AZBH
"SECTION C:
DEFINITIONS...
BEHAVIORAL
HEALTH PARAPROFESSIONAL
A staff member
of a licensed behavioral health service agency as specified in AAC Title
9, Chapter 20, Article 1.
BEHAVIORAL HEALTH
PROFESSIONAL
A psychiatrist,
psychologist, social worker, counselor, certified psychiatric nurse practitioner,
registered nurse, or physician's assistant who meets the requirements of
AAC title 9, Chapter 20, Article 1...
BEHAVIORAL HEALTH
TECHNICIAN
A staff member
of a licensed behavioral health service agency as specified in AAC Title
9, Chapter 20, Article 1.
CERTIFIED PSYCHIATRIC
NURSE PRACTITIONER
A registered
nurse licensed according to ARS Title 32, Chapter 15 and certified under
the American Nursing Association's Statement and Standards for Psychiatric-Mental
Health Clinical Nursing Practice as specified in AAC Title 4, Chapter 19,
Article 505...
CRISIS STABILIZATION
FACILITY
A behavioral
health alternative residential setting, licensed by ADHS as a Level I or
II behavioral health agency, with sixteen (16) or fewer treatment beds,
which provides twenty-four (24) hour supervision of members who require
a protected supervised environment to reduce or eliminate acute symptoms
of a behavioral health condition. Room and board is not a covered
service in this facility...
LEVEL I BEHAVIORAL
HEALTH FACILITY
A behavioral
health agency licensed by ADHS to provide a structured treatment setting
with twenty-four (24) hour supervision, on-site medical services, and an
intensive behavioral health treatment program. These facilities are
the highest level of inpatient behavioral health services (other than inpatient
psychiatric hospitalization), and when considered an alternative residential
setting, may provide behavioral crisis stabilization and/or substance abuse
detoxification. (Level I Behavioral Health Facilities which provide
the services of an inpatient psychiatric facility for individuals under
age 21 are considered an institutional setting, not an alternative residential
setting.) Psychiatric Health Facilities and Residential Detoxification
Facilities may be licensed as Level I Behavioral Health Facilities.
LEVEL II BEHAVIORAL
HEALTH FACILITY
A behavioral
health service facility licensed by ADHS to provide a structured residential
setting with twenty-four (24) hour supervision and counseling or other
therapeutic activities for individuals who do not require the intensity
of treatment services or on-site medical services found in a Level I behavioral
health facility. A Crisis Stabilization Facility and Therapeutic
Group Home may be licensed as a Level II Behavioral Health facility.
LEVEL III BEHAVIORAL
HEALTH FACILITY
Behavioral
health service agency licensed by ADHS to provide a residential setting
with twenty four (24) hour supervision and supportive protective oversight,
behavior management or psychosocial rehabilitation and assure that residents
receive required mediation, obtain needed treatment and have transportation
to outside treatment agencies if necessary. Life skills training,
social/recreational activities may be provided directly or by referral
to outside treatment agencies...
MOBIL CRISIS
UNIT
One or more
individuals who provide emergency/crisis behavioral health services under
the authority of a licensed behavioral health service agency. At
a minimum, one member of the unit shall be a behavioral health professional
pursuant to ADHS R9-20-306(B). The mobile crisis unit shall be available
twenty-four (24) hours a day, seven (7) days a week to travel to crisis
locations to provide behavioral health crisis or emergency services...
PSYCHIATRIC
HEALTH FACILITY (PHF)
A behavioral
health alternative residential setting licensed by ADHS as a Level I behavioral
health facility in accordance with ADHS R9-20-601, et seq. This facility
provides services to members with an acute psychiatric or behavioral health
disorder or those who need to stabilize a chronic mental illness.
Room and board is not a covered service in this facility.
PSYCHIATRIST
A person who
is a licensed physician as defined in ARS Title 32, Chapter 13 or Chapter
17 and who holds psychiatric board certification from the American Board
of Psychiatry and Neurology; the American College of Osteopathic Neurologist
and Psychiatrists; or the American Osteopathic Board of Neurology and Psychiatry;
or is board eligible.
PSYCHOLOGIST
A person licensed
under ARS Title 32, Chapter 19.1...
REGIONAL BEHAVIORAL
HEALTH AUTHORITY (RBHA)
An organization
under contract with ADHS to administer the provision of covered behavioral
health services in a geographically specific area of the state.
REGISTERED NURSE
A person who
is licensed by the Arizona Board of Nursing as specified in ARS Title 32,
Chapter 15. In addition, a registered nurse providing a behavioral
health service to a member must have a minimum of 1 year of experience
in a behavioral health-related field as specified in 9 AAC, Article 1...
RESIDENTIAL
DETOXIFICATION FACILITY
A behavioral
health alternative residential setting licensed by ADHS as a Level I Behavioral
Health Facility which provides twenty-four (24) hour supervision and treatment
services to systematically reduce physical dependence upon alcohol, or
other drugs through the use of therapeutic procedures, medications, rest,
diet, counseling, and medical supervision. Covered behavioral health
services are compensable only in facilities with sixteen (16) or fewer
beds. Room and board is not a covered service in this facility.
RESIDENTAL TREATMENT
CENTER(RTC)
An inpatient
psychiatric facility for persons under the age of 21, accredited by the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
and licensed by ADHS as a residential treatment center pursuant to ADHS
R9-20-Article-6. Room and board is a covered service in this facility...
THERAPEUTIC
FOSTER HOME (TFH)
A behavioral
health alternative residential setting licensed by DES with ADHS' endorsement
to ensure Title XIX standards are met as a behavioral health facility which
provides a program of planned activities and individualized treatment within
a structured twenty-four (24) hour family oriented setting, limited to
no more than five (5) eligible children. Services provided in a TFH
are designed to influenced socially acceptable behavior and may be provided
within a continuum of other behavioral health treatment services.
Room and board is not a covered service in this facility.
THERAPEUTIC
GROUP HOME
A behavioral
health alternative residential setting licensed by ADHS as a Level II or
III behavioral health facility with twenty-four (24) hour supervision.
The level or number of rehabilitative services provided at the TGH will
vary in intensity, based on the type of program offered. Covered
behavioral health services are only compensable in facilities with sixteen
(16) or fewer beds. Room and board is not a covered service in this
facility." Arizona Behavioral Health Contract, pages 3-8.
"8. ASSIGNED
CLINICIAN
Maricopa County
GSA: ADHS shall ensure that each Title XIX or Title XXI member in
the Maricopa County GSA identified by evaluation as needing covered behavioral
health services is assigned to a clinician who is either a psychiatrist,
certified psychiatric nurse practitioner, registered nurse, psychologist,
physician assistant as defined in this contract, certified social worker,
certified professional counselor, certified marriage and family therapist
or certified substance abuse counselor.
If a member is in one (or more) of the following categories, ADHS shall ensure that the member is assigned to either a psychiatrist, a physician assistant as defined in this contract or certified psychiatric nurse practitioner...
Assigned clinicians other than physicians, physician assistants as defined in this contract, certified psychiatric nurse practitioners, psychologists and certified independent social workers must be credential by the RBHA through a process which includes assessment and documentation of experience and competence in addressing diagnosis, functional level and presenting problem…" Arizona Behavioral Health Contract, page 15.
CA
"ARTICLE II
- DEFINITIONS...
M2. Specialty
Mental Health Provider means a person or entity who is licensed, certified
or otherwise recognized or authorized under State law governing the healing
arts to provide Specialty Mental Health Services and who meets the standards
for participation in the Medi-Cal program. Specialty Mental Health
Providers include clinics, hospital outpatient departments, certified residential
treatment facilities, skilled nursing facilities, psychiatric health facilities,
hospitals, and licensed mental health professionals, including psychiatrists,
psychologists, licensed clinical social workers, marriage, family and child
counselors, and registered nurses authorized to provide Specialty Mental
Health Services." California Contract, pages 13-14.
CT
"3.6 Geographic
Coverage
a… The
MCO shall ensure that its provider network includes access for each Member
to … Mental Health Providers…" Connecticut Contract, page 19.
"3.16
Mental Health and Substance Abuse Access...
d. In
reference to services for children with psychiatric/mental health and substance
abuse needs, the MCO and any subcontracted entity is required to contract
with and refer to qualified Medicaid providers who meet benchmark requirements
or demonstrate that equal or superior services are being made available
through other providers. The benchmark providers are Child Guidance
Clinics, Family Service Agencies and other Qualified Substance Abuse Providers
with a specialization in serving children (who provide services in compliance
with state law)…" Connecticut Contract, pages 25-26.
DE
"II.8
Provider Networks
The MCO must
establish and maintain provider networks in geographically accessible locations
for the populations to be served. These networks must be comprised of hospitals,
physicians, behavioral health providers, and other specialists in sufficient
numbers to make available all covered services in a timely manner…"
Delaware RFP, page II.52.
"8.3 Other
Network Providers
8.3.1 Behavioral
Health Providers
To ensure a
broad range of treatment options are available to members, the MCOs must
agree to include a mix of behavioral health providers in their networks.
The behavioral health provider network must at least include psychiatrists,
psychiatric nurses, and certified clinical social workers. The MCO will
contract with and reimburse certified alcohol and drug abuse counselors
(i.e. those with a CADC) for treatment services provided in an alcohol
and /or drug abuse treatment program that is licensed by the State in which
the program operates. The MCOs may generally establish any mix of behavioral
health providers it desires as long as at least the above specialties are
represented in the network." Delaware RFP, page II.55.
FL
"E. Minimum
Staffing and Access Standards...
2. Minimum
staffing standards shall be as follows and, for the purpose of meeting
these staffing standards, plan staff shall include those staff available
through subcontract:
a. The plan's staff shall include at least one board certified adult psychiatrist, one who meets all education and training criteria for board certification, to be available within thirty minutes typical travel time of all enrolled recipients. However, the agency may waive this requirement, in writing, if a provider with this experience is not available in a rural county.
b. The plan's staff shall include at least one board certified child psychiatrist, or one who meets all education and training criteria for board certification, to be available within thirty minutes typical travel time of all enrolled recipients. However, the agency may waive this requirement, in writing, if a provider with this experience is not available in a rural county..." Florida Contract, pages 172-173.
FLMH
"2.5 Minimum
Staffing and Access Standards...
1. The
contractor's staff shall include at least one board certified adult psychiatrist,
or one who meets all education and training criteria for board certification...
2. The
contractor's staff shall include at least one board certified child psychiatrist,
or one who meets all education and training criteria for board certification..."
Florida Mental Health RFP, page 28.
"2.5 Minimum
Staffing and Access Standards...
The contractor's
array of direct service mental health care providers for adults and children
must include providers that are licensed or eligible for licensure, and
demonstrate two years of clinical experience in the following specialty
areas:
(1) Adoption,
(2) Separation
and loss,
(3) Victims
and perpetrators of sexual abuse,
(4) Victims
and perpetrators of physical abuse,
(5) court
ordered evaluations, and
(6) Expert
witness testimony...
The contractor
shall provide staff appropriately trained and experienced to provide psychological
testing.
The contractor
shall provide staff appropriately trained and experienced to provide rehabilitation
and support services to persons with severe and persistent mental illness."
Florida Mental Health RFP, page 29.
"To demonstrate the plan will have the staffing resources necessary for the provision of services, complete and attach Attachment 26, PMHP Service Provider Staffing Table, denoting, for each county in the service area, the number of actual and proposed FTE psychiatrists; child psychiatrists; mental health care case managers; psychologists; psychiatric nurses; licensed, certified social workers; other licensed mental health care professionals..." Florida Mental Health RFP, page 85.
HI
"30.410
Required Providers...
The following
is a listing of required components of the provider network...
* Behavioral
health services such as therapy, counseling, and substance abuse services…"
Hawaii RFP, page 9.
"30.720 Behavioral
Health...
The plan may
utilize a full array of effective interventions and qualified care givers
such as psychiatrists, psychologists, counselors, social workers, registered
nurses and others...The health plans are encouraged to utilize currently
existing publicly-funded community-based substance abuse treatment programs
which have received ADAD oversight, through accreditation and monitoring."
Hawaii RFP, pages 20, 22.
"33.300
Department of Health (DOH) Services...
Adult Mental
Health Division (AMHD)...
The health
plans are encouraged to include the AMHD CMHCs in their provider networks.
The AMHD will contract for its CMHCs with the health plans to make the
CMHCs part of the plan's provider network. No individual CMHC will contract
independently with any health plan. The provider agreement shall not bind
the plan to use any of the CMHCs on a preferential basis or to use all
of the CMHCs...
Child and Adolescent
Mental Health Division (CAMHD)...
The health
plans are encouraged to include the CAMHD centers in their provider networks.
The CAMHD will contract for its centers with the health plans to make the
centers part of the plan's provider network. No individual center will
contract independently with any health plan. The provider agreement shall
not bind the plan to use any of the center on a preferential basis or to
use all of the centers…" Hawaii RFP, pages 35, 37-38.
HIBH
"30.410
Required Providers
The BHMC plan
shall develop and maintain a provider network statewide capable of providing
a 24 hour a day comprehensive behavioral health and substance abuse services
to approximately 4,000 members statewide...
The following
is a listing of required components of the provider network. It is
not meant to be an all-inclusive listing of the components of the network
and additional components may be required based on the needs of the members...
• Behavioral
healthcare specialist services such as psychiatrists, psychologists, geriatricians,
QMRPs or other professionals trained to manage MR/DD members, social workers,
certified substance abuse counselors and nurses trained in psychiatry…"
Hawaii Behavioral Health RFP, page 15.
"30.430
Behavioral Healthcare Practitioner (BHP)
Each BHP shall
be licensed in Hawaii as:
1) a
physician, either an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathy)
and must be board certified or board eligible in psychiatry;
2)a
psychologist licensed under HRS 465;
3) a
registered nurse recognized by the State Board of Nursing as a psychiatric
nurse practitioner or Clinical Specialist in (Adult/Child) Psychiatric
and Mental Health Nursing; or
4) a
social worker with clinical experience and/or substance abuse certification.
If the BHMC plan intends to utilize other specialists and/or nurses as
BHP's, the BHMC plan shall submit a plan to DHS for monitoring their performance
as a BHP, for approval prior to implementation of the BHMC contracted services...
The BHMC plan
shall have an adequate number of psychiatrists with admission and treatment
privileges in a minimum of one general acute care hospital or psychiatric
facility in the area being served. If a BHP with an ambulatory practice
does not have admission and treatment privileges with a acute care hospital
or psychiatric facility..." Hawaii Behavioral Health RFP, page 17.
"30.700
Scope of Behavioral Health Services
The behavioral
health services to be provided by the BHMC plan includes basically all
medically necessary behavioral health services for QUEST adults who are
SMI and children and youth who are SED…Services may be provided or arranged
for in a variety of ways such as through…mental health agencies, general
hospitals, family members, consumer help approaches, or through the use
of recovering consumers as paid or volunteer staff." Hawaii Behavioral
Health RFP, page 25.
"Behavioral
Healthcare Practitioner or BHP - a provider in the BHMC network who is
licensed in the State of Hawaii as:
1) a
physician, either an M.D. (Doctor of Medicine) or a D.O. (Doctor
of Osteopathy) and must be board certified or board eligible in psychiatry;
2) a
psychologist licensed under HRS 465;
3) a
registered nurse recognized by the State Board of Nursing as a psychiatric
nurse practitioner or Clinical Specialist in (Adult/Child) Psychiatric
and Mental Health Nursing; or
4) a
social worker with clinical experience and/or substance abuse certification...
Care coordinator/Case manager - an individual who coordinates, monitors and ensures that appropriate and timely care/services are provided to the member. The care coordinator or the case manager work in conjunction with the BHP, the member and an interdisciplinary team as appropriate...
Certified Substance Counselor - means a person who is certified as a substance abuse counselor by the Department of Health...
Continuous treatment teams - professional diverse teams of 3-4 staff working under the direction of a physician and which always includes a physician or nurse. Such teams perform aggressive, intensive treatment in the community including evaluation, crisis intervention and case management with support being provided to persons who have not responded to traditional service delivery or who are heavy utilizes of the BHMCP service. Clients who have multiple problems such as homelessness and substance abuse or who are very ill, are appropriate for these services which help interrupt the cycles of relapse...
Crisis hotelmen - a 24-hour seven-day-a-week telephone service staffed by live agents to provide support, advice and referral to other services including immediate linkage to mobile crisis response services." Hawaii Behavioral Health RFP, page A1-A3.
IN
"3.1.4
Provider Types
There are over
18,000 active providers in the Indiana Medicaid program. Basic provider
types include: ...
* Psychiatric hospitals…" Indiana RFP, pages 3-5 - 3-6.
IABH
"26.0
QUALIFICATIONS OF STAFF...
Managed care
and treatment staff shall have the capacity to analyze the needs of and
provide specialized services for
a) adolescents;
b) women;
c) culture
and ethnic diversity:
d) intravenous
drug users;
e) parolees/probationers;
f) persons
with a history of chronic mental illness and/or substance abuse."
Iowa Behavioral Health Contract, page 13.
"44.0
NETWORK MANAGEMENT
The Contractor
shall conduct ongoing network management activities which include, but
are not limited to: ...
In managing
the provider network, the Contractor shall also meet the following requirements:
...
2) With
respect to Medicaid-funded services, the Contractor shall contract with
all providers of mental health and substance abuse treatment services who
are appropriately licensed, certified or accredited, who meet the credentialing
criteria, who agree to the standard contract provisions and who wish to
participate. With respect to DPH funded substance abuse services,
the Contractor shall negotiate with all providers who have substance abuse
license through DPH to provide multi levels of substance abuse treatment
or have formed a collaborative relationship and who agree to state and
block grant requirements;
The Contractor
has the option to propose, for approval or disapproval of DHS, other provider
categories for panel membership which are not licensed, certified or accredited
providers of mental health treatment. In proposing such alternative
or step-down services, the Contractor must clearly demonstrate the provision
of a level of mental health treatment appropriate to the needs of enrollees
who the Contractor proposes to serve in such services.
3) The
Contractor shall only contract, either directly or through sub-contracts,
for the provision of targeted case management with the provider designated
by the applicable county board of supervisors" Iowa Behavioral Health
Contract, pages 29-30.
"MBC of Iowa Proposals Modifications
The following are modifications made to the MBC of Iowa proposal for the Iowa Plan:
I. Staffing
Requirements and Titles (Proposal Section 7A.2.4)...
B.
Highlights of the Iowa Plan Utilization Management Staff: ...
Care
Teams will include clinicians with broad clinical experience, as well as
specialists in substance abuse, child and adolescent treatment, dual diagnosis,
and SPMI…" Iowa Behavioral Health Contract, page 54.
KS
"ADDENDUM ONE...
#6.)
Page 4, II, C: Please provide a brief description of Community Development
Disability Organizations (CDDO) and the services they provide.
ANSWER:
A CDDO is any community mental retardation facility that is organized pursuant
to KSA 19-4001 et seq. That is an agency appointed by the county
commission to be responsible for services to persons with DD in a specific
geographic service area." Kansas Contract, Addendum 1, page 1.
MD
"Chapter 62
Maryland Medicaid Managed Care Program: Definitions
.01 Definitions…
(57-4)
'Halfway house' means a transitional residential substance abuse treatment
facility, certified by the Licensing and Certification Administration and
the Alcohol and Drug Abuse Administration of the Department, that provides
substance abuse rehabilitative treatment services, focused toward clients'
employment and self-sufficiency, to clients who have received prior valuation
and treatment in a primary or intermediate care program...
(78) Institution
for Mental Disease.
(a) 'Institution
for mental disease (IMD)' means a hospital, nursing facility, or other
institution of more than 16 beds that is primarily engaged in providing
diagnosis, treatment, or care of persons with mental diseases or substance
abuse problems, including medical attention, nursing care, and related
health care services.
(b) 'Institution
for mental disease (IMD)' includes the following categories of facilities,
if the particular facility has more than 16 beds:
(i) Psychiatric hospitals;
(ii) Residential treatment centers;
(iii)
In the context of admissions of enrollees who are 21 years old or older,
intermediate care facilities-alcoholic (ICF-A) facilities; and
(iv) Residential drug-free treatment programs.
(c) 'Institution
for mental disease' does not include intermediate care facilities-alcoholic
(ICF-A) facilities, except in the context of admission of enrollees who
are 21 years old or older...
(80-1)
'Intermediate care facility-alcoholic (ICF-A)' means an institution that:
(a) Falls
within the scope of Health-General Article, §19-308, Annotated code
of Maryland;
(b) Is
certified as required under COMAR 10.47.01 by the Alcohol and Drug Abuse
Administration and the Licensing and Certification Administration, or other
applicable standards established by the jurisdiction in which the service
is provided; and
(c) Provides
residential substance abuse treatment services.
(81) 'Intermediate care facility for the mentally retarded (ICF-MR)' means a residential facility providing care and services for individuals with mental retardation or developmental disabilities, or both...
(101) 'Mental health professional' means an individual who is licensed, certified, or otherwise legally authorized by Health Occupations Article, Annotated Code of Maryland, to provide the service for which the individual is privileged...
(143) 'Psychiatrist' means a physician who is certified by the American Board of Psychiatry and Neurology or who has completed the minimum educational and training requirements to be qualified to take the Board examination." Maryland COMAR 10.09.62.01.
"10.09.67.10...
B. An
MCO shall provide for outpatient substance abuse treatment to be provide
only by:
(1) Substance
abuse treatment programs that are certified by the Department in accordance
with Health-General Article §8-404, Annotated Code of Maryland;
(2) Health
care professionals who are appropriately licensed, certified, or otherwise
legally authorized under the Health Occupations Article, Annotated Code
of Maryland:
(a) For
whom substance abuse treatment services falls within their scope of practice,
and
(b) Who
do not advertise their practice as an alcohol, drug, or substance abuse
treatment program; and
(3) Entities
exempted from certification requirements in accordance with Health-General
Article, §8-403(d), Annotated Code of Maryland." Maryland COMAR
10.09.67.10.
MA
"Section 2.5
Provider Network
A. General...
6. The
Contractor shall maintain a Provider Directory (or Directories) that identifies
the Contractor's Providers, including at a minimum the following… BH Providers…"
Massachusetts Contract, pages 39-40.
"Section 2.12
Behavioral Health Program Services...
C. BH
Program Provider Network Development, Administration and Management
The Contractor
shall develop a BH Program Provider Network that shall be comprised of
a sufficient number of appropriately credential, licensed, or otherwise
qualified Providers to meet the requirements of this Contract…" Massachusetts
Contract, pages 68-69.
"APPENDIX H:
BEHAVIORAL HEALTH EXHIBIT 1: CREDENTIALING CRITERIA
1.0 BEHAVIORAL
HEALTH CREDENTIALING CRITERIA
The Contractor
will only execute contracts with providers of Behavioral Health services,
including individual providers, facilities, hospitals or organizations
that are credential and qualified or licensed, or both, to perform Behavioral
Health services...
1.0.4
Adult Psychiatrist...
1.0.5
Child & Adolescent Psychiatrist...
1.0.6
Psychiatrist Residents...
1.0.7
Addictionologists...
1.0.8
Psychologists...
1.0.9
Psychology Interns…" Massachusetts Contract, Appendix H, pages 1-4.
MABH
"SECTION 2:
DEFINITIONS
The following
terms shall have the meaning stated, as they appear hereunder, unless the
context clearly indicates otherwise…" Massachusetts MH/SAP Contract,
Appendix A, page 6.
DMH Medication Management Clinic - shall mean the list of clinics as set forth in Appendix R to this Contract." Massachusetts MH/SAP Contract, Appendix A, page 9.
"5.02
Emergency Screening, Emergency Services, and Short Term Crisis Stabilization
Services
The Contractor
shall: ...
5.02.05 The
Contractor shall ensure the availability of clinicians in the DEPs or ESPs
who have special training and experience in mental health and substance
abuse, including but not limited to, the following specialty areas:
1) children
and adolescents,
2) Dual Diagnosis,
3) Emergency
Services,
4) Emergency
Screening Services,
5) Short Term
Crisis Stabilization Services, and
6) geriatrics.
5.02.06 Require and ensure that DEPs or ESPs have arrangements, agreements, or procedures to coordinate care with Network Providers, DMH area offices, and all DMH Continuing Care Service providers in each Region.
5.02.07 Ensure that the provision of services in DEPs or ESPs must includes access for DMH area directors to short-term crisis beds for DMH Continuing Care Consumers for up to 48 hour stays." Massachusetts MH/SAP Contract, Appendix B, pages 33-34
"SELECTIVE PROVIDER
CONTRACTING PROCUREMENT
The Contractor
shall maintain and utilize the current MH/SAP provider network and DEP's,
until such time as the Contractor has completed the competitive procurement
process for each type of service, as set forth below, or as otherwise agreed
to by the Division...
The Division shall require the Contractor to select and procure a Provider Network according to the purchasing specifications set forth in Section 2.0 of Appendix B to this Contact entitled 'Provider Network Development, Administration and Management' and the following timetable:
Type of Service...
Acute inpatient
mental health services...
Acute inpatient
detoxification services...
Designated
Emergency Programs (DEP's) or ESP, whichever is applicable...
Residential
and Day Treatment...
Outpatient
Services...
All other Covered
Services..." Massachusetts MH/SAP Contract, Appendix J.
MN
"Section 9.2.10. Children's Mental Health Collaborative. The HEALTH PLAN must subcontract with a children's mental health collaborative organized under Minnesota Statutes, Sections 245.491-245.496 that has an integrated services system approved by the Children's Cabinet, has entered into an agreement with the STATE to provide MA, GAMC or MinnesotaCare services, is capable of providing inpatient and outpatient mental health services in return for an actuarial based capitated payment from the HEALTH PLAN to be determined by the STATE and requests to become a subcontractor… The HEALTH PLAN must work cooperatively with a collaborative to assure the integration of physical and mental health services to enrollees of the collaborative. The collaborative must be willing to hold the HEALTH PLAN harmless from all liability of any kind associated with the collaborative's performance…" Minnesota Contract, pages 85-86.
MO
"2.2.2 Provider Networks: The health plan must establish and maintain provider networks…mental health providers, substance abuse providers…" Missouri RFP, page 24.
"e. The health plan must agree to include a mix of behavioral health providers in its network to ensure a broad range of treatment options available. The behavioral health provider network must include Qualified Mental Health Professional, Qualified Substance Abuse Professionals, and Qualified Behavioral Health Professional.
The behavioral health provider network, must, at a minimum, include psychiatrists, psychologists, psychiatric nurses, professional counselor, licensed clinical social workers, clinical nurse specialists." Missouri RFP, page 25.
"2) A Qualified Substance Abuse Professional (QSAP) shall be one of the following and provide services within their defined scope of practice: …" Missouri RFP, page 26.
NE
"4.1.33 The term 'Mental Health/Substance Abuse (MH/SA) Network' means the network of MH/SA providers that constitutes the MH/SA services component of the NMAP, and is addressed under a separate contractual arrangement." Nebraska Contract, page 10.
NEBH
"4.1 Applicable
Definitions: The following definitions apply under this contract: ...
4.1.25
The term ‘Mental Health and Substance Abuse (MH/SA) Provider Network’ means
the network of MH/SA providers that provide the MH/SA services component
of the Nebraska Health Connection." Nebraska Behavioral Health Contract,
pages 6, 8.
"11.11 MH/SA
Providers: The following provisions describe the MH/SA provider's responsibilities
in the NHC:
11.11.1 Types of Providers: MH/SA services covered by the Nebraska Medicaid
state plan may be provided by psychiatrists/physicians, licensed psychologists,
nurses, licensed mental health practitioners, appropriately trained para-professionals,
certified alcohol and drug abuse counselors, or doctoral/masters level
professionals with a provisional license. Services approved by the
Department but not covered under the Nebraska Medicaid state plan may be
offered by appropriately trained and credentialed service providers.
Services must be within the scope of practice for that provider type.
Other appropriately licensed/certified providers may provide services within
the MH/SA Package pursuant to this contract and 471 NAC 20-000 and 32-000,
within the scope of practice and licensure. Emphasis shall be placed
on providers who have experience in an individualized system of care environment."
Nebraska Behavioral Health Contract, page 54.
"11.17
Adequate Network of Providers: The PHP shall provide a full continuum
of MH/SA providers maintain sufficient numbers and types of qualified and
experienced MH/SA providers to ensure adequate access to clients enrolled
in the NHC.
11.17.1 Adequate Defined: The PHP shall provide an appropriate
range of services and access to MH/SA services on a statewide basis, and
maintain a sufficient number, mix, and geographic distribution of providers
that are skilled in areas such a cultural diversity and sensitivity, languages,
accessibility to clients with mental, physical and communication disabilities…"
Nebraska Behavioral Health Contract, page 57.
NM
"2.C.15 Behavioral
Health Organization:
The CONTRACTOR
shall contract with one or more behavioral health organization(s) for provision
of behavioral health services that include, but are not limited to those
specialty services uniquely associated with Seriously Disabled Mentally
Ill (SDMI) adults, Seriously Emotionally Disturbed (SED) children and adolescents
and chronic substance abuse (CSA) populations. The behavioral health
organization(s) must have a sufficient network of providers with demonstrated
expertise in treating these populations. The CONTRACTOR shall continue
to be responsible for the quality, access, and all other contractor shall
continue to be responsible for the quality, access, and all other contractual
aspects of the services provided to the members by the behavioral health
organization(s). The CONTRACTOR's agreement with the behavioral
health organization(s) shall be appended and incorporated by reference
in the CONTRACTOR's response." New Mexico Contract, pages 33-34.
NY
"21.17
Mental Health, Alcohol and Substance Abuse Providers
The Contractor
will include a full array of mental health and substance abuse providers
in its networks, in sufficient numbers to assure accessibility to services
on the part of both children and adults, using either individual, appropriately
licensed practitioners or New York State Office of Mental Health (OMH)
and Office of Alcohol and Substance Abuse Services (OASAS) licensed programs
and clinics, or both.
The State defines mental health and substance abuse providers to include the following: Individual Practitioners, Psychiatrists, Psychologists, Psychiatric Nurse Practitioners, Psychiatric Clinical Nurse Specialists, Licensed Certified Social Workers, OMH and OASAS Programs and Clinics, and Providers of mental health and/or alcoholism/substance abuse services certified or licensed pursuant to Article 23 or 31 of Mental Hygiene Law, as appropriate. OASAS programs include Certified Drug and Alcohol Counselors, employed only by OASAS licensed programs…" New York Contract, pages 21-1-21-9.
"21. PARTICIPATING
PROVIDERS
21.1 Network
Requirements
a) Sufficient
Number
ii) The Contractor's
network must contain all of the provider types necessary to furnish the
prepaid Benefit Package, including but not limited to: mental health and
substance abuse providers…" New York Contract, page 21-1.
OK
"2.7.12
Behavioral Health Providers
Health Plan
must contract with at least one Psychiatric Crisis Response Provider in
each service area to ensure crisis response services in each county…"
Oklahoma RFP, page 40.
ORMH
"C. Delivery
System Capacity
1. Contractor
shall maintain a Provider Panel sufficient to ensure adequate Capacity
and expertise to provide timely and Appropriate access to Covered Services
across the age span from child to older adult...
c. Contractor shall assure that OMAP Members have a choice of providers within Contractors; Provider Panel consistent with Section 1932(a)(1)(2)(3) of title XIX of the social security act and Section (1)(b) of OAR 410-141-0120, Oregon Health Plan Prepaid Health Provisions of Health Care Services; Section (2)(c) of OAR 410-141-0320, Oregon Health Plan Prepaid Health Member Rights and Responsibilities; and Section (1)(a) of OAR 410-141-0160, Oregon Health Plan Prepaid Health Plan Continuity of Care.
d. Contractor shall assure OMAP Members have access, as Medically Appropriate, to psychiatrists, other licensed mental health practitioners." Oregon Mental Health Contract, page 23.
"DEFINITIONS
With the following
exceptions and additions, the terms in this agreement have the same definitions
as those terms appearing in Oregon Administrative Rules(OARs)...
Mental Health
Practitioner: Persons with current and appropriate licensure, certification,
or accreditation in a mental health profession, which include but not limited
to: psychiatrists, psychologists, registered psychiatric nurses, QMHAs,
and QMHPs...
Qualified Mental Health Associate (QMHA): A person delivering services under the direct supervision of a QMHP and meeting the following minimum qualifications as documented by the Contractor: A bachelor's degree in behavioral sciences field; or a combination of at least three years, relevant work, education, training or experience; and has the competencies necessary to communicate effectively; understand mental health assessment, treatment and terminology and to apply the concepts; and provide psychosocial Skills Development and to implement interventions prescribed on a Treatment Plan within their scope of practice.
Qualified Mental Health Professional(QMHP): a LMP or any other person meeting the following minimum qualifications as documented by the Contractor: graduate degree In psychology; bachelor's degree in nursing and licensed by the State of Oregon; graduate degree in social work; graduate degree in behavioral science field; graduate degree in recreational, art, or music therapy; or bachelor's degree in occupational therapy and licensed by the State of Oregon; and whose education and experience demonstrates the competencies to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess Family, social and work relationships; conduct a mental status examination; document a multiaxial DSM Diagnosis; write and supervise a treatment plan; conduct a Comprehensive Mental Health Assessment; and provide Individual Therapy, Family Therapy and/or Group Therapy within their scope of training." Oregon Mental Health Contract, Appendix K, pages K1, K13, K18.
PABH
"Request for
Proposals (RFP) Definitions
For the purpose
of this Health Choices behavioral health services RFP, the definitions
set forth shall apply...
Drug and Alcohol Addictions Professional - A nationally accredited addictions practitioner or a person possessing a minimum of a bachelor's degree is social science and two years experience in treatment/case management services for person with substance abuse/addiction disorders...
Mental Health Professional - A person trained in a generally recognized clinical discipline including, but not limited to, psychiatry, social work, psychology, and nursing who has a graduate degree and mental health clinical experience." Pennsylvania Behavioral Health RFP, pages 3-4, 6.
"4. Provider
Network/Relations
a.
The MCO must provide access to all covered services for members through
a network of qualified professionals and facilities. The MCO
must not discriminate among classes of behavioral health providers on grounds
unrelated to effectiveness of efficiency. The network must have the
following features: ...
3)
Timely access to covered services and needed specialists…clinicians experienced
in working with persons with mental retardation with co-existing D&A
or mental health/behavioral difficulties." Pennsylvania Behavioral
Health RFP, pages 61-62.
RI
"2.08.01
Network Composition
Contractor
shall establish and maintain geographically accessible provider networks,
comprised of… mental health providers, substance abuse providers… in sufficient
numbers to make available all services in a timely manner…" Rhode
Island RFP, page 32.
"2.08.03
Mental Health Providers
2.08.03.01
Provider Mix
Contractor
agrees to include a mix of mental health providers in its network to ensure
that a broad range of treatment options is available. The mental
health provider network shall at least include Psychiatrists, Clinical
Psychologists, Psychiatric Nurses, licensed Social Workers, and providers
approved by the Departments of Children, Youth and Families (DCYF), and
Mental Health, Retardation and Hospitals (MHRH).
The network must include providers experienced in serving low income populations subspecialists or specialty providers experienced in child abuse, sexual abuse, domestic violence, rape, dual diagnosis (mental health and substance abuse), and children's mental health in sufficient numbers to meet the needs of the population to be served in a timely manner. The composition of the network shall also recognize the multi-lingual, multi-cultural nature of the population to be served and include providers in locations where members are concentrated. In order to accomplish this, contractor may ease customary credentialing standards provided this does not jeopardize Contractor's licensure or accreditation status." Rhode Island RFP, pages 34-35.
SC
"4.8.5 Other
Ancillary Medical Service Providers
Ancillary medical
service providers including, but not limited to, psychologists...must be
qualified to provide services under the Medicaid program. All services
must be provided in accordance with applicable state and federal laws and
regulations." South Carolina Contract, page 26.
"Alcohol and Substance Abuse Clinics - Clinics are required to be licensed by the Department of Health and Environmental Control (DHEC).
Mental Health Clinics (DMH) - Clinics must be a Department of Mental Health (DMH) sanctioned Community Mental Health Center. Out-of-state providers must furnish proof of Medicaid participation in the State in which they are located." South Carolina Contract, Appendix C, Tab 3, page 3.
"Network Providers
and Subcontractors...
For each county
utilize the following to describe the provider's type of service and specialty.
1.
Type of Service*** Provider Type/Practice Specialty
Ancillary
Services***Mental Health...Substance Abuse." South Carolina Contract,
Appendix D, Tab 1, page 1.
TX
"6.6 BEHAVIORAL
HEALTH CARE SERVICES - SPECIFIC REQUIREMENTS...
6.6.2
HMO must maintain a behavioral health provider network that includes psychiatrists,
psychologists and other behavioral health providers. HMO must provide
or arrange to have provided behavioral health benefits described as covered
services... The network must include providers with experience in
serving children and adolescents to ensure accessibility and availability
of qualified providers to all eligible children and adolescents in the
service area…" Texas Contract, page 38.
"7.12
BEHAVIORAL HEALTH - LOCAL MENTAL HEALTH AUTHORITY (LMHA)
7.12.1
Assessment to determine eligibility for rehabilitative and targeted MHMR
case management services is a function of the LMHA. HMO must provide
all covered services described in detail in the Texas Medicaid Provider
Procedures Manual...Covered services must be provided to Members with SPMI
and SED, when medically necessary, whether or not they are also receiving
targeted case management or rehabilitation services through the LMHA."
Texas Contract, page 68.
UTMH
"Article I
DEFINITIONS...
'Institution
for Mental Disease' means a hospital, nursing facility or other institution
of more than 16 beds that is primarily engaged in providing diagnosis,
treatment or care of person with mental diseases, including medical attention,
nursing care and related services." Utah Mental Health Contract,
page 1.
"Article IV
CONTRACTOR
ASSURANCES
A. Enrollee's
Rights...
g.
The CONTRACTOR must have sufficient capacity to provide needed services.
The CONTRACTOR shall provide the DEPARTMENT and the Health Care Financing
Administration (HCFA) adequate assurances that the CONTRACTOR, with respect
to the service area, has the capacity to provide needed services, including
assurances that the CONTRACTOR offers an appropriate range of services
and maintains a sufficient number, mix and geographic distribution of providers
of services.
h.
If the CONTRACTOR does not have sufficient capacity to provide needed services
directly, the CONTRACTOR must ensure needed services are available timely
by subcontracting with other provider(s) that offer the same level of care...
i. If subcontracting providers are unable or unwilling to provide
needed services, the CONTRACTOR must make other arrangements to ensure
clients have timely access or continued access to needed services."
Utah Mental Health Contract, pages 8-9.
"G. Staffing
1.
The CONTRACTOR shall employ or contract with an adequate number of licensed
physicians (including psychiatrists), registered nurses, certified social
workers, psychologists, and appropriate supportive personnel to provide
services in accordance with the standards in the Utah Medicaid Mental Health
Centers Provider Manual." Utah Mental Health Contract, page 14.
VA
"5. Specialist
Services
The Contractor
shall maintain in its network and in its referral listing a number of specialists
in the following specialties which is adequate to provide covered services
to its Medallion II enrollees: ...
Child Psychiatry...
Psychiatry
Psychology…"
Virginia Contract, pages 64-65.
WI
"ADDENDUM II
POLICY GUIDELINES
FOR MENTAL HEALTH/SUBSTANCE ABUSE AND COMMUNITY
HUMAN SERVICE
PROGRAMS...
1. CONDITIONS
ON COVERAGE OF MENTAL HEALTH/SUBSTANCE ABUSE TREATMENT FOR DISABLED PERSONS
- On the effective date of this Contract, unless waived by DHFS, the HMO
shall, in compliance with the provision of s. 632.89 Wis. Stats.:
a. be
certified as an outpatient Mental Health and/or Substance Abuse treatment
facility; or
b. have
contracted with a certified facility or other certified providers under
s. 632.89, Wis. Stats., for the treatment of mental health/substance abuse
problems." Wisconsin Contract, Addendum II, page 79.