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1 PROVIDER CREDENTIALING & RE-CREDENTIALING CRITERIA MEDICAID Credentialing & Re-Credentialing Criteria Medicaid qmc Page 1 of 15

2 Sandhills Center Credentialing Criteria Agency/Facility: The agency/facility must be established as a legally recognized entity in the United States and registered to do business as a corporate entity in the State of North Carolina The agency/facility must have a National Provider Indicator (NPI) number for all services that are Medicaid reimbursable The agency/facility must have a Division of Medical Assistance (DMA) number for all services that are Medicaid reimbursable. (Not applicable if a new agency/facility being credentialed for the first time for Medicaid reimbursable services) The agency/facility must have a Federal Tax Identification number Attest that staff meet the requirements specified in the attached definitions as required in the service specific credentialing criteria (attached) Agencies are responsible for supervising their own staff Attest to compliance with service specific credentialing criteria Not have current or previous censures, sanctions or exclusions from participation in the Medicare and Medicaid programs Agency/facility Insurance Requirements: An original Certificate of Liability Insurance demonstrating proof of compliance with insurance requirements. The following requirements are reflected in the Sandhills Center Service Agreement document. Provider shall have: a. Professional Liability: The CONTRACTOR shall purchase and maintain professional liability insurance protecting the CONTRACTOR and any employee performing work under the Contract for an amount of not less than $1,000, per occurrence and proof of coverage at or exceeding $3,000, in the annual aggregate. In the event that the CONTRACTOR discovers that a claim, suit of criminal/administrative proceeding has been brought or may be brought against the CONTRACTOR and/or Practitioner relating to the quality of services provided under this Agreement, then CONTRACTOR shall notify LME-MCO within ten (10) days and LME-MCO will determine whether to terminate this Agreement. b. Comprehensive General Liability: Bodily Injury and Property Damage Liability Insurance shall protect the CONTRACTOR and any employee performing work under the Contract from claims of Bodily Injury or Property Damage, which may arise from operations under the Contract. The amounts of such insurance shall not be less than $1,000, per Occurrence/$3,000, per Aggregate/$1,000, Personal and Advertising Injury/$50, Fire Damage. The insurance shall not include exclusion for contractual liability. Credentialing & Re-Credentialing Criteria Medicaid qmc Page 2 of 15

3 c. Automobile Liability: Automobile Bodily Injury and Property Damage Liability Insurance covering all owned, non-owned, and hired automobiles for limits of not less than $1,000, each person and $1,000, each occurrence of Bodily Injury Liability and $1,000, each occurrence of Property Damage Liability. Policies written on a combined single limit basis should have a limit of not less than $1,000, d. Workers Compensation and Occupational Disease Insurance: Insurance Coverage must meet the statutory requirements of the State of North Carolina; and Employer s Liability Insurance for an amount of not less than: Bodily Injury by Accident $100, each Accident, Bodily Injury by Disease $100, each Employee, and Bodily Injury by Disease $500, Policy Limit. e. Certificate of Coverage: The CONTRACTOR shall provide the LME-MCO with Certificates of Insurance Coverage consistent with the Contract within thirty (30) days following the effective date of the Contract and on an annual basis within ten (10) days of the anniversary date of the Contract, and shall provide a new Certificate within ten (10) days of the expiration date if the Insurance Certificate expires during the contract period. Certificates shall contain the provision that the LME- MCO is given thirty (30) days written notice of any intent to amend or terminate by either the CONTRACTOR or the insurance company. The CONTRACTOR shall notify the LME-MCO of any cancellation or material change, within forty-eight (48) hours, and within ten (10) days of any change in insurance provider during the period of the Contract. If the CONTRACTOR changes insurance providers during the performance period of the Contract, the CONTRACTOR shall provide evidence to the LME-MCO that the LME-MCO will be indemnified to the limits specified above for the entire performance period of the Contract, either under the policy or a combination of old and new policies. f. Tail Coverage: Liability insurance may be on either an occurrence basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail coverage) for a period of not less than three (3) years after the end of the contract term, or an agreement to continue liability coverage with a retroactive date on or before the beginning of the contract term, shall also be provided. g. Waivers of Subrogation: CONTRACTOR shall obtain and provide to LME-MCO waivers from CONTRACTOR S workers compensation and occupational disease and commercial general liability carriers of any right of recovery that such liability carriers may have because of payments made by them for injury or damage arising out of work done by CONTRACTOR under this Contract, including contract documents issued under this Contract such as an LME-MCO Service Authorization Request Form. Credentialing & Re-Credentialing Criteria Medicaid qmc Page 3 of 15

4 Sandhills Center Re-Credentialing Criteria Agency/Facility For Sandhills Center to re-credential a participating provider agency/facility, the provider must: Meet applicable Credentialing Criteria* Submit a re-credentialing application updating any information that is subject to change (example, licensure, board certification, liability claims history, disciplinary actions) Must be in good standing with Sandhills Center as demonstrated by: No current or previous censures, sanctions or exclusions from participation in the Medicare and Medicaid Programs. No unresolved Plans of Correction with the LME-MCO or regulatory agencies, and LME-MCO has no identified concerns related to timely reporting and response to incidents or complaints *Refer to Service Specific Credentialing Criteria Credentialing & Re-Credentialing Criteria Medicaid qmc Page 4 of 15

5 Individual Practitioner: Sandhills Center Credentialing Criteria Is enrolled with the Division of Medical Assistance (DMA) as an Outpatient Mental Health Provider Has an active license and/or certification in good standing with the appropriate governing authority in the state of North Carolina Has a Medicaid Identification Number Has a National Provider Identifier (NPI) number If a Doctor of Medicine has a DEA number Provides social security number or federal tax ID number Provides or has a written agreement with another entity for access to 24 hour coverage for emergency service. If a written agreement with another provider has been established the provider must be credentialed, be a member of the Sandhills Center Network, and have an equivalent degree, license, or higher Insurance Requirements: The CONTRACTOR shall purchase and maintain insurance as listed below from a company, which is licensed and authorized to do business in the State of North Carolina by the North Carolina Department of Insurance. Insurance policies shall require that the coverage cannot be suspended, voided, canceled or reduced in coverage or limits without thirty (30) days prior notice to the LME- MCO. Any loss of insurance shall be the basis of a payback to the LME-MCO for services billed during this period and may result in the termination of this Contract. All insurance requirements of this Contract must be fully met unless specifically waived in writing by LME-MCO. a. Professional Liability: The CONTRACTOR shall purchase and maintain professional liability insurance protecting the CONTRACTOR and any employee performing work under the Contract for an amount of not less than $1,000, per occurrence and proof of coverage at or exceeding $3,000, in the annual aggregate. In the event that the CONTRACTOR discovers that a claim, suit of criminal/administrative proceeding has been brought or may be brought against the CONTRACTOR and/or Practitioner relating to the quality of services provided under this Agreement, then CONTRACTOR shall notify LME-MCO within ten (10) days and LME-MCO will determine whether to terminate this Agreement. b. Comprehensive General Liability: Bodily Injury and Property Damage Liability Insurance shall protect the CONTRACTOR and any employee performing work under the Contract from claims of Bodily Injury or Property Damage, which may arise from operations under the Contract. The amounts of such insurance shall not be less than $1,000, per Occurrence/$3,000, per Aggregate/$1,000, Personal and Advertising Injury/$50, Fire Damage. The insurance shall not include exclusion for contractual liability. c. Automobile Liability: Automobile Bodily Injury and Property Damage Liability Insurance covering all owned, non-owned, and hired automobiles for limits of not less than $1,000, each person and $1,000, each occurrence of Bodily Injury Liability and $1,000, each occurrence of Property Damage Liability. Policies written on a combined single limit basis should have a limit Credentialing & Re-Credentialing Criteria Medicaid qmc Page 5 of 15

6 of not less than $1,000, Automobile Liability may be waived if the CONTRACTOR certifies to the LME-MCO in writing that an automobile is not used as part of their business. If the CONTRACTOR intends to use the CONTRACTOR S automobile for business, the CONTRACTOR must immediately notify the LME-MCO (prior to the change) of the intent and provide the required certificate of coverage. d. Workers Compensation and Occupational Disease Insurance: CONTRACTOR with three (3) or more employees shall secure Worker s Compensation and Occupational Disease Insurance. The insurance coverage must meet the statutory requirements of the State of North Carolina; and Employer s Liability Insurance for an amount of not less than: Bodily Injury by Accident $100, each Accident, Bodily Injury by Disease $100, each Employee, and Bodily Injury by Disease $500, Policy Limit. e. Certificate of Coverage: The CONTRACTOR shall provide the LME-MCO with Certificates of Insurance Coverage consistent with the Contract within thirty (30) days following the effective date of the Contract and on an annual basis within ten (10) days of the anniversary date of the Contract, and shall provide a new Certificate within ten (10) days of the expiration date if the Insurance Certificate expires during the contract period. Certificates shall contain the provision that the LME-MCO is given thirty (30) days written notice of any intent to amend or terminate by either the CONTRACTOR or the insurance company. The CONTRACTOR shall notify the LME-MCO in writing of any cancellation or material change, within forty-eight (48) hours, and within ten (10) days of any change in insurance provider during the period of the Contract. If the CONTRACTOR changes insurance providers during the performance period of the Contract, the CONTRACTOR shall provide evidence to the LME-MCO that the LME-MCO will be indemnified to the limits specified above for the entire performance period of the Contract, either under the policy or a combination of old and new policies. f. Tail Coverage: Liability insurance may be on either an occurrence basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail coverage) for a period of not less than three (3) years after the end of the contract term, or an agreement to continue liability coverage with a retroactive date on or before the beginning of the contract term, shall also be provided g. Waivers of Subrogation: CONTRACTOR shall obtain and provide to the LME-MCO waivers from CONTRACTOR S workers compensation and occupational disease and commercial general liability carriers of any right of recovery that such liability carriers may have because of payments made by them for injury or damage arising out of work done by the CONTRACTOR under this Contract, including Contract documents issued under this Contract such as an LME- MCO Service Authorization Request Form. Provider makes available information on office hours, clinical specialty areas, languages spoken, and special accommodations Attests to compliance with service specific criteria Not have current or previous censures, sanctions or exclusions from participation in the Medicare and Medicaid programs Credentialing & Re-Credentialing Criteria Medicaid qmc Page 6 of 15

7 Sandhills Center Re-Credentialing Criteria Individual Practitioner: For Sandhills Center to re-credential a participating individual practitioner as a provider, the provider must: Meet outpatient services criteria * Submit a re-credentialing application updating any information that is subject to change (ex. licensure, board certification, professional liability claims history, disciplinary actions) Not have current or previous censures, sanctions or exclusions from participation in the Medicare and Medicaid programs. Insurance Requirements: The CONTRACTOR shall purchase and maintain insurance as listed below from a company, which is licensed and authorized to do business in the State of North Carolina by the North Carolina Department of Insurance. Insurance policies shall require that the coverage cannot be suspended, voided, canceled or reduced in coverage or limits without thirty (30) days prior notice to the LME- MCO. Any loss of insurance shall be the basis of a payback to the LME-MCO for services billed during this period and may result in the termination of this Contract. All insurance requirements of this Contract must be fully met unless specifically waived in writing by LME-MCO. a. Professional Liability: The CONTRACTOR shall purchase and maintain professional liability insurance protecting the CONTRACTOR and any employee performing work under the Contract for an amount of not less than $1,000, per occurrence and proof of coverage at or exceeding $3,000, in the annual aggregate. In the event that the CONTRACTOR discovers that a claim, suit of criminal/administrative proceeding has been brought or may be brought against the CONTRACTOR and/or Practitioner relating to the quality of services provided under this Agreement, then CONTRACTOR shall notify LME-MCO within ten (10) days and LME-MCO will determine whether to terminate this Agreement. b. Comprehensive General Liability: Bodily Injury and Property Damage Liability Insurance shall protect the CONTRACTOR and any employee performing work under the Contract from claims of Bodily Injury or Property Damage, which may arise from operations under the Contract. The amounts of such insurance shall not be less than $1,000, per Occurrence/$3,000, per Aggregate/$1,000, Personal and Advertising Injury/$50, Fire Damage. The insurance shall not include exclusion for contractual liability. c. Automobile Liability: Automobile Bodily Injury and Property Damage Liability Insurance covering all owned, non-owned, and hired automobiles for limits of not less than $1,000, each person and $1,000, each occurrence of Bodily Injury Liability and $1,000, each occurrence of Property Damage Liability. Policies written on a combined single limit basis should have a limit of not less than $1,000, Automobile Liability may be waived if the CONTRACTOR certifies to the LME-MCO in writing that an automobile is not used as part of their business. If the CONTRACTOR intends to use the CONTRACTOR S automobile for business, the CONTRACTOR must immediately notify the LME-MCO (prior to the change) of the intent and provide the required certificate of coverage. Credentialing & Re-Credentialing Criteria Medicaid qmc Page 7 of 15

8 d. Workers Compensation and Occupational Disease Insurance: CONTRACTOR with three (3) or more employees shall secure Worker s Compensation and Occupational Disease Insurance. The insurance coverage must meet the statutory requirements of the State of North Carolina; and Employer s Liability Insurance for an amount of not less than: Bodily Injury by Accident $100, each Accident, Bodily Injury by Disease $100, each Employee, and Bodily Injury by Disease $500, Policy Limit. e. Certificate of Coverage: The CONTRACTOR shall provide the LME-MCO with Certificates of Insurance Coverage consistent with the Contract within thirty (30) days following the effective date of the Contract and on an annual basis within ten (10) days of the anniversary date of the Contract, and shall provide a new Certificate within ten (10) days of the expiration date if the Insurance Certificate expires during the contract period. Certificates shall contain the provision that the LME-MCO is given thirty (30) days written notice of any intent to amend or terminate by either the CONTRACTOR or the insurance company. The CONTRACTOR shall notify the LME-MCO in writing of any cancellation or material change, within forty-eight (48) hours, and within ten (10) days of any change in insurance provider during the period of the Contract. If the CONTRACTOR changes insurance providers during the performance period of the Contract, the CONTRACTOR shall provide evidence to the LME-MCO that the LME-MCO will be indemnified to the limits specified above for the entire performance period of the Contract, either under the policy or a combination of old and new policies. f. Tail Coverage: Liability insurance may be on either an occurrence basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail coverage) for a period of not less than three (3) years after the end of the contract term, or an agreement to continue liability coverage with a retroactive date on or before the beginning of the contract term, shall also be provided g. Waivers of Subrogation: CONTRACTOR shall obtain and provide to the LME-MCO waivers from CONTRACTOR S workers compensation and occupational disease and commercial general liability carriers of any right of recovery that such liability carriers may have because of payments made by them for injury or damage arising out of work done by the CONTRACTOR under this Contract, including Contract documents issued under this Contract such as an LME- MCO Service Authorization Request Form. Provider makes available information on office hours, clinical specialty areas, languages spoken, and special accommodations *Refer to outpatient services credentialing criteria Credentialing & Re-Credentialing Criteria Medicaid qmc Page 8 of 15

9 Sandhills Center Credentialing Criteria Hospital: The hospital must be accredited by The Joint Commission The hospital must have a National Provider Indicator (NPI) number for all services that are Medicaid reimbursable The hospital must have a Division of Medical Assistance (DMA) number for all services that are Medicaid reimbursable The hospital must have a Federal Tax Identification number Hospitals are responsible for credentialing and supervising their own inpatient staff. NOTE: If the Hospital has a Behavioral Health outpatient clinic it is the responsibility of the hospital to ensure that each Practitioner completes and submits the Uniform Application to Participate as a Health Care Practitioner. Attest to compliance with service specific credentialing criteria Attest to the hospital s professional liability and claims history Not have current or previous censures, sanctions or exclusions from participation in the Medicare and Medicaid programs. Hospital Insurance Information: An original Certificate of Liability Insurance demonstrating proof of compliance with insurance requirements. The following requirements are reflected in the Sandhills Center Service Agreement document. a. Professional Liability: The CONTRACTOR shall purchase and maintain professional liability insurance protecting the CONTRACTOR and any employee performing work under the Contract for an amount of not less than $1,000, per occurrence and proof of coverage at or exceeding $3,000, in the annual aggregate. In the event that the CONTRACTOR discovers that a claim, suit of criminal/administrative proceeding involving an LME- MCO Member has been brought or may be brought against the CONTRACTOR and/or Practitioner relating to the quality of services provided under this Agreement, then CONTRACTOR shall notify LME-MCO within ten (10) days. b. Comprehensive General Liability: Bodily Injury and Property Damage Liability Insurance shall protect the CONTRACTOR and any employee performing work under the Contract from claims of Bodily Injury or Property Damage, which may arise from operations under the Contract. The amounts of such insurance shall not be less than $1,000, per Occurrence/$3,000, per Aggregate/$1,000, Personal and Advertising Injury/$50, Fire Damage. The insurance shall not include exclusion for contractual liability. Credentialing & Re-Credentialing Criteria Medicaid qmc Page 9 of 15

10 c. Automobile Liability: Automobile Bodily Injury and Property Damage Liability Insurance covering all owned, non-owned, and hired automobiles for limits of not less than $1,000, each person and $1,000, each occurrence of Bodily injury Liability and $1,000, each occurrence of Property Damage Liability. Policies written on a combined single limit basis should have a limit of not less than $1,000, d. Workers' Compensation and Occupational Disease Insurance: Insurance Coverage must meet the statutory requirements of the State of North Carolina; and Employer's Liability Insurance for an amount of not less than: Bodily Injury by Accident $100, each Accident, Bodily Injury by Disease $100, each Employee, and Bodily Injury by Disease $500, Policy Limit. e. Certificate of Coverage: The CONTRACTOR shall provide Sandhills Center with Certificates of Insurance Coverage consistent with the Contract within thirty (30) business days following the effective date of the Contract and on an annual basis within ten (10) business days of the anniversary date of the Contract, and shall provide a new Certificate within ten (10) business days of the expiration date if the Insurance Certificate expires during the Contract period. The CONTRACTOR shall notify Sandhills Center in writing of any cancellation or material change, within forty-eight (48) hours, and within ten (10) days of any change in insurance provider during the period of the Contract. If the CONTRACTOR changes insurance providers during the performance period of the Contract, the CONTRACTOR shall provide evidence to Sandhills Center that Sandhills Center will be indemnified to the limits specified above for the entire performance period of the Contract, either under the policy or a combination of old and new policies. Notwithstanding anything to the contrary herein, the CONTRACTOR shall have the right to self-insure so long as the CONTRACTOR's self-insurance program is licensed by the Department of Insurance of the State of North Carolina and is actuarially determined sufficient to pay the insurance limits required in this paragraph. f. Tail Coverage: Liability insurance may be on either an occurrence basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail coverage) for a period of not less than three (3) years after the end of the contract term, or an agreement to continue liability coverage with a retroactive date on or before the beginning of the contract term, shall also be provided. Credentialing & Re-Credentialing Criteria Medicaid qmc Page 10 of 15

11 Sandhills Center Re-Credentialing Criteria Hospital: For Sandhills Center to re-credential a participating provider hospital, the hospital must: Meet applicable Credentialing Criteria* Submit a re-credentialing application updating any information that is subject to change (ex. licensure, board certification, liability claims history, disciplinary actions) The hospital must remain accredited with The Joint Commission Attest to the hospital s professional liability and claims history. Attest to compliance with service specific credentialing criteria Not have current or previous censures, sanctions or exclusions from participation in the Medicare and Medicaid programs *Refer to Hospital Inpatient Credentialing Criteria Credentialing & Re-Credentialing Criteria Medicaid qmc Page 11 of 15

12 Staff Definitions 1. Associate Professional (AP) within the mental health, developmental disabilities and substance abuse services (mh/dd/sas) system of care means an individual who is a: Graduate of a college or university with a Masters degree in a human service field with less than one year of full-time, post-graduate degree accumulated mh/dd/sas experience with the population served, or a substance abuse professional with less than one year of full-time, post-graduate degree accumulated supervised experience in alcoholism and drug abuse counseling. Supervision shall be provided by a qualified professional with the population served until the individual meets one year of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually; or Graduate of a college or university with a bachelor s degree in a human service field with less than two years of full-time, post-bachelor s degree accumulated mh/dd/sas experience with the population served, or a substance abuse professional with less than two full years of full-time, post-bachelor s degree accumulated supervised experience in alcoholism and drug abuse counseling. Supervision shall be provided by a qualified professional with the population served until the individual meets two years of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually; or Graduate of a college or university with bachelor s degree in a field other than human services with less than four years of full-time, post-bachelor s degree accumulated mh/dd/sas experience with the population served, or a substance abuse professional with less than four years of full-time, postbachelor s degree accumulated supervised experience in alcoholism and drug abuse counseling. Supervision shall be provided by a qualified professional with the population served until the individual meets four years of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually; or Registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing with less than four years of full-time accumulated experience in mh/dd/sas with the population served. Supervision shall be provided by a qualified professional with the population served until the individual meets four years of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually. 2. Certified Clinical Supervisor (CCS) means an individual who is certified as such by the North Carolina Substance Abuse Professional Certification Board. 3. Certified Substance Abuse Counselor (CSAC) means an individual who is certified as such by the North Carolina Substance Abuse Professional Certification Board. 4. Certified Substance Abuse Prevention Consultant (CSAPC) means an individual who is certified as such by the North Carolina Substance Abuse Professional Practice Board 5. Licensed Clinical Addictions Specialist Criteria A: A minimum of a master's degree with a clinical application in a human services field; Two years post-graduate supervised substance abuse counseling experience; Three letters of reference from Licensed Clinical Addictions Specialist or a master's level Certified Substance Abuse Counselor; Credentialing & Re-Credentialing Criteria Medicaid qmc Page 12 of 15

13 Achievement of a passing score on a master's level written examination administered by the Board; 180 hours of substance abuse specific training as defined in the statute and in policy statement of the Board; Signed verification statements attesting to the intention to adhere fully to the ethical standards of the Board; That the applicant is not and has not engaged in any practice or conduct that would be grounds for disciplinary action under this statute; Payment of fees. Criteria B: Minimum of a master's degree with clinical application in a human services field; Current certification as a Certified Substance Abuse Counselor; Achievement of a passing score on a master's level written examination administered by the Board; Three letters of reference from Licensed Clinical Addictions Specialist or a master's level Certified Substance Abuse Counselor; Signed verification statements attesting to the intention to adhere fully to the ethical standards of the Board; That the applicant is not and has not engaged in any practice or conduct that would be grounds for disciplinary action under this statute; Payment of fees. Criteria C: Minimum of a master's degree in a human services field with a substance abuse specialty that includes 180 hours of substance abuse specific training/education; One year of post-graduate supervised substance abuse counseling experience; Achievement of a passing score on the written examination administered by the Board; Three letters of reference from Licensed Clinical Addictions Specialist or a master's level Certified Substance Abuse Counselor; Signed verification statements attesting to the intention to adhere fully to the ethical standards of the Board; That the applicant is not and has not engaged in any practice or conduct that would be grounds for disciplinary action under this statute; Payment of fees. Criteria D: The applicant must be a member of a professional discipline granted deemed status by the Board; (Deemed status organizations) The applicant must be licensed, certified or otherwise recognized by that discipline as having met the standards of a substance abuse specialist; and Must hold a substance abuse certification from that professional discipline which has been granted deemed status by the North Carolina Substance Abuse Professional Practice Board; Certification may be obtained through the process as described, and by payment of certification fees. 6. Paraprofessional within the mh/dd/sas system of care means an individual who, with the exception of staff providing respite services or personal care services, has GED or high school diploma; or no GED or high school diploma, employed prior to November 1, 2001 to provide a mh/dd/sas service. Supervision shall be provided by a qualified professional or associate professional with the population served. The supervisor Credentialing & Re-Credentialing Criteria Medicaid qmc Page 13 of 15

14 and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually. 7. Qualified professional means within the mh/dd/sas system of care: an individual who holds a license, provisional license, certificate, registration or permit issued by the governing board regulating a human service profession, except a registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing who also has four years of full-time accumulated experience in mh/dd/sas with the population served; or a graduate of a college or university with a Masters degree in a human service field and has one year of full-time, post-graduate degree accumulated mh/dd/sas experience with the population served, or a substance abuse professional who has one year of full-time, post-graduate degree accumulated supervised experience in alcoholism and drug abuse counseling; or a graduate of a college or university with a bachelor s degree in a human service field and has two years of a full-time, post-bachelor s degree accumulated mh/dd/sas experience with the population served, or a substance abuse professional who has two years of full-time, post-bachelor s degree accumulated supervised experience in alcoholism and drug abuse counseling; or a graduate of a college or university with a bachelor s degree in a field other than human services and has four years of full-time, post-bachelor s degree with accumulated mh/dd/sas experience with the population served, or a substance abuse professional who has four years of full-time, postbachelor s degree accumulated supervised experience in alcoholism and drug abuse counseling. Credentialing & Re-Credentialing Criteria Medicaid qmc Page 14 of 15

15 Sandhills Center Credentialing & Re-Credentialing Criteria For Service Definitions and Requirements, please refer to the North Carolina DHHS/DMA websites at NC DMA: Medicaid Clinical Coverage Policies and Provider Manuals for Providers Credentialing & Re-Credentialing Criteria Medicaid qmc Page 15 of 15

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