Provider Qualifications. 1) The provider must be a licensed Community Based Residential Facility (CBRF).
2) The provider must be experienced with at least 5 years as a community based provider of non-institutional sub-acute psychiatric services.
3) DQA certification as an Outpatient Mental Health clinic is required.
4) The staffing plan shall include the following positions:
i. Director
ii. Clinical Coordinator
iii. Community Recovery Specialist
iv. Peer Recovery Specialist v. Mental Health Professional vi. Registered Nurse
Provider Qualifications. 4.1 Provider states it consists of health care providers who:
a) Maintain current licenses, certifications, and permits required for such health care services in accordance with Federal statutes and regulations; and
b) Are physicians, physician assistants and/or nurse practitioners who are general practice or are board eligible or certified in family medicine, general internal medicine or general pediatrics, or are specialized in other areas of medicine but practicing in a more general capacity and, in either case, are authorized to serve as PCPs.
4.2 Provider, if employing a medical resident(s) serving as a PCP, states:
a) He/she is licensed to practice medicine;
b) He/she is at the Post-Graduate (PG-2) level or higher;
c) He/she serves as a PCP only within his/her continuity clinic (e.g., family practice residents may only serve as CMs within the family practice residency clinic setting); and
d) He/she works under the supervision of a licensed attending physician.
Provider Qualifications. Provider shall remain, for the duration of the contract, a qualified firm, and CCPS reserves the right to investigate as such. The investigation may include the submittal of qualifications of Provider to include, but not be limited to: • Organization Description / Acknowledgement of Business Type • Updated Licensure/Certificates and any License Sanction information • References • Financial Information / Bank Statements / Statement of Qualifications • Updated legal action information • Qualifications of Administrative Staff • Qualifications of Employees and Site Staff Request for any information will be made in writing and shall be submitted by Provider within five (5) business days.
Provider Qualifications. The CHC-MCO may only include Providers in its Network that meet the minimum qualification requirements established by the Department. The CHC-MCO must credential Providers in accordance with the credentialing framework provided by the Department.
Provider Qualifications. 9.3.1 The following requirements apply to specific Providers in the Contractor’s Network:
Provider Qualifications. In order to receive a contract to serve LTC clients, the Administration must consider an applicant’s ability to perform successfully under the terms and conditions of the contract. This includes contractor integrity, compliance with public policy, record of past performance, and financial and technical resources. Providers must meet the following minimum qualifications:
a. The Contractor must have at least one year of demonstrated experience and ability to provide services per the specifications in this Contract and maintain all necessary licenses, registration, and certification as required by law.
b. Employees of the Contractor providing Community Choice Guide: Supportive Housing Specialist services must meet the following criteria:
(1) Bachelor’s degree in in a related field with one years’ experience in the coordination of supportive housing or in the coordination of independent living services in a social service setting, or
(2) Two years’ experience in the coordination of supportive housing or in the coordination of independent living services in a social service setting under qualified supervision.
(3) If the services to be provided require licensure or certification, the employee shall have the applicable license or certification, which shall be current and in good standing.
c. Certification of commitment to Supportive Housing quality standards include the following to ensure delivery of quality services and common program practices across provider agencies:
(1) Agency policies and procedures reflect the Contractor’s commitment to:
(a) Housing First principles,
(b) HUD’s health and safety standards for affordable housing,
(c) State and federal privacy and security regulations,
(d) Harm reduction principles,
(e) The provision of services to people with complex long-term care needs.
(2) Coordinating with local housing authorities, non-profit and for-profit housing providers, and others to provide and sustain independent housing for individuals with complex needs.
(3) Coordinating access to housing as applicable, including the use of coordinated referrals and triage, common applications, common entrance criteria and centralized waitlists.
(4) Understanding programs, principles, regulations and statutes related to community based long- term care.
(5) Services provided will reflect the Contractor’s commitment to:
(a) Tenant choice. Supportive housing tenants will have choices in what support services they receive. Services will reflect tenant-defined ne...
Provider Qualifications. (1) Those subcontractors who have medicaid provider agreements with ODJFS must be providers in good standing. Providers who do not have medicaid provider agreements with ODJFS must not have previously had a medicaid provider agreement with ODJFS that was terminated, suspended, denied, or not renewed as a result of any action in accordance with the Revised Code, the Administrative Code, CMS, or the medicaid fraud unit of the office of the Ohio attorney general. Providers who are not in good standing are not allowed to treat or be reimbursed for treating medicaid patients. ODJFS will notify the MCP of medicaid providers who do not meet the qualifications as specified in this rule.
(2) An MCP may not discriminate in regard to the participation, reimbursement, or indemnification of any provider who is acting within the scope of his or her license or certification under applicable state law, solely on the basis of that license or certification. If an MCP declines to include individual or groups of providers in its network, it must give the affected providers written notice of the reasons for its decision. This paragraph may not be construed to:
(a) Require the MCP to contract with providers beyond the number necessary to meet the needs of its members.
(b) Preclude the MCP from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or
(c) Preclude the MCP from establishing measures that are designated to
(3) MCPs must have written policies and procedures for the selection and retention of providers which cannot discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment.
(4) MCPs must credential/recredential all providers using the standardized credentialing form and process as prescribed by the Ohio department of insurance under section 173.03 of the Revised Code, when initially credentialing and recredentialing providers in connection with policies, contracts, and agreements providing basic health care services. Upon ODJFS' request, MCPs must demonstrate the record keeping associated with maintaining this documentation.
(5) If any MCP delegates the credentialing/recredentialing of providers to another entity, the MCP must retain the authority to approve, suspend, or terminate any providers.
Provider Qualifications. Provider shall meet all applicable State and Federal regulations, including but not limited to all applicable Hawaii Administrative Rules (“HAR”) sections and Medicaid requirements for licensing, certification, and recertification, including all credentialing and re-credentialing activities.
3.7.1. Provider shall be enrolled with the State as a Medicaid provider, unless an exception applies.
3.7.2. Provider shall be licensed in good standing in the state of Hawaii.
Provider Qualifications. The provider must be a licensed Community Based Residential Facility (CBRF). The provider must be experienced with at least 5 years as a community based provider of non-institutional sub-acute psychiatric services. DQA certification as an Outpatient Mental Health clinic is required. The staffing plan shall include the following positions: Director Clinic Coordinator Community Recovery Specialist Peer Recovery Specialist Mental Health Professional Registered Nurse Advanced Practice Nurse Prescriber Medical Director Other professional and/or para-professional staff as required to meet the needs of the members. Certified Peer Specialist Services The HMO may elect to provide an enhanced behavioral health benefit to eligible members through the use of Certified Peer Specialist providers. This benefit is available for BadgerCare Plus and/or Medicaid SSI HMO enrolled adults (18 years and older) with a mental health and/or substance abuse diagnosis, especially members with a co-morbid diagnosis, who are at risk of hospitalization or who may have been hospitalized. Peer Specialists will be supervised by the HMO rendering provider, who must be a qualified mental health professional. Peer Specialists will be certified and trained by the Department’s Division of Care and Treatment Services (DCTS). DTCS maintains oversight of the training, certification and supervision requirements for peer specialist providers eligible for providing this benefit to HMO members. Peer specialist services will be billed under their supervising clinician’s NPI, using HCPCS code H0038 – Self-help/peer services. Up to 16 units may be billed per week. A unit is 15 minutes. Travel time to and from the member visits may not be billed separately, this time considered covered within the direct time reimbursement.
Provider Qualifications. Provider shall be licensed to practice dentistry in the State, maintain good professional standing at all times, and maintain throughout the term of this Agreement all necessary licenses, certifications, registrations and permits as are required to provide the Covered Services. Evidence of such licensure shall be submitted to MCNA upon request.