre-Qualification criteria.
Letter of Intent to Provide Services Form: The LOI is a form used to collect applicant information and pertinent documents in order to determine the provider's qualification to deliver requested services. (Attachment A: Letter of Intent Form).
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. DBHDD representative(s) will also use the checklist to complete the site survey during the application process. Attachment B: Behavioral Health Services Site Inspection Form.
Nonprofit Organization: An organization qualified and approved as a tax-exempt organization under section 501(c) (3) of the Internal Revenue Code.
Pend Letter: Documentation provided by the Georgia Collaborative ASO to the applicant outlining the items that are incomplete or insufficient in the enrollment process.
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.
- Announcement of Provider Recruitment
The Georgia Collaborative ASO announces the Recruitment of Providers within the month prior to the beginning of each recruitment cycle. The announcement is posted on the website for the Georgia Collaborative at www.georgiacollaborative.com and is posted on the DBHDD website at www.dbhdd.georgia.gov.
- Informational Session for Applicants
The Georgia Collaborative ASO hosts an Applicant Forum prior to the beginning of each recruitment cycle to meet with interested providers considering application. The Applicant Forum supplies information concerning the Pre-Qualifiers, Georgia Collaborative Agency Application, DCH (Medicaid) Application and other pertinent policy requirements. Attendance at this Forum is mandatory for all new applicants who submit an LOI during the following enrollment period. Registering your attendance upon arrival and receipt of the Certificate of Attendance will be used to verify your participation.
- Process for Qualifying Applicants
The Georgia Collaborative ASO utilizes a Pre-Qualification determination process to review new applicants of behavioral health services. New applicants who meet the Pre-Qualifiers receive an invitation to complete and submit the Georgia Collaborative ASO Agency Application to the Collaborative. Existing DBHDD approved behavioral health providers may submit the Georgia Collaborative ASO Agency Application at any time throughout the year. Upon receipt of a complete application packet the Georgia Collaborative notifies the applicant to schedule a site visit with DBHDD. After the completion of a successful site visit and application review, the Georgia Collaborative ASO will request the provider to complete and submit a DCH online application. If approved by DCH, DBHDD and the provider are notified of the approval and the Medicaid provider number. If denied by DCH, DBHDD and the provider are notified of the denial. The provider is advised of the appeal rights. Once the Medicaid number is assigned, DBHDD will issue the appropriate agreement to the provider to deliver the approved service(s). Once the agreement is signed and returned, DBHDD will notify the Georgia Collaborative ASO and the provider will be added to the Network and allowed to submit authorizations to deliver services to qualified individuals.
Note: All documents submitted to the Georgia Collaborative ASO must be submitted to their mailing address. Handwritten documents and forms are not accepted.
- Pre-Qualifiers for all NEW Applicants: The following pre-qualifiers are required for all NEW Applicants requesting to become a DBHDD Behavioral Health Provider.
- Letter of Intent Form (Attachment A):
- Résumé and Professional License for the Clinical Director, if applicable.
- See Clinical Director definition above for additional requirements for this pre-qualifier.
- Current résumé(s) of the Owner(s) of the applicant organization.
- Current résumé(s) of the applicant's CEO/Director, if different from the Owner.
- Georgia Secretary of State (SOS) Registration:
- The applicant must submit a copy of the current Georgia Secretary of State (SOS) Registration. For more information visit the Secretary of State website at http://sos.ga.gov/.
- Trade Name or "DBA" Registration:
- The applicant must submit a 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.
- Evidence of Delivering Community-Based Behavioral Health Services: The 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:
- A copy of a fully executed, verifiable contract with an organization that has the authority to enter into such an agreement, and
- Documentation that the services described in the contract were delivered. Volunteer work is not acceptable.
- Contracts submitted must demonstrate a contractual relationship with one of the following types of organizations:
- An Insurance company for Behavioral Health Services; or
- A government agency of the State of Georgia or a government agency of another state.
- The contract must:
- Include a description of each service listed in the contract; and
- Clearly identify the specific population served for each service listed; and
- 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:
- Describes the specific service provision during the term of the contract being submitted as verification of service delivery; and
- Describes staff (i.e., title and credentials) employed for each service during contract period being submitted as verification of service delivery.
- 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.
- Additional Contract Requirements for Tier 2 Applicants: Tier 2 applicants requesting the Core Services Benefit Package must demonstrate experience delivering 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 (only if requesting to be a provider of Adult services)
- Community Support Individual (CSI) (only if requesting to be a provider of C&A Services)
- Individual Counseling
- Group Counseling
- Family Counseling
NOTE: 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.
- Three Professional Reference Letters
- 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.
- 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.
- 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. If not required by the municipality. documentation for the municipality must be submitted stating a business license or permit is not required.
- 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.
- 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)
- All accreditation documents must list:
- The type of service the agency is accredited to provide,
- The address of the service site(s),
- The services the agency is currently providing.
- 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.
- Tax Returns or Audited Financials
- The applicant must provide copies of last two year’s agency business tax returns or audited financials to support assertions that applicant has been in business for a year.
- Agency Bank Statements
- The applicant must provide copies of the agency’s bank statement for the previous 6 months.
- 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).
- Application Requirements for EXISTING DBHDD Behavioral Health Providers: The following are required for existing DBHDD Behavioral Health Providers, adding a new Service and/or New Site. The LOI is not required for Existing DBHDD providers.
- Georgia Collaborative ASO Agency Application:
- The applicant must submit a fully completed Georgia Collaborative ASO/DBHDD Agency Existing Application available on the Georgia Collaborative ASO website, www.georgiacollaborative.com and attached to this policy as Attachment C1.
- 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.
- Résumé and Professional License for the Clinical Director (if applicable):
- See Clinical Director definition above for additional requirements for this requirement.
- Copy of the current Georgia Secretary of State Registration.
- 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 application submission. If not required by the municipality, documentation from the municipality must be submitted stating a business license or permit is not required.
- 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 application Submission.
- Letter of Intent (LOI)
- The Letter of Intent and Pre-Qualifiers must be submitted to the Georgia Collaborative ASO at the following address:
Georgia Collaborative Provider Enrollment
240 Corporate Blvd., Suite 100
Norfolk, VA 23502
- The information must be postmarked on or before the last date of the enrollment period specified in the announcement.
- Information must arrive in a typed, hard copy format, organized with each pre-qualifier tabbed. Handwritten documents will NOT be accepted. Pre-Qualifiers that are not submitted as specified in this policy will not be processed.
- All information sent to the Georgia Collaborative as any part of the pre-qualification or application process must be submitted via US Postal Service certified return receipt requested, FedEx, or UPS delivery to the address listed above. Hand delivered information will not be accepted.
- The applicant's email address specified in the Pre-Qualifiers must be valid and able to accept emails from the Georgia Collaborative ASO (GA_Enrollment@beaconhealthoptions.com) as this will be the main form of communication between the Georgia Collaborative ASO and the applicant. It is the responsibility of the applicant to ensure that emails from the Collaborative are accepted by their email system and do not go to the "spam" mailbox. During the review process, it is incumbent of the designated contact person to routinely check for e-mails due to timeliness of information critical to the process.
- Within five (5) business days of receipt of the LOI and Pre-Qualifiers, the Georgia Collaborative ASO sends an acknowledgment of receipt to the contact person listed on the LOI. This will be sent via email.
- Within thirty (30) calendar days of receipt of the Pre-Qualifiers, the Georgia Collaborative ASO sends a Pend Letter, via email, to the contact listed for the applicant with notification of any deficiencies in the submitted Pre-Qualifiers.
- The applicant is allowed five (5) business days from the date of the Pend Letter to submit the corrections via email.
- Within fifteen (15) business days of receipt of these corrections, the Georgia Collaborative ASO 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 the Georgia Collaborative ASO Agency Application.
- If the pre-qualifiers are not complete, the applicant is informed that the LOI is closed and no further review will occur
- Important LOI Information:
- The Georgia Collaborative ASO may close an applicant’s Letter of Intent if each of the required Pre- Qualifiers is not included in the submission of information. The LOI is considered incomplete and will not be accepted or reviewed. The provider will be informed via email that the LOI is closed.
- 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.
- The applicant's email address specified in the Pre-Qualifiers must be valid and able to accept emails from the Georgia Collaborative ASO as this will be the main form of communication.
- The Georgia Collaborative ASO and DBHDD reserve the right to request any additional information deemed relevant to the qualification process.
- Invitation to Apply
- Invitation Letter
Applicants are notified of successful completion of the LOI and Pre-Qualification process via the Invitation Letter which invites the applicant to move forward in the process. This Invitation Letter is sent via email and will include the following:
- Georgia Collaborative ASO Agency Application for New Providers (Attachment C2)
- Behavioral Health Services Site Inspection Form (Attachment B) to be used for self-survey and DBHDD Site Visit verification
- Application Submission for New and Existing DBHDD Behavioral Health Providers
- The completed application must be submitted to the Georgia Collaborative ASO at the following address:
Georgia Collaborative Provider Enrollment
240 Corporate Blvd., Suite 100
Norfolk, VA 23502
- New Applicants:
The Application must be submitted by US Postal Service certified return receipt requested, FedEx, or UPS. The information must be postmarked on or before the date specified in the Invitation Letter. NOTE: Existing DBHDD BH Providers are not limited to the Open Enrollment period and may submit an application at any time throughout the year.
- Information must arrive in a typed hard-copy format, organized with each application section tabbed. Handwritten documents will NOT be accepted. Applications not submitted as requested in this policy will not be processed.
- Within five (5) business days of receipt of the application, the Georgia Collaborative ASO sends an email notification of receipt to the contact person listed on the application. This notification includes information on contacting DBHDD to schedule a site visit. The site visit must be requested within fourteen (14) days of notification and scheduled within thirty (30) days thereafter.
- Within thirty (30) days of receipt of application, the Georgia Collaborative ASO sends a Pend Letter outlining any and all deficiencies via email correspondence to the contact person listed on the application with required response confirmation.
- The applicant is allowed five (5) business days from the date of the Pend Letter to submit the corrections via email.
- Within fifteen (15) days of receipt of the corrections, the Georgia Collaborative ASO reviews the application and submits recommendations to DBHDD.
- DBHDD reviews the recommendation and notifies the Georgia Collaborative ASO of their decision.
- The Georgia Collaborative ASO submits notification via email correspondence to the applicant notifying the applicant of the completion of the review by DBHDD.
- Once the application and site visit is successfully completed and notification is submitted to the Georgia Collaborative ASO, the applicant will be instructed to complete the DCH online application and pay the application fee, if applicable.
- DCH submits a formal notification to DBHDD and the provider agency outlining their decision.
- 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.
- After notification from DCH that the application was approved, DBHDD generates the appropriate Contractual agreement or amendment to deliver the approved services.
- Once the agreement is signed and returned, DBHDD will notify the Georgia Collaborative ASO and the provider will be added to the Network and allowed to submit authorizations to deliver services to qualified individuals.
- If denied, the applicant is notified by DCH and advised of appeal rights.
- Important Application Information
- Handwritten documents and forms will NOT be accepted.
- Applications not submitted as specified in this policy will not be accepted nor processed.
- 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.
- 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(s).
- Additional Important Information
- The Georgia Collaborative ASO may close an applicant's Letter of Intent or deny an application if the applicant or the applicant's principals, officers, managers, or managing employees have a history of termination or suspension of a contract, Provider Agreement 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.
- The Georgia Collaborative ASO may close an applicant's Letter of Intent or deny an application if the applicant or the applicant's principals, officers, managers, or managing employees have a history of termination or suspension of a contract, Provider Agreement or Letter of Agreement with any other government agency or entity ( 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.
- The Georgia Collaborative ASO may disqualify an applicant from participation in the process due to material misrepresentation or falsification of information.
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
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
Community Medicaid Provider (CMP) Standards for Georgia's Tier 2 Behavioral Health Services, 01-230
CMP Standard 8 - Required Staffing, 01-238 or CMP+ Standard 8 - Required Staffing, 01-238a