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Viewing: Community Medicaid Provider (CMP) Standards for Georgia's Tier 2 Behavioral Health Services, 01-230

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Current Status: Active PolicyStat ID: 3913366

Community Medicaid Provider (CMP) Standards for Georgia's Tier 2 Behavioral Health Services, 01-230

IMPLEMENTATION DATE – August 8, 2017

APPLICABILITY

Community Medicaid Providers (CMP)

POLICY

Community Medicaid Providers are governed by this policy.  DBHDD is set forth in law to establish, provide and supervise an adequate array of services within a service area. DBHDD is responsible to direct and coordinate treatment; recovery; and social, employment, housing, and community supports (O.C.G.A. § 37-1-20). In order to manage this charge, DBHDD (in partnership with the Department of Community Health, DCH) requires a robust provider network which offers 24 hour/7 day a week crisis service capacity for enrolled individuals, and yet also allows choice and flexibility for individuals served. More specifically, in its role as the state behavioral health authority, the DBHDD serves as a provider network management agent for the DCH (the state Medicaid authority) for its services named in the Community Behavioral Health Rehabilitation Services program.

The Community Behavioral Health Provider Network was published in July 2014 and displays the structure for achieving the desired provider network as shown in Attachment A in Comprehensive Community Provider (CCP) Standards for Georgia's Tier 1 Behavioral Health Safety Net, 01-200. A description of all tiers of service provision is shown in Community Behavioral Health Provider Network Structure, 01-199

With quality, accountability, efficiency, and access as goals, DBHDD is creating a community safety net of behavioral health providers of services for Georgians. A safety net is defined as a network of providers that offers care and recovery supports to individuals regardless of their ability to pay for services. This safety net is provided by Tier 1 providers. As a complement to the safety net, established Community Medicaid Providers (CMPs) (Tier 2 providers) have an important role in Georgia's public behavioral health system by offering Medicaid members choice from among a variety of Medicaid qualified and enrolled providers.

A DBHDD CMP is a provider within a recovery oriented system of care that has the capacity to deliver community-based mental health and Substance Use Disorder (SUD) services. The CMP must have the capacity and infrastructure to provide a seamless continuum of care for the target population identified by DBHDD and Department of Community Health (DCH).

A CMP is required to operate in compliance with the CMP Standards as well as all contract or Letter Of Agreement (LOA) and Provider Manual requirements. This document outlines each of the standards, a description of the standards, and key performance indicators for applicable standards. The CMP Standards, along with DBHDD policy and the DBHDD Provider Manual for Community Behavioral Health Providers, are intended to provide clear guidance for CMP providers on the expectations and requirements of operating a CMP. 

DBHDD GOALS FOR CMP

Goals for the CMP system for both the provider and DBHDD are as follows: 

  1. Ensure Access, Capacity and Choice to deliver Behavioral Health services and supports to the target population. 
  2. Increase occurrence of positive clinical outcomes. 
  3. Improve efficiency within the provider network. 
  4. Improve the individual's perception of care. 
  5. Promote a recovery oriented system of care. 

DBHDD EXPECTATIONS FOR CMP

CMPs are designed to provide behavioral health services and supports identified in the Medicaid State Plan for children, adolescents, emerging adults and/or adults with a mental illness and/or substance use disorder and who are medically determined to need rehabilitative services. As such, the following are the requirements for CMPs. 

  1. Serves children, adolescents, emerging adults, and/or adults.
  2. Competently serves individuals with mental health, substance use and co-occurring issues.
  3. Capacity to provide all the services in the core benefit package. 
  4. Provides culturally and linguistically competent services.

CMP STANDARDS AND KEY PERFORMANCE INDICATORS

Each CMP is required to operate in compliance with the CMP Standards set forth by DBHDD. Standards 1 through 12 apply to all CMPs.  There is a subset of CMPs (CMP+) who have additional requirements.  These CMP+ are required to follow Standards 1 through 16 and where applicable use the 'a' version.

Each CMP Standard has Key Performance Indicators (KPI) that identify targets for expected outcomes. The CMP Standards provide guidance regarding the unique expectations of being a CMP. 

Below is the list of 12 CMP Standards. Each Standard is set forth in an individual policy which is linked below. Each policy includes guidelines and explanation of the Standard, the key performance indicator(s) and related information. In line with communications between DBHDD's Division of Behavioral Health and CMPs, revisions to standards posted August 8, 2017 take effect as of August 1, 2017.

CMP Standard 1   - Administrative Infrastructure, 01-231 or 01-231a 

CMP Standard 2   - Accreditation, Certification and Licensing, 01-232

CMP Standard 3   - Access to Services, 01-233

CMP Standard 4   - Engagement in Care, 01-234

CMP Standard 6   - Substance Use Disorder Treatment & Supports, 01-236 

CMP Standard 8   - Required Staffing, 01-238 or 01-238a

CMP Standard 9   - Administrative Services Organization (ASO) & Audit Compliance, 01-239 

CMP Standard 10 - Recovery Oriented Care, 01-240

CMP Standard 11 - Transitioning of Individuals in Crisis, 01-241 

CMP Standard 12 - Crisis Management, 01-242 

CMP Standard 15 - Benefits Eligibility, 01-245a

CMP Standard 16 - Suicide Prevention, 01-246a

Process for Reporting Compliance with Standards for Tier 2 Community Medicaid Providers (CMPs), 01-249

Process for Reporting Compliance with Standards for Tier 2 Community Medicaid Providers (CMP+), 01-249a

CORE BENEFIT PACKAGE AND OTHER SERVICES

Table 1 below displays the Core Benefit Package that CMPs must have the capacity to provide for individuals for whom the service is deemed clinically appropriate. Some services are not available for all ages, and/or require special approval to provide. The current Provider Manual for Community Behavioral Health Providers, 01-112 contains the requirements for each service.

TABLE 1
SERVICE  ADULT MENTAL HEALTH  CHILD & ADOLESCENT MENTAL HEALTH  ADULT SUBSTANCE USE DISORDER CHILD & ADOLESCENT SUBSTANCE USE DISORDER
Behavioral Health Assessment / Service Plan Development. X X X X
Psychological Testing (may be contracted). X X X X
Diagnostic Assessment. X X X X
Crisis Intervention. X X X X
Psychiatric Treatment. X X X X
Nursing Assessment & Health Services. X X X X
Medication Administration. X X X X
Community Support Individual / Case Management / PSR-I. X X X X
Individual Outpatient Services. X X X X
Group Outpatient Services X X X X
Family Outpatient Services X X X X
Addictive Disease Support Services     X  
*Peer Support Individual Services X   X  

*Peer Support Individual service is optional and based on workforce availability. 

RELATED POLICIES

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

Community Behavioral Health Provider Network Structure, 01-199

Provider Manual for Community Behavioral Health Providers, 01-112

Process for Reporting Compliance with Standards for Tier 2 Community Medicaid Providers (CMP), 01-249

Process for Reporting Compliance with Standards for Tier 2 Community Medicaid Providers (CMP+) 01-249a

Attachments:

Approval Signatures

Approver Date
Anne Akili, Psy.D.: Director, Policy Management 8/8/2017
Monica Johnson, MA, LPC: Director, Division of Behavioral Health 8/8/2017
Anne Akili, Psy.D.: Director, Policy Management 8/7/2017
Keisha Blackwell, LMSW, MBA: Policy Coordinator 8/7/2017
Older Version Approval Signatures
Approver Date
Anne Akili, Psy.D.: Director, Policy Management 8/8/2017
Monica Johnson, MA, LPC: Director, Division of Behavioral Health 8/8/2017
Anne Akili, Psy.D.: Director, Policy Management 8/7/2017
Keisha Blackwell, LMSW, MBA: Policy Coordinator 8/7/2017
Older Version Approval Signatures
Anne Akili, Psy.D.: Policy Director 8/22/2016
Monica Johnson, MA, LPC: Director, Division of Behavioral Health 8/22/2016
Anne Akili, Psy.D.: Policy Director 8/19/2016
Joetta Prost, Ph.D.: DBHDD Policy Director 5/18/2015
Monica Johnson, MA, LPC: Director, Division of Behavioral Health 5/17/2015
Joetta Prost, Ph.D.: DBHDD Policy Director 4/13/2015