Keywords: Discipline, Credentialing, Criteria, Practitioner
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1 Page 1 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s I. Purpose: A. To establish policy and procedure that ensures VOC Mental Health and Substance Abuse (MHSA) and Employee Assistance Program (EAP) practitioner applicants and network participants meet ValueOptions of California (VOC) credentialing and recredentialing criteria, including the primary source verification process. B. This policy replaces ValueOptions, Inc. (VOI) policy N205. II. Departments and Committee(s) Affected: A. VOC Credentialing Committee B. VOC Quality Management Committee and Sub-committees C. VOC Network Operations D. VOC Provider Relations E. VOI National Credentialing Committee F. VOI Network Operations G. VOI Company Quality Council (CQC) and Sub-committees III. Policy: A. It is the policy of VOC that a practitioner applicant must meet, at a minimum, the established discipline specific credentialing and recredentialing criteria for VOC network participation. In addition, applicants must demonstrate compliance with applicable California licensure statues and regulations, professional training and work history that meet VOC s standard criteria. VOC credentials individual practitioners who provide service to its members in a setting independent of an inpatient hospital or facility/organization. s who have dedicated their
2 Page 2 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s practice to an inpatient setting and/or other alternative levels of care and render services within a participating facility/organization that exclude professional fees are authorized to be credentialed and contracted as an independent practitioner. IV. Criteria: A. The following criteria applies to all practitioners serving the ValueOptions of California Mental Health and Substance Abuse and/or Employee Assistance Program networks: Accessible twenty-four (24) hours a day, seven (7) days a week, and agree to make appointments available within the following guidelines: - Life threatening emergency seen immediately - Non-life threatening emergency seen within 6 hours of the request - Urgent Care Appointments within 24 hours of the request - Routine MHSA Appointments within seven (7) calendar days of the request - Routine EAP Appointments within seven (7) calendar days of the request B. All practitioners must meet the following criteria in order to participate in the VOC MHSA and/or EAP networks as applicable. Refer to VOC Policy N605.VOC Exceptions to VOC Credentialing Criteria for any exceptions. 1. Psychiatrists a) Must possess a Doctor of Medicine (MD) degree or Doctor of Osteopathy (DO) degree from an accredited medical school. b) Board certified in psychiatry as defined by the American Board of Psychiatry and Neurology (ABPN) OR the American Osteopathic Board of Psychiatry and Neurology (AOBPN), OR certified by the American Society of Addiction Medicine (ASAM) or the American
3 Page 3 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s Board of Psychiatry and Neurology in Addiction Medicine OR completed a three (3) year psychiatry residency training program approved by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA). c) Licensed to practice medicine in California. d) Must possess a current Drug Enforcement Administration (DEA) Certificate. e) State Controlled Substance Registration Certificate (where applicable). f) Foreign medical school graduates must submit an Educational Commission for Foreign Medical Graduates (ECFMG) Certificate. g) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. Copy of current 2. Addictionologist (non-psychiatrist) a) Must possess a Doctor of Medicine (MD) degree or Doctor of Osteopathy (DO) degree from an accredited medical school. b) Certified by the American Board of Psychiatry and Neurology (ABPN) or the American Osteopathic Board of Psychiatry and Neurology (AOBPN) with added qualification in addiction psychiatry or completed a three- (3) year residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).
4 Page 4 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s c) Certified by the America Society of Addiction Medicine (ASAM) as an addiction s specialist. d) Licensed to practice medicine in California. e) Must possess a current Drug Enforcement Administration (DEA) Certificate. f) State Controlled Substance Registration Certificate (where applicable) g) Graduates of foreign medical schools must submit an Educational Commission for Foreign Medical Graduates (ECFMG) Certificate. h) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. Copy of current face sheet must be included (must indicate applicant as the 3. Developmental Behavioral Pediatrician a. Must possess a Doctor of Medicine (MD) degree or Doctor of Osteopathy (DO) degree. b. Completed a pediatric residency from an Accreditation Council Graduate Medical Education (ACGME) accredited residency program c. Completed a two year accredited Developmental Behavioral Fellowship. Prior to availability of accreditation, documentation of an accepted application to sit for the Sub-Board of Developmental Behavioral Pediatrics or an attestation from the fellowship director that the fellowship was completed and provided developmental behavioral training will be sufficient.
5 Page 5 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s d. Board Certified in pediatrics as defined by the American Board of Pediatrics (ABP). e. Board Certified in Developmental Behavioral Pediatrics by the Sub- Board of Developmental Behavioral Pediatrics within three years of credentialing or within two years of the first available exam whichever is later. f. Licensed to practice medicine in California g. Graduates of foreign medical schools must submit an Educational Commission for Foreign Medical Graduates (ECFMG) certificate. h. Possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. Copy of current 4. Psychologists a) Doctoral degree (PhD, EdD, PsyD) in clinical psychology or counseling psychology from an accredited college or university and meet one of the following: (1) Doctorate degree received from a college or university program on the American Psychological Association (APA) accredited list of counseling psychology or clinical psychology programs or, (2) Completion of a pre-doctoral APA approved clinical internship at the time of graduation or, (3) Listed in the National Register of Health Services Providers in Psychology or,
6 Page 6 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s (4) Be a diplomat with the American Board of Professional Psychology (ABPP) under the clinical psychology or counseling psychology categories. b) Licensed independently as a clinical psychologist at the highest level in California. c) All provider applicants must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care. VOC will consider other post licensure experience at the highest degree level. d) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Copy of current 5. Social Worker a) Master's degree or higher from a graduate school of social work accredited by the Council on Social Work Education (CSWE). b) Licensed or certified to practice at the highest level of independent practice in California. c) All provider applicants must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care. d) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Copy of current
7 Page 7 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s 6. Advanced Practice Nurse, APN (Clinical Nurse Specialist or Nurse ) a) Master's degree or higher in nursing from an accredited college or university recognized by the National League for Nursing or Commission on Collegiate Nursing Education, OR must meet licensing requirements acceptable by the board to practice at the highest level of independent practice in California. b) Licensed at the highest level of independent practice in California. c) Must possess a current Drug Enforcement Administration (DEA) Certificate (if applicable for prescriptive authority) d) Must possess a current State Controlled Dangerous Substances (CDS) registration (if applicable for prescriptive authority) e) Prescription Number or Certificate issued to APN in order to provide prescriptive authority (if applicable for prescriptive authority) f) Board Certified by the American Nurses Credentialing Center (ANCC) in one of the following areas: (1) Clinical Specialist in Adult Psychiatric and Mental Health Nursing, or (2) Clinical Specialist in Child and Adolescent Psychiatric and Mental Health Nursing, or (3) Family Psychiatric and Mental Health Nurse, or (4) Adult Psychiatric and Mental Health Nurse. g) All provider applicants must have a minimum of three (3) years post-licensure experience in a mental health/substance abuse setting providing direct patient care
8 Page 8 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s h) Required to maintain compliance with collaboration/supervision licensing requirements issued in California. Where required, the APN must be supervised by a psychiatrist (MD or DO) and submit a copy of the agreement. i) APN with prescriptive authority must possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. APN without prescriptive authority must possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Copy of current 7. Marriage & Family Therapist a) Master s degree or higher in a mental health discipline. b) Licensed or certified at the highest level of independent practice in California. c) All provider applicants must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care. VOC will consider other post licensure experience at any master level. d) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Copy of current 8. Pastoral Counselors a) Master s degree or higher in mental health discipline.
9 Page 9 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s b) Must be licensed in one of the disciplines recognized by ValueOptions of California at the highest level of independent practice in California and meet VOC credentialing criteria. c) All provider applicants must have a minimum of three (3) years post-licensure clinical experience in mental health/substance abuse setting providing direct patient care. d) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Copy of current 9. EAP Counselors a) Must be licensed in one of the disciplines recognized by ValueOptions of California at the highest level of independent practice in California and meet ValueOptions of California credentialing criteria. b) All eligible provider applicants (with the exception of an MD or DO) must have a minimum of three (3) years post licensure experience in a mental health/substance abuse/eap setting providing direct patient care. c) Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Copy of current face sheet must be included (must indicate applicant as the d) Possess knowledge and work experience of EAP Core Technology as indicated by: 1) Active status as a Certified Employee Assistance Professional (CEAP); or
10 Page 10 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s 2) Two (2) years of verifiable experience as an internal EAP counselor, and/or as an external EAP consultant to other organizations. Examples of verifiable experience include but are not necessarily limited to: (a) Management and/or union representative consultation on the impact of personal problems on performance issues, the appropriate use of constructive confrontation and the role of the EAP. (b) Direct care functions of an EAP practice including assessment and referral, short-term counseling and linkages to treatment and/or community resources. (c) Crisis Intervention including critical incident stress management (CISM) services (d) Training and experience in organizational dynamics/development, human resource management or industrial social work/psychology. (e) Assessment and identification of drug and alcohol abuse/dependency problems and appropriate treatment interventions. e) Possess knowledge and work experience in the assessment and treatment of substance abuse as indicated by: (1) Active status as a Certified Employee Assistance Professional (CEAP) with an acceptable level of experience in the assessment and/or treatment of chemical dependency: or (2) Possess one (1) year of experience in a substance abuse treatment facility: or
11 Page 11 of 11 3/13/2006, 6/19/2006, 8/14/2006, Recredentialing Criteria for s (3) Completed a state-level certification acceptable to support eligibility for the National Certified Addiction Counselor (NCAC) credential; or (4) Possess International Certified Alcohol and Drug Counselor Certification (ICADC); or (5) Possess a minimum of six (6) units of continuing education (CEU s, PDH s, etc) in chemical dependency assessment/treatment; or (6) Completed three (3) graduate level hours of course work in chemical dependency
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