Common use of PROVIDER ENROLLMENT AND RETENTION Clause in Contracts

PROVIDER ENROLLMENT AND RETENTION. 1. The Network Provider must be enrolled in the Regional Network and must demonstrate the capacity to provide BH services, implementation of a person-centered philosophy that guides service delivery, fiscal stability and ethical practices in business and service delivery. The Network Provider shall demonstrate adherence to applicable legal requirements, health and safety requirements, risk management practices, capacity to fulfill the mission of the network, ability to fulfill its potential role in the network and conformance to accreditation standards applicable to its operations. This shall be verified through documentation of (a) facility licenses, fire inspections, food permits, and any other licensing required for the specific service; (b) professional licenses; (c) insurance (requirements for workers’ compensation, motor vehicle liability, professional/director’s /officer’s liability, and general liability coverage; (d) fiscal stability and viability through an independent CPA audited financial statement; (e) accreditation and (f) program plans for each service (admission and discharge criteria, assessment procedures, consumer input, staffing, quality improvement). The provider shall participate in any modification or revisions of this system as it is revised by the State and Region. 2. The Network Provider must meet and maintain all requirements of the Minimum Standards to become enrolled as and remain a member in good standing of Region V’s Behavioral Health Provider Network. 3. The Network Provider shall maintain State licensure, as applicable. 4. The Network Provider shall provide the services as specified in the agency’s Request for Approval, and the approved Regional Budget Plan, as defined by state standards and regulations, and federal requirements. 5. Region V and DHHS reserve the right to be Payer of Last Resort for consumers who meet the clinical criteria for an identified level of care and who are without the financial resources to pay for care. The Network Provider agrees to submit claims to Region V for individuals who meet the Clinical Criteria for an identified level of care and the Financial Eligibility Criteria set by DHHS and Region V. 6. The Network Provider agrees to comply with the State standards for BH listed below. A provider that does not comply will not be eligible for continued funding under this contract or continued enrollment in the network. a. State approved standards of care and service definitions, b. State approved clinical eligibility criteria (utilization criteria), c. State approved financial eligibility criteria and fee schedule, d. State approved service rates as identified in Attachment A of this Contract.

PROVIDER ENROLLMENT AND RETENTION. 1. The Network Provider must be enrolled in the Regional Network and must demonstrate the capacity to provide BH services, implementation of a person-centered philosophy that guides service delivery, fiscal stability and ethical practices in business and service delivery. The Network Provider shall demonstrate adherence to applicable legal requirements, health and safety requirements, risk management practices, capacity to fulfill the mission of the network, ability to fulfill its potential role in the network and conformance to accreditation standards applicable to its operations. This shall be verified through documentation of (a) facility licenses, fire inspections, food permits, and any other licensing required for the specific service; (b) professional licenses; (c) insurance (requirements for workers’ compensation, motor vehicle liability, professional/director’s /officer’s liability, and general liability coverage; (d) fiscal stability and viability through an independent CPA audited financial statement; (e) accreditation and (f) program plans for each service (admission and discharge criteria, assessment procedures, consumer input, staffing, quality improvement). The provider shall participate in any modification or revisions of this system as it is revised by the State and Region. 2. The Network Provider must meet and maintain all requirements of the Minimum Standards to become enrolled as and remain a member in good standing of Region V’s Behavioral Health Provider Network. 3. The Network Provider shall maintain State licensure, as applicable. 4. The Network Provider shall provide the services as specified in the agency’s Request for Approval, and the approved Regional Budget Plan, as defined by state standards and regulations, and federal Federal requirements. 5. Region V and DHHS reserve the right to be Payer of Last Resort for consumers who meet the clinical criteria for an identified level of care and who are without the financial resources to pay for care. The Network Provider agrees to submit claims to Region V for individuals who meet the Clinical Criteria for an identified level of care and the Financial Eligibility Criteria set by DHHS and Region V. 6. The Network Provider agrees to comply with the State standards for BH listed below. A provider that does not comply will not be eligible for continued funding under this contract or continued enrollment in the network. a. State approved standards of care and service definitions, b. State approved clinical eligibility criteria (utilization criteria), c. State approved financial eligibility criteria and fee schedule, d. State approved service rates as identified in Attachment A of this Contract.

PROVIDER ENROLLMENT AND RETENTION. 1. The Network Provider must be enrolled in the Regional Network and must demonstrate the capacity to provide BH behavioral health services, implementation of a person-centered philosophy that guides service delivery, fiscal stability and ethical practices in business and service delivery. The Network Provider shall demonstrate adherence to applicable legal requirements, health and safety requirements, risk management practices, capacity to fulfill the mission of the network, ability to fulfill its potential role in the network and conformance to accreditation standards applicable to its operations. This shall be verified through documentation of (a) facility licenses, fire inspections, food permits, and any other licensing required for the specific service; (b) professional licenses; (c) insurance (requirements for workers’ compensation, motor vehicle liability, professional/director’s /officer’s liability, and general liability coverage); (d) fiscal stability and viability through an independent CPA audited financial statement; (e) accreditation and (f) program plans for each service (admission and discharge criteria, assessment procedures, consumer input, staffing, quality improvement). The provider shall participate in any modification or revisions of this system as it is revised by the State and Region. 2. The Network Provider must meet and maintain all requirements of the Minimum Standards to become enrolled as and remain a member in good standing of Region V’s Behavioral Health Provider Network. 3. The Network Provider shall maintain State licensure, as applicable. 4. The Network Provider shall provide the services as specified in the agency’s Request for Approval, and the approved Regional Budget Plan, as defined by state standards and regulations, and federal Federal requirements. 5. Region V and DHHS reserve the right to be Payer of Last Resort for consumers who meet the clinical criteria for an identified level of care and who are without the financial resources to pay for care. The Network Provider agrees to submit claims to Region V for individuals who meet the Clinical Criteria for an identified level of care and the Financial Eligibility Criteria set by DHHS and Region V. 6. The Network Provider agrees to comply with the State standards for BH behavioral health listed below. A provider that does not comply will not be eligible for continued funding under this contract or continued enrollment in the network. a. State approved standards of care and service definitions, b. State approved clinical eligibility criteria (utilization criteria), c. State approved financial eligibility criteria and fee schedule, d. State approved service rates as identified in Attachment A of this Contract.