SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery P age 11 of 5 Department Policy and Procedure Section Sub-section Policy Policy# Quality Care Management General Contracted Provider Relations 4.012 Effective: 7/1/2004 Last Revised: 6/14/2017 Director's Approval Chief Quality Care and Strategy Officer Supersedes: Alice Gleghorn, PhD Suzanne Grimmesey, MFT #24 - Provider Relations Date 7.-7:-.1 7 - Audit 61 f 4/2020 Date: 1. PURPOSE/SCOPE 1.1. To ensure monitoring of contracted provider (1) satisfaction; (2) documentation training and completion; (3) selection, retention, credentialing and re-credentialing; and (4) timely access to services in accordance with requirements set by the Department of Health Care Services (DHCS) and Title 9 regulations. 2. POLICY 2.1. The (hereafter "the Department") has a monitoring system in place to ensure all contracted providers are in compliance with regulatory requirements. 2.2. This policy applies to all contracted providers, including network providers and community-based organizations (CBOs) who provide Specialty Mental Health Services (SMHS). 3. DEFINITIONS 3.1. Community-based organizations (CBOs) - entities contracted to provide Specialty Mental Health Services (SMHS) and programs for individuals with moderate-to-severe conditions. 3.2. Network providers - a pool of mental health providers/practitioners contracted with the Department to provide outpatient brief therapy for Medi-Cal beneficiaries for specialty mental health needs. This network of providers may include individual, group and organizational providers.
Contracted Provider Relations Page I 2 of 5 3.3. Outpatient brief therapy - treatments and services that address functional impairments and/or prevent or slow further deterioration of a patient's mental health condition. Brief therapy may not exceed 12 sessions without authorization. 4. ASSESSMENT AND PROVIDER SATISFACTION 4.1. The Department conducts a satisfaction survey at least every two (2) years for contracted providers using the Provider Satisfaction Survey (see Attachment A) form. The Department uses this information to identify problem areas and address identified items of dissatisfaction. 5. MONITORING OF DOCUMENTATION AND CERTIFICATION REQUIREMENTS 5.1. The Department monitors all contracted providers to ensure compliance with regulatory documentation standards. 1. All contracted providers are required to complete annual documentation training provided by the Department as indicated in the "Mandatory Training" policy. This requirement is noted in all provider contracts and monitored by the Quality Care Management (QCM) division. A schedule of trainings can be accessed on the Department's website via this link: http://countyofsb.org/behavioralwellness/training-calendar.sbc. a. Network Providers Only: Individual network providers are required to attend the assessment portion of the Medi-Ca/ Clinical Assessment and Treatment Planning Training only. 5.2. The Department monitors all contracted providers to ensure compliance with regulatory certification and re-certification timelines and requirements. 1. QCM maintains a database of all contracted network and community-based providers including recertification dates for all contracted providers. 6. PROVIDER SELECTION AND RETENTION (CFR, Title 42, Section 438.214 (a-e)) 6.1. The Department verifies current licensure, waiver, and registrations for all contracted providers and staff providing Specialty Mental Health Services (SMHS) on an annual basis. 1 6.2. The Department recertifies all contracted community-based providers every three (3) years from the date of initial contract (CCR, Title 9, Chapter 11, Section 1810.435). Network providers are recertified every two (2) years. 2 1 Please see policy QCM-4.015 "Staff Credentialing and Licensing" for further details on verification of eligibility, credentialing, and licensing. 2 Please see policy 58 "Site Certification" for further details for recertification requirements.
Contracted Provider Relations P age I 3 of 5 6.3. The selection process does not discriminate against providers who treat high users/high-cost clients or against providers solely based on their type of license/certification. 6.4. The Department does not employ or contract with providers excluded from participation in federal health care programs under Section 1128 or Section 1128a of the Social Security Act. Contracted providers are screened initially and annually thereafter to identify violations including, but not limited to, the following: conviction of health carerelated crime, patient abuse, health care fraud, and use of controlled substances. 6.5. Contracted providers selected to join the Medi-Cal Mental Health Plan (MHP) to deliver SMHS will receive a welcome letter and an information packet. All materials intended for beneficiaries will be provided in English and Spanish. The information packet includes the following: 1. Provider Brochure 2. Beneficiary Brochure 3. Directory of Network Providers 4. Problem Resolution Process Posters 5. Grievances and Appeals Forms with self-addressed envelopes 6. Poster informing of free interpreter services 7. Advance Directives Pamphlet 6.6. The Department will send written notification to all providers not selected to join or renew their contract with the Department. This notification letter will identify reasons for lack of contract or severance of contract. 6.7. The Department will comply with any additional requirements established by the State, pending notification. 7. MONITORING OF ACCESS AND AVAILABILITY TO SERVICES 7.1. The Department monitors all contracted providers to ensure compliance with state standards for timely access to services, taking into account the urgency of need for such services. In compliance with regulatory standards, the Department has in place a 24/7 Access Line for routine, urgent and emergency conditions. 7.2. Per Department provider contracts, the contracted provider is required to make initial contact with the accepted referred client within 72 hours of the referral. Providers are notified of county-established standards for timeliness of routine appointments through an annual mailing of the Provider Brochure. 1. Network Providers Only: On a monthly basis, network providers will submit the Network Provider Referral and Contact Log (see Attachment B) to QCM. This log compiles the date of referral to the network provider and the date of first contact
Contracted Provider Relations Page 14 of 5 made by the network provider. For clients who self-refer, the log will capture the date of first contact made by the client. QCM will submit a report analysis of the Network Provider Referral and Contact Logs to the Quality Improvement Committee (QIC) on a quarterly basis. 8. COMPLIANCE AND CORRECTIVE ACTIONS 8.1. Contracted providers who are identified as operating outside of the federal and state compliance standards are notified and asked to rectify the areas in which they are out of compliance. A copy of this notification is placed in the provider file. QCM will contact providers to ensure corrections are made within 30 calendar days of receipt of notice. 8.2. Following the 30 day period of review, if a provider is unable to fulfill contractual obligations regarding compliance, the QCM Program Manager, Chief of Compliance and the provider will meet to identify barriers to compliance. If an agreement is reached, the provider will have 15 calendar days to furnish proof of compliance. If an agreement is not attained, the issue will be referred to the Department's Leadership Team for review and a determination of appropriate action, including, but not limited to, suspension of referrals to the individual or community-based provider, decision to decertify, or termination of contract. ASSISTANCE Deana Huddleston, MFT, Quality Care Management Program Manager Suzanne Grimmesey, Chief Quality Care and Strategy Officer REFERENCE California Code of Regulations Title 9, Chapter 11, Sections 1810.315, 1810.110, 1810.435, 1810.345 & 1810.405 Code of Federal Regulations Title 42, Sections 438.206, 438.214 (a-e) and 438.230 Social Security Act Title 11, Sections 1128 and 1128A ATTACHMENTS Attachment A - Provider Satisfaction Survey Attachment B - Network Provider Referral and Contact Log
Contracted Provider Relations Pa ge I 5 of 5 REVISION RECORD DATE VERSION REVISION DESCRIPTION 3/1/17 2.0 Updates on network provider requirements,.. rev1s1ons made to attachments and new departmental template. 6/5/17 2.1 Section 5.1.1 - completion of annual documentation training requirement will be monitored by QCM. Section 8.1 - QCM will contact providers to ensure corrections to any identified compliance issues are made within 30 calendar days of receipt of notice. Culturally and Linguistically Competent Policies The Department of Behavioral Wellness is committed to the tenets of cultural competency and understands that culturally and linguistically appropriate services are respectful of and responsive to the health beliefs, practices and needs of diverse individuals. All policies and procedures are intended to reflect the integration of diversity and cultural literacy throughout the Department. To the fullest extent possible, information, services and treatments will be provided (in verbal and/or written form) in the individual's preferred language or mode of communication (i.e. assistive devices for blind/deaf).