Common use of Provider Qualifications Clause in Contracts

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. 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 : a) Director b) Clinic Coordinator Coordinator c) Community Recovery Specialist Specialist d) Peer Recovery Specialist Specialist e) Mental Health Professional Professional f) Registered Nurse Nurse g) Advanced Practice Nurse Prescriber Prescriber h) Medical Director Director i) Other professional and/or para-professional staff as required to meet the needs of the members. Certified Peer Specialist Services The HMO PIHP 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 WI FCMH PIHP 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 PIHP 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 PIHP 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.