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Mental Health Partners
will procure and oversee a provider network to serve persons with mental
health, developmental disabilities and substance abuse needs within Burke
and Catawba Counties. The Area Director delegates provider/service
procurement to the Provider Relations Unit through supervision and
oversight. Mental Health Partners and the Network Providers’ rights and
responsibilities are clearly and separately outlined in the NC Division of
MH/DD/SA Services’ State standardized contract and/or Memorandum of
Agreement.
POLICY: It
shall be the policy of Mental Health Partners that all
providers seeking to do business with the LME and be a part of the provider
network fall into one of the following categories:
·
Have the ability to provide state dollar services to
Burke/Catawba consumers
·
Have the ability to be Direct Enrolled with the Division of
Medical Assistance and deliver Medicaid services to Burke/Catawba consumers
PROCEDURE: Mental Health Partners
requires that providers submit and maintain the LME Network Application with
required attachments for review and processing:
1)
National accreditation, if applicable
2)
Certification, if applicable
3)
Fiscal stability
4)
Fiscal responsibility
5)
A commitment to consumer choice
6)
Capacity to provide access to services within Burke and Catawba
counties
7)
The ability to deliver services to defined populations
8)
Licensure, if applicable
9)
Insurance coverage as applicable
10)
Endorsement
11)
Direct enrollment
12)
NPI
Prior to accepting a new contract provider,
the LME will assess funding availability and current network capacity for
the requested service/population.
Prior to accepting a new MOA provider, the
LME will apply the 30 miles/30 minute rule to assess whether or not the
provider’s location is within adequate range to serve consumers in the MHP
catchment area.
Further, the LME will assess whether or not out of
area providers have a current catchment area consumer referral prior to
accepting any out of catchment area providers into the network.
Once the provider application package has been
processed and approved/denied, the provider will be notified of the LME
decision in writing, specifying reasons for acceptance or denial.
Mental Health Partners will ensure maintenance of
the application requirements through routine monitoring of all network
providers.
Required Network Provider Criteria Attachment Corporate Application
Required Network Provider Criteria Attachment Form A
Required Network Provider Criteria Attachment Form B |
