D. Monitoring: A process utilized by Authority staff to systematically review the implementation and compliance of funded programs.

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2 Abuse Disorder (SUD) Providers, Autism Spectrum Disorder Providers, Hospitals, Individuals (i.e., Physician (MD/DO), licensed clinicians, etc.) Services are provided via outpatient (ambulatory), residential and/or inpatient settings C. Managers of Comprehensive Provider Networks (MCPNs): A business entity contracted by the Agency to develop and manage a comprehensive network of providers who can meet the needs of individuals with or at risk of developing severe mental illness, serious emotional disturbance, developmental disabilities and/or substance abuse. D. Monitoring: A process utilized by Authority staff to systematically review the implementation and compliance of funded programs. E. Subcontractor: A legal entity contracted to perform all or part of a community mental health service that is the contractual obligation of an entity contracted with the Authority. F. Utilization Management: Using established criteria to recommend or evaluate services provided in terms of medical necessity, effective use of resources and cost effectiveness. V. STANDARDS A. Providers of Behavioral Health services that want to contract with the Detroit- Wayne Mental Health Authority must complete the Organization/Facility Application in order to become a credentialed provider B. The applications must include evidence of their Medicaid and/or Medicare enrollment and Accreditation C. If the provider is not accredited they will receive a site visit prior to implementation of contract D. The applications will be submitted to the Managed Care Operations unit of the Authority for review E. The application assessment will include a review of the Office of Inspector General List of Excluded Individuals Entities (LEIE), Medicare Exclusion database (MED) and the System for Awards Management prior to contracting with the Provider, at least monthly thereafter and at the time of re-credentialing. F. Upon review a determination will be made based on the Authority s need for the requested services in the application G. The applicant will receive a letter stating that they met all requirements, or that they need to submit additional information or that the Authority does not need their services at this time. 5/20/15 Page 2 of 6

3 H. Providers that have not had a contract with the Detroit Wayne Mental Health Authority or one of the Integrated Care Organizations within 12 months prior to their application submission will receive a site visit before implementation of their contract I. Providers added to the Authority s panel will attend an orientation which will include provider education, reporting requirements and training regarding the Authority s policies and procedures J. Providers will also be oriented to the Provider Manual which will include reporting requirements K. Providers will be added to the provider directory L. Providers will be re-credentialed every three (3) years M. The Authority ensures that the full array of Medicaid and Medicare services are provided within 30 miles or 30 minutes of consumer s residence. N. The Authority monitors that the hours of operation are convenient to the population served. Access to mental health and/or substance use services are available 24 hours/day 7 days a week when medically necessary. O. Authority staff will conduct comprehensive site visits of the MCPN s provider networks, direct contract providers, and contracted County Department providers no less than annually to assure that delegated functions are in compliance with federal, state and local requirements. P. The review of the provider network will include an assessment of adequacy of space to provide the designated services. Q. A report of findings will be submitted to the MCPN, direct contract provider, or the contracted County Department. R. If there are any areas of deficiency, the Authority will require an appropriate response which could include a plan of correction, immediate resolution to the deficiency or contractual sanctions. S. The MCPN, direct contract provider, or contracted County Departments may be required to submit status updates, quarterly, at a minimum, indicating how they are meeting specific standards. T. The Authority reserves the right to monitor the compliance of the MCPNs, direct contract providers, and contracted County Departments on a random basis or as needed. 5/20/15 Page 3 of 6

4 U. MCPNs, and other Authority contractors with subcontractors are responsible, at least annually, for conducting site reviews of those providers to monitor the compliance with all federal, state and local requirements. V. The Authority will review and monitor this activity during their annual MCPN, and direct contract provider site visits. The Authority may randomly validate the findings of the MCPNs. W. MCPNs, their subcontractors, direct contract providers, and Contracted County Departments must have staffing standard requirements that ensure appropriate qualified staff are providing services. X. Failure to comply with applicable federal, state, county and local laws, administrative directives, guidelines and/or policies will result in sanctions outlined in the Authority s contract. Y. Michigan Department of Community Health, Integrated Care Organizations, National Practitioner Database (NPDB) and Authority units will be notified if a provider is terminated, suspended or decline further participation in the Authority s panel of providers Z. Contract Managers, and if necessary, Authority staff from the Office of Recipient Right, Quality Management, Budget and Finance, Utilization Management, Customer Service, and Clinical Services will meet with MCPNs no less than monthly. AA. Contract Managers will meet with direct contract providers, and contracted Wayne County Departments no less than quarterly to ensure compliance with all applicable standards, laws and regulations. BB. An assigned Contract Manager will meet and provide technical assistance as needed with new contractors bi-monthly, at a minimum, until they are substantially compliant with their contract. CC. At the onset of the contractual relationship, MCPNs, direct contract providers and Contracted Wayne County Departments must be in substantial compliance with all key requirements of the Authority s contract. DD. The Authority will monitor the contractor s clinical and managerial structures, processes and outcomes objectively. EE. Providers will receive updates through newsletters, bulletins, and the Detroit Wayne Mental Health Authority website including significant changes to the Authority s provider network 5/20/15 Page 4 of 6

5 VI. VII. VIII. QUALITY ASSURANCE/IMPROVEMENT The Authority shall review and monitor contractor adherence to this policy as one element in its network management program, and as one element of the QAPIP Goals and Objectives. The quality improvement programs of MCPNs, their subcontractors and direct contractors must include measures for both the monitoring of and the continuous improvement of the programs or processes described in this policy. COMPLIANCE WITH ALL APPLICABLE LAWS Authority staff, MCPNs, contractors and subcontractors are bound by all applicable local, state and federal laws, rules, regulations and policies, all federal waiver requirements, state and county contractual requirements, policies, and administrative directives, as amended. LEGAL AUTHORITY AND REFERENCES A. Michigan Mental Health Code, P.A. 258 of 1974, as amended; MCL , MCL B. 42 Code of Federal Regulations , 42CFR C. Agreement Between Michigan Department of Community Health and Detroit Wayne County Community Mental Health Agency for the Medicaid Managed Specialty Supports and Services Concurrent 1915 (b)(c) Waiver Program 10/1/14-9/30/15 D. MDCH Application for Participation, 2013 E. Detroit Wayne Mental Health Authority Cultural Competence Policy F. Detroit Wayne Mental Health Authority Credentialing and Re-credentialing Policy IX. EXHIBIT(S) 5/20/15 Page 5 of 6

6 Please Check: Policy: New Revised Annual Review Effective Date: Reviewed By: Reviewed Date: Fiscal Year: 5/20/2015 Ricarda Pope-King, Lorraine Taylor- Muhammad, J. Davis 7/20/2015 Ricarda Pope-King, Lorraine Taylor- Muhammad, J. Davis 5/20/2015 FY /20/2015 FY /20/15 Page 6 of 6