Common use of Additional Credentialing and Recredentialing Criteria for Certain Providers Clause in Contracts

Additional Credentialing and Recredentialing Criteria for Certain Providers. Additional credentialing criteria for PCPs, obstetricians/gynecologists and other high-volume specialists must include a visit to the provider’s office, documenting a structured review of the site and medical record keeping practices to ensure conformance with the MCO standards. The MCO must maintain a recredentialing policy with all activities continuing to be conducted every three (3) years. Site visits are not required at the time of recredentialing. Additional credentialing and recredentialing criteria for dental providers must include: Anesthesia permit and/or certificate from the West Virginia Board of Dental Examiners for those dental providers who induce central nervous system anesthesia. Additional credentialing and recredentialing criteria for home health care providers must include: • The MCO must ensure that any agency or organization providing home health services maintains a surety bond as specified in Section 1861(o)(7) of the Social Security Act.. Effective January 1, 2018, BMS will review as part of provider enrollment process. Additional credentialing and recredentialing criteria for behavioral health care providers and agencies must include: • The MCO must verify that a Comprehensive Behavioral Health Center or a Licensed Behavioral Health Center holds a valid license through the West Virginia Office of Health Facility Licensure and Certification; • The MCO must verify that an independent psychologist or an independent practicing licensed social worker holds current license with their professional boards; and • The MCOs must verify the MCO physician is approved to provide Suboxone® treatment by the Department. A licensed MCO physician who intends to provide Suboxone® treatment must meet the following requirements: 1. Physician must qualify for a waiver under the Drug Addiction Treatment ACT (DATA); 2. Physician must have an assigned DEA (X) number and complete the training regarding Suboxone® treatment guidelines; and 3. Physician must notify the Center for Substance Abuse Treatment of the intention to treat addiction patients.

Additional Credentialing and Recredentialing Criteria for Certain Providers. Additional credentialing criteria for PCPs, obstetricians/gynecologists and other high-volume specialists must include a visit to the provider’s office, documenting a structured review of the site and medical record keeping practices to ensure conformance with the MCO standards. The MCO must maintain a recredentialing policy with all activities continuing to be conducted every three (3) years. Site visits are not required at the time of recredentialing. Additional credentialing and recredentialing criteria for dental providers must include: Anesthesia permit and/or certificate from the West Virginia Board of Dental Examiners for those dental providers who induce central nervous system anesthesia. Additional credentialing and recredentialing criteria for home health care providers must include: • The MCO must ensure that any agency or organization providing home health services maintains a surety bond as specified in Section 1861(o)(7) of the Social Security Act.. Effective January 1, 2018, BMS will review as part of provider enrollment process. Additional credentialing and recredentialing criteria for behavioral health care providers and agencies must include: • The MCO must verify that a Comprehensive Behavioral Health Center or a Licensed Behavioral Health Center holds a valid license through the West Virginia Office of Health Facility Licensure and Certification; • The MCO must verify that an independent psychologist or an independent practicing licensed social worker holds current license with their professional boards; and • The MCOs must verify the MCO physician is approved to provide Suboxone® treatment by the Department. A licensed MCO physician who intends to provide Suboxone® treatment must meet the following requirements: 1. Physician physician must qualify for a waiver under the Drug Addiction Treatment ACT (DATA); 2. Physician physician must have an assigned DEA (X) number and complete the training regarding Suboxone® treatment guidelines; and; 3. Physician physician must notify the Center for Substance Abuse Treatment of the intention to treat addiction patients; and 4. at no time can a Nurse Practitioner or a Physician’s Assistant be qualified to prescribe Suboxone®. Additional credentialing and re-credentialing criteria for the personal care providers must include: • Certificate of Need (CON) granted by the West Virginia Health Care Authority.

Additional Credentialing and Recredentialing Criteria for Certain Providers. Additional credentialing criteria for PCPs, obstetricians/gynecologists and other high-volume specialists must include a visit to the provider’s office, documenting a structured review of the site and medical record keeping practices to ensure conformance with the MCO standards. The MCO must maintain a recredentialing policy with all activities continuing to be conducted every three (3) years. Site visits are not required at the time of recredentialing. Additional credentialing and recredentialing criteria for dental providers must include: Anesthesia permit and/or certificate from the West Virginia Board of Dental Examiners for those dental providers who induce central nervous system anesthesia. Additional credentialing and recredentialing criteria for home health care providers must include: • The MCO must ensure that any agency or organization providing home health services maintains a surety bond as specified in Section 1861(o)(7) of the Social Security Act.. Effective January 1, 2018, BMS will review as part of provider enrollment process. Additional credentialing and recredentialing criteria for behavioral health care providers and agencies must include: •  The MCO must verify that a Comprehensive Behavioral Health Center or a Licensed Behavioral Health Center holds a valid license through the West Virginia Office of Health Facility Licensure and Certification; •  The MCO must verify that an independent psychologist or an independent practicing licensed social worker holds current license with their professional boards; and •  The MCOs must verify the MCO physician is approved to provide Suboxone® treatment by the Department. A licensed MCO physician who intends to provide Suboxone® treatment must meet the following requirements: 1. Physician must qualify for a waiver under the Drug Addiction Treatment ACT (DATA); 2. Physician must have an assigned DEA (X) number and complete the training regarding Suboxone® treatment guidelines; and 3. Physician must notify the Center for Substance Abuse Treatment of the intention to treat addiction patients.