Common use of Facilities and Resources Clause in Contracts

Facilities and Resources. MCO shall provide directly, or indirectly by contract, the following: a. Sufficient numbers of experienced and qualified utilization and care management staff to meet the terms of this Contract. Utilization managers and care managers for individuals with mental health/substance abuse needs shall be at minimum Master’s level Behavioral Health professionals licensed by the State of North Carolina with a minimum of two years post-Master’s experience in a clinical setting with the population served. Utilization managers and care managers for developmental disabilities services shall be completed by a Qualified Professional in the area of Developmental Disabilities as specified in 42 CFR 483.430 (a) and N.C. Gen. Stat. §122C-3; b. A designated emergency service facility providing care 24 hours per day, seven days per week; c. Facilities that meet the applicable Federal, State, and local requirements pertaining to health care facilities and laboratories. All clinical laboratory testing sites shall have a CLIA identification number and either a CLIA certificate of compliance, a CLIA certificate of registration, or a CLIA certificate of waiver; d. A telecommunications system sufficient to meet the needs of Enrollees 24 hours per day, seven days per week. The system shall have an intake line with clinical back-up by a licensed Master’s level clinician 24 hours per day, seven days per week; e. Sufficient support staff; f. A physician, licensed in the State of North Carolina and board certified in psychiatry, to serve as Medical Director. The Medical Director shall oversee and be responsible for the proper authorization and review of covered services to Enrollees. The Medical Director shall ensure that all staff conducting reviews operate within the scope of their areas of clinical expertise; g. A full-time contract manager with at least seven years of management experience, preferably in human services; h. One full time director of management information systems with a minimum of five years experience in data management and IT project management in health care; i. A full-time utilization management director that is a masters-level clinician licensed in North Carolina and has a minimum of five years utilization review and management experience in mental health, developmental disabilities and substance abuse care; j. A full time Clinical Director for Innovations (I/DD) services that has a minimum of seven years utilization review , care management, and/or habilitative and case management experience in developmental disabilities care; k. A full-time quality management director with at least five years recent quality management experience and two years managed care experience or experience in mental health, developmental disabilities and substance abuse care. The Quality Assurance Director shall have a Bachelor’s Degree in a Human Services Field or a Master's Degree in a human services field. l. A full-time finance director with at least seven years experience managing progressively larger budgets; m. A full-time provider network director that is a licensed clinician with at least five years combined clinical, network operations, provider relations and management experience; n. A full-time customer services director with at least five years combined customer service, clinical and management experience;

Facilities and Resources. MCO The LME shall provide directly, or indirectly by contract, the following: a. Sufficient numbers of experienced and qualified utilization and care management staff to meet the terms of this Contract. Utilization managers and care managers for individuals with mental health/substance abuse needs shall be at minimum Master’s level Behavioral Health professionals licensed by the State of North Carolina with a minimum of two years post-Master’s experience in a clinical setting with the population servedsetting. Utilization managers and care managers Authorization for developmental disabilities services shall be completed by a Qualified Professional in the area of Developmental Disabilities as specified in 42 CFR 483.430 (a) and N.C. Gen. Stat. §122C-3; b. A designated emergency service facility providing care 24 hours per day, seven days per week; c. Facilities that meet the applicable Federal, State, and local requirements pertaining to health care facilities and laboratories. All clinical laboratory testing sites shall have a CLIA identification number and either a CLIA certificate of compliance, a CLIA certificate of registration, or a CLIA certificate of waiver; d. A telecommunications system sufficient to meet the needs of Enrollees 24 hours per day, seven days per week. The system shall have an intake line with clinical back-up by a licensed Master’s level clinician 24 hours per day, seven days per week; e. Sufficient support staff; f. A physician, licensed in the State of North Carolina and board certified in psychiatry, to serve as Medical Director. The Medical Director shall oversee and be responsible for the proper authorization and review of covered services to Enrollees. The Medical Director shall ensure that all staff conducting reviews operate within the scope of their areas of clinical expertise; g. A full-time contract manager with at least seven years of management experience, preferably in human services; h. One full A full-time director of management information systems with a minimum of five two years experience in data management for health care , and IT project management in health careinformation systems staff qualified to provide necessary and timely reports and encounter data to DMA; i. A full-time utilization review/management director that is a masters-level clinician licensed in North Carolina and has a minimum of five years utilization review and management experience in mental health, developmental disabilities and substance abuse care; j. A full time Clinical Director for Innovations (I/DD) services Utilization management and care management staff with expertise that has a minimum reflects the prevalent disorders of seven years utilization review , care management, and/or habilitative and case management experience in developmental disabilities carethe populations served; k. A full-time quality management director director, that is preferably a licensed clinician, with at least five years recent quality management experience and two years managed care experience or experience in mental health, developmental disabilities and substance abuse care. The Quality Assurance Director shall have a Bachelor’s Degree in a Human Services Field or a Master's Degree in a human services field. l. A full-time finance director with at least seven years experience managing progressively larger budgets; m. A full-time provider network director that is a licensed clinician with at least five years combined clinical, network operations, provider relations and management experience; n. A full-time customer services director with at least five years combined customer service, clinical and management experience;