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

Current Status: Active PolicyStat ID: 308935

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

FULL IMPLEMENTATION DATE – Nov. 1, 2012

APPLICABILITY

Potential Providers of Behavioral Health Services

POLICY

DBHDD accepts and reviews provider applications for the provision of behavioral health services. This recruitment and qualifying process is accomplished through the use of a prequalification process and an application process. 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 prequalification 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, notification is provided and a Medicaid provider number is issued. If denied by DCH, notification and an appeal notice are issued. DCH holds the final decision regarding the approval or denial of an application and the issuance of a Medicaid provider number.

The enrollment process is managed through several steps. In order to be considered, applicants must submit required Pre-Qualifiers during the specified month of the Open Enrollment period for review by the Office of Provider Enrollment Management. All applicants must meet the Pre-Qualifiers to be considered for further review.

DBHDD may deny applicants whose records reveal a history of termination and/or suspension of a Contract or Letter of Agreement or Provider Agreement with DBHDD (or the former Department of Human Resources) for any health and/or safety concern.

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 Request for Proposal (RFP) process for any behavioral health services. Providers selected through the RFP process may not be subject to this policy.

DBHDD may elect at any time to revise the requirements set forth in this policy. 

DEFINITIONS

Applicant: For the purposes of this policy, the term "applicant" refers to a Corporation, Partnership, Limited Liability Corporation (LLC) or other 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.

Clinical Director: This individual must be independently fully licensed, must have at least 2 years experience in behavioral health service delivery, and is responsible for the following within the applicant organization:

    • the clinical review and management of consumer 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
    • regularly training and evaluating staff members
    • ensuring that clinical practice is in line with chosen therapeutic models.

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 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

New Site Inspection Checklist: This is a required self survey form regarding the therapeutic and safety environment for service provision. It is submitted by the applicant as a self survey. It must be reviewed and approved by the Regional Coordinator or Designee in order for the application process to continue.

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 organizations or persons approved to serve individuals with mental illness and/or addictive diseases, wherein those services are financially supported in whole or in part by funds authorized through DBHDD.

Recruitment Cycle: A six (6) month cycle of recruitment, prequalification determination, 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 based on identified needs, service area and service type. Distribution of the announcement occurs within the month prior to the beginning of each 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.
  4. Pre-Qualification Elements and Review Process
    1. Pre-Qualifiers for NEW Applicants
      1. Letter of Intent (Attachment B)
      2. Resume and professional license for the Clinical Director. Applicants requesting Core Services, must employ a full time person for this position. Applicants requesting certain specialty services must maintain contractual support from a licensed clinician to provide service review, service monitoring and assistance in directing an appropriate course of treatment. The specific service application will note the type of access or employment for clinical review.
      3. Resume(s) of the Owner(s) of the applicant organization.
      4. Resume of the CEO/Director, if different than the Owner.
      5. Copy of the current Georgia Secretary of State Registration.
      6. Proof that the agency has provided same or similar community based behavioral health services that are similar in definition to those being requested) for a minimum of one year immediately prior to submission of Pre-Qualifiers.
        NOTE: It is not permitted under DBHDD contracts 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. This relationship is not approved and does not qualify the applicant for the opportunity to meet the one year experience requirement.
      7. Three professional reference letters, signed and on professional letterhead from individuals or organizations that have had experience with the applicant and can validate that the applicant has provided these Community Behavior Health services. The person or organization providing the reference must be able to personally attest to the credibility and quality of the applicant’s services.
      8. Copy of current City or County Business license/permit.
      9. Copy of current Drug Abuse Treatment Program (DATP) License for each site, if applying for any Substance Abuse (SA) Services.
      10. Proof of completed accreditation for Community Behavioral Health
        Services from one of the following four accrediting bodies:
        • Council on Accreditation (COA)
        • Commission on Rehabilitative Facilities (CARF)
        • The Council on Quality and Leadership (CQL)
        • The Joint Commission (TJC)

          Please note that a three year accreditation is preferable. If the accreditation was issued for less than three years, the full survey report must also be submitted. Details revealed in this report may impact the status of the on-going review.
      11. A 12-month pro-forma (projected) operating budget which outlines and includes expenses such as: professional fees, employee salaries and other employee costs, facility costs and utilities, transportation, service contracts, administrative cost, other support services, etc. and identify all revenue sources based on the numbers of individuals projected to be served and the type services.
      12. Non-profit applicants must submit Internal Revenue Service exempt status determination letters and Internal Revenue Service exempt organization information returns (IRS Form 990).
    2. Pre-Qualifiers for EXISTING approved DBHDD Behavioral Health Providers adding a New Service or New Site.
      1. Letter of Intent (Attachment B)
      2. Existing DBHDD Behavioral Health (BH) providers applying for additional services or sites must submit the designated pre-qualifying information to request to add additional services or sites. Only providers who have achieved a score of 75% or greater on their two most recent External Review Organization (ERO) audit scores will be considered.
      3. Resume and professional license for the Clinical Director. Applicants requesting Core Services must employ a full time person for this position. Applicants requesting certain specialty services must maintain contractual support from a licensed clinician to provide service review, service monitoring and assistance in directing an appropriate course of treatment. The specific service application will note the type of access or employment for clinical review.
      4. Copy of the current Georgia Secretary of State Registration.
      5. Copy of current City or County Business license/permit.
      6. Copy of current Drug Abuse Treatment Program (DATP) License for each site if applying for any Substance Abuse (SA) Services.
    3. 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.
    4. Information must arrive in a typed, organized hardcopy format in a notebook, organized with each section tabbed. Handwritten documents will NOT be accepted. Pre-Qualifiers that are not submitted as requested in this policy will not be processed.
    5. Within 2 business days of receipt of the Pre-Qualifiers, the Office of Provider Network Management (PNM) submits via email an acknowledgment of receipt to the contact person listed.
    6. Within 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. Applicants are allowed one opportunity to submit the additional or corrected information within 5 business days of the email date of the request.
    7. Within 15 business days of receipt of these additional documents, the Office of PNM informs the applicant of the status of their information. If the Pre-Qualifiers are complete, an Invitation Letter via email correspondence is extended, inviting the applicant to submit both a DBHDD and Medicaid application. If the pre- qualifiers are not complete, the applicant is informed.
    8. 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-Qualifier may result in a determination that the request is not approved and applicant is then notified that they may submit at the next Open Enrollment period.
      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 to the emailing body.
      3. The Department 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
  5. 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. DBHDD Application User's Guide
      3. DCH (Medicaid) application packet
      4. Behavioral Health Services Site Inspection Form (Attachment C) to be used for self-survey and Regional Office Site Visit verification
    2. Applications must be postmarked within 30 calendar days of the Invitation Letter date.
  6. Application Submission
    1. 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 typed, organized and section-tabbed hardcopy format in a notebook, organized with each section tabbed. 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
    2. Within two business days of receipt of the application, the Office of Provider Network Management sends an email notification of receipt to the contact person listed on the application.
    3. Within 30 days of receipt of application, the Office of Provider Network Management sends a Status Report outlining any and all deficiencies via email correspondence to the contact person listed on the application with required response confirmation.
    4. The applicant is allowed 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.
    5. Within 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 DBHDD. This notification includes information on contacting the Regional Office to schedule the site visit. The site visit must be scheduled within 30 days of notification. See Behavioral Health Services Site Inspection Form  (Attachment C).
    6. The DCH application is forwarded to DCH for their review.
    7. DCH submits a formal notification to the provider agency outlining their decision and next steps.
      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.
    8. 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.
    9. A new provider is authorized to deliver services only with a fully executed Letter of Agreement, Provider Agreement, or Contract with DBHDD.
  7. 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 Department of Community Health that application was unsuccessful.
    2. The counties of service requested in the application may not exceed a 50 mile radius from the requested site location.
    3. Providers interested in expanding their programs by adding services or sites must have the most two recent ERO audit scores of at least 75%.

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

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