Common use of Rendering Provider Credentialing and Recredentialing Clause in Contracts

Rendering Provider Credentialing and Recredentialing. PROVIDER agrees to meet MSHN and MDHHS credentialing and recredentialing requirements, required criminal background checks, and accepts and shall abide by all credentialing policies and procedures. The PROVIDER shall ensure, through credentialing, that the PROVIDERS’s staff professionals and the PROVIDER’s subcontractors and their staff professionals have obtained and maintain all approvals, certifications and licenses required by Federal, State and local laws, ordinances, rules and regulations to practice their professions in the State of Michigan and to perform Medicaid supports/services hereunder. PROVIDER shall ensure credentialing and re-credentialing processes do not discriminate against: a. A health care professional solely on the basis of license, registration or certification; b. A health care professional who serves high-risk populations or who specializes in the treatment of conditions that require costly treatment PROVIDER shall not assign a consumer to any practitioner who has not fully complied with credentialing process as outlined in the MDHHS Credentialing and Re-credentialing Process (Attachment P7.1.1), the MDHHS-BHDDA Substance Abuse Disorder Policy Manual – Credentialing and Staff Qualification Requirements (Attachment P.II.B.A of the MDHHS/PIHP Contract), and MSHN Credentialing and Recredentialing policies and procedures. Rendering providers must meet qualifications outlined in MDHHS Michigan PIHP/CMHSP Provider Qualifications per Medicaid Services & HCPCS/CPT Codes. PROVIDER staff cannot provide services if they are not certified or do not have a registered development plan with MCBAP. Staff in this situation must complete a Temporary Privileging Form. The privileging form must be completed and submitted to MSHN along with a completed development plan before staff can render services. This form must be signed by the requesting staff person and program director. If a request is received by a PROVIDER outside the MSHN twenty-one county region, MSHN will accept the PROVIDER’s Home PIHP’s privileging form. If the PROVIDER’s Home PIHP does not require one, then MSHN’s must be submitted. PROVIDER must notify MSHN once the staff member has achieved certification and/or had their plan registered with MCBAP. MSHN retains the right to approve, suspend or terminate providers from participation in the Medicaid-funded services (e.g., exclusions from Medicare/Medicaid; specific regional performance issues and/or criminal convictions under sections 1128(a) and 1128(b)(1)(2) or (3). PROVIDER acknowledges and agrees MSHN or any representative agent shall have the right to review and inspect records related to credentialing activities maintained by PROVIDER relative to its staff and contracted personnel/agencies. To the extent permitted by law, PROVIDER shall make such records available to MSHN or any representative agent and any governmental agency without charge to MSHN.

Rendering Provider Credentialing and Recredentialing. PROVIDER agrees to meet MSHN and MDHHS credentialing and recredentialing requirements, required criminal background checks, and accepts and shall abide by all credentialing policies and procedures. The PROVIDER shall ensure, through credentialing, that the PROVIDERS’s staff professionals and the PROVIDER’s subcontractors and their staff professionals have obtained and maintain all approvals, certifications and licenses required by Federal, State and local laws, ordinances, rules and regulations to practice their professions in the State of Michigan and to perform Medicaid supports/services hereunder. PROVIDER shall ensure credentialing and re-credentialing processes do not discriminate against: a. A health care professional solely on the basis of license, registration or certification; b. A health care professional who serves high-risk populations or who specializes in the treatment of conditions that require costly treatment PROVIDER shall not assign a consumer to any practitioner who has not fully complied with credentialing process as outlined in the MDHHS Credentialing and Re-credentialing Process (Attachment P7.1.1Provider Credentialing), the MDHHS-BHDDA Substance Abuse Disorder Policy Manual – Credentialing and Staff Qualification Requirements (Attachment P.II.B.A of the MDHHS/PIHP Contract), and MSHN Credentialing and Recredentialing policies and procedures. Rendering providers must meet qualifications outlined in MDHHS Michigan PIHP/CMHSP Behavioral Health Code Sets, Charts, and Provider Qualifications per Medicaid Services & HCPCS/CPT CodesQualifications. PROVIDER staff cannot provide services if they are not certified or do not have a registered development plan with MCBAP. Staff in this situation must complete a Temporary Privileging Form. The privileging form must be completed and submitted to MSHN along with a completed development plan application before staff can render services. This form must be signed by the requesting staff person and program director. If a request is received by a PROVIDER outside the MSHN twenty-one county region, MSHN will accept the PROVIDER’s Home PIHP’s PIHP temporary privileging form. If the PROVIDER’s Home PIHP does not require one, then MSHN’s temporary privileging form must be submitted. PROVIDER must notify MSHN once the staff member has achieved certification and/or had their plan registered with MCBAP. MSHN retains the right to approve, suspend or terminate providers from participation in the Medicaid-funded services (e.g., exclusions from Medicare/Medicaid; specific regional performance issues and/or criminal convictions under sections 1128(a) and 1128(b)(1)(2) or (3). PROVIDER acknowledges and agrees MSHN or any representative agent shall have the right to review and inspect records related to credentialing activities maintained by PROVIDER relative to its staff and contracted personnel/agencies. To the extent permitted by law, PROVIDER shall make such records available to MSHN or any representative agent and any governmental agency without charge to MSHN.

Rendering Provider Credentialing and Recredentialing. PROVIDER agrees to meet MSHN XXXX and MDHHS credentialing and recredentialing requirements, required criminal background checks, and accepts and shall abide by all credentialing policies and procedures. The PROVIDER shall ensure, through credentialing, that the PROVIDERS’s staff professionals and the PROVIDER’s subcontractors and their staff professionals have obtained and maintain all approvals, certifications and licenses required by Federal, State and local laws, ordinances, rules and regulations to practice their professions in the State of Michigan and to perform Medicaid supports/services hereunder. PROVIDER shall ensure credentialing and re-credentialing processes do not discriminate against: a. A health care professional solely on the basis of license, registration or certification; b. A health care professional who serves high-risk populations or who specializes in the treatment of conditions that require costly treatment PROVIDER shall not assign a consumer to any practitioner who has not fully complied with credentialing process as outlined in the MDHHS Credentialing and Re-credentialing Process (Attachment P7.1.1), the MDHHS-BHDDA Substance Abuse Disorder Policy Manual – Credentialing and Staff Qualification Requirements (Attachment P.II.B.A of the MDHHS/PIHP Contract), and MSHN Credentialing and Recredentialing policies and procedures. Rendering providers must meet qualifications outlined in MDHHS Michigan PIHP/CMHSP Provider Qualifications per Medicaid Services & HCPCS/CPT Codes. PROVIDER staff cannot provide services if they are not certified or do not have a registered development plan with MCBAP. Staff in this situation must complete a Temporary Privileging Form. The privileging form must be completed and submitted to MSHN along with a completed development plan before staff can render services. This form must be signed by the requesting staff person and program director. If a request is received by a PROVIDER outside the MSHN twenty-one county region, MSHN will accept the PROVIDER’s Home PIHP’s privileging form. If the PROVIDER’s Home PIHP does not require one, then MSHN’s must be submitted. PROVIDER must notify MSHN once the staff member has achieved certification and/or had their plan registered with MCBAP. MSHN retains the right to approve, suspend or terminate providers from participation in the Medicaid-funded services (e.g., exclusions from Medicare/Medicaid; specific regional performance issues and/or criminal convictions under sections 1128(a) and 1128(b)(1)(2) or (3). PROVIDER acknowledges and agrees MSHN or any representative agent shall have the right to review and inspect records related to credentialing activities maintained by PROVIDER relative to its staff and contracted personnel/agencies. To the extent permitted by law, PROVIDER shall make such records available to MSHN or any representative agent and any governmental agency without charge to MSHN.

Rendering Provider Credentialing and Recredentialing. PROVIDER agrees to meet MSHN XXXX and MDHHS credentialing and recredentialing requirements, required criminal background checks, and accepts and shall abide by all credentialing policies and procedures. The PROVIDER shall ensure, through credentialing, that the PROVIDERS’s staff professionals and the PROVIDER’s subcontractors and their staff professionals have obtained and maintain all approvals, certifications and licenses required by Federal, State and local laws, ordinances, rules and regulations to practice their professions in the State of Michigan and to perform Medicaid supports/services hereunder. PROVIDER shall ensure credentialing and re-credentialing processes do not discriminate against: a. A health care professional solely on the basis of license, registration or certification; b. A health care professional who serves high-risk populations or who specializes in the treatment of conditions that require costly treatment PROVIDER shall not assign a consumer to any practitioner who has not fully complied with credentialing process as outlined in the MDHHS Credentialing and Re-credentialing Process (Attachment P7.1.1Provider Credentialing), the MDHHS-BHDDA Substance Abuse Disorder Policy Manual – Credentialing and Staff Qualification Requirements (Attachment P.II.B.A of the MDHHS/PIHP Contract), and MSHN Credentialing and Recredentialing policies and procedures. Rendering providers must meet qualifications outlined in MDHHS Michigan PIHP/CMHSP Behavioral Health Codes Sets, Charts, and Provider Qualifications per Medicaid Services & HCPCS/CPT CodesQualifications. PROVIDER staff cannot provide services if they are not certified or do not have a registered development plan with MCBAP. Staff in this situation must complete a Temporary Privileging Form. The privileging form must be completed and submitted to MSHN along with a completed development plan application before staff can render services. This form must be signed by the requesting staff person and program director. If a request is received by a PROVIDER outside the MSHN twenty-one county region, MSHN will accept the PROVIDER’s Home PIHP’s temporary privileging form. If the PROVIDER’s Home PIHP does not require one, then MSHN’s temporary privileging form must be submitted. PROVIDER must notify MSHN once the staff member has achieved certification and/or had their plan registered with MCBAP. PROVIDER acknowledges and agrees MSHN or any representative agent shall have the right to review and inspect records related to credentialing activities maintained by MSHN retains the right to approve, suspend or terminate providers from participation in the Medicaid-funded services (e.g., exclusions from Medicare/Medicaid; specific regional performance issues and/or criminal convictions under sections 1128(a) and 1128(b)(1)(2) or (3). PROVIDER acknowledges and agrees MSHN or any representative agent shall have the right to review and inspect records related to credentialing activities maintained by PROVIDER relative to its staff and contracted personnel/agencies. To the extent permitted by law, PROVIDER shall make such records available to MSHN or any representative agent and any governmental agency without charge to MSHN.

Rendering Provider Credentialing and Recredentialing. PROVIDER agrees to meet MSHN and MDHHS credentialing and recredentialing requirements, required criminal background checks, and accepts and shall abide by all credentialing policies and procedures. The following background checks are required initially for each new employee: a. Criminal history- Internet Criminal History Access Tool (ICHAT) or from a source that reveals substantially similar information found on an ICHAT. xxxxx://xxxx.xxxxxxxx.xxx b. Michigan Public Sex Offender Registry: xxxxx://xxxxxx.xxx c. National Sex Offender Registry: xxxxx://xxx.xxxxx.xxx/ d. MDHHS Central Registry Check is required for staff working directly with children. xxxxx://xxx.xxxxxxxx.xxx/mdhhs/adult-child-serv/abuse- neglect/accordion/forms/central-registry-clearance-requests The criminal history check must be completed at minimum, every two years. All other checks listed are required only initially. Use information from the Medicaid Provider Manual (General Information for Providers; Section 6 – Denial of Enrollment, Termination, and Suspension; Item 6.1 Termination or Denial of Enrollment) and the Social Security Act (Subsection 1128(a)(b)), to determine whether to prohibit any employee from working within a publicly funded healthcare system. PROVIDER shall ensure, through credentialing, that the PROVIDERS’s staff professionals and the PROVIDER’s subcontractors and their staff professionals have obtained and maintain all approvals, certifications and licenses required by Federalfederal, State state and local laws, ordinances, rules and regulations to practice their professions in the State state of Michigan and to perform Medicaid supports/services hereunder. PROVIDER shall ensure credentialing and re-credentialing processes do not discriminate against: a. A health care professional solely on the basis of license, registration or certification;; or b. A health care professional who serves high-risk populations or who specializes in the treatment of conditions that require costly treatment PROVIDER shall not assign a consumer to any practitioner who has not fully complied with credentialing process as outlined in the MDHHS Credentialing and Re-credentialing Process (Attachment P7.1.1Provider Credentialing), the MDHHS-BHDDA Substance Abuse Disorder Policy Manual – Credentialing and Staff Qualification Requirements (Attachment P.II.B.A of the MDHHS/PIHP Contract)Requirements, and MSHN Credentialing and Recredentialing policies and procedures. Rendering providers Providers must meet the qualifications outlined in MDHHS Michigan PIHP/CMHSP Behavioral Health Codes Sets, Charts, and Provider Qualifications per Medicaid Services & HCPCS/CPT Codes. PROVIDER staff cannot provide services if they are not certified or do not have a registered development plan with MCBAP. Staff in this situation must complete a Temporary Privileging Form. The privileging form must be completed and submitted to MSHN along with a completed development plan before staff can render services. This form must be signed by the requesting staff person and program director. If a request is received by a PROVIDER outside the MSHN twenty-one county region, MSHN will accept the PROVIDER’s Home PIHP’s privileging form. If the PROVIDER’s Home PIHP does not require one, then MSHN’s must be submitted. PROVIDER must notify MSHN once the staff member has achieved certification and/or had their plan registered with MCBAPQualifications. MSHN retains the right to approve, suspend or terminate providers from participation in the Medicaid-funded services (e.g., exclusions from Medicare/Medicaid; specific regional performance issues and/or criminal convictions under sections 1128(a) and 1128(b)(1)(2) 1128(b)(1),(2), or (3). PROVIDER acknowledges and agrees MSHN or any representative agent shall have the right to review and inspect records related to credentialing activities maintained by PROVIDER relative to its staff and contracted personnel/agencies. To the extent permitted by law, PROVIDER shall make such records available to MSHN or any representative agent and any governmental agency without charge to MSHN.