LifeWays Operating Procedures

Transcription

1 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/ CREDENTIALING APPLICATION PURPOSE: The purpose of this operating procedure is to detail the process for provider network credentialing application, including both individual practitioners and organizational providers. The Credentialing process is completed to assure LifeWays members receive care from competent, qualified professionals. GENERAL PROCEDURE The organization or practitioner can obtain an application (Form #490 or #492), for provider network participation, from the Provider Network Management or Customer Services Team. The organization or practitioner should complete the application and any requested additional information. Once an application is received, the LifeWays Provider Network Management Team creates an individual credentialing file. The file will include the initial application, re-credentialing application, documentation of credentials, references, adverse findings, site review reports, correspondence, Credentialing Committee recommendations, and any and all other relevant information regarding the provider's application to, and/or inclusion in the provider network. All individual files will include a checklist for tracking the verification process. LifeWays Credentialing Committee shall have up to 31 days from receipt of a complete application, accompanied by the minimum documents required, within which to render a decision regarding temporary provisional membership. In the event of a service-need emergency the Provider Network Director may grant temporary membership if the committee is not scheduled to meet in sufficient time to meet the need. SCOPE The organization or practitioner who is granted membership to the LifeWays Provider Network is expected to adhere to applicable federal and state laws and regulations governing the practice of his or her respective discipline(s) in the provision of publicly funded mental health services. The provider will be familiar with, and adhere to, the requirements specified in the Michigan Mental Health Code, as well as the professional principles described in discipline specific ethical codes. The scope of this credentialing/ re-credentialing process applies to all the following health care professionals employed or contracted by LifeWays: Physicians (M.D.s or D.O.s). including board certified or board eligible Physicians Assistants(P.A.s) Psychologists ( Licensed, Limited License, or Temporary License) Licensed Master s Social Workers, Licensed Bachelor s Social Workers, Limited License Social Workers, or Registered Social Service Technicians Licensed Professional Counselors Nurse Practitioners, Registered Nurses, or Licensed Practical Nurses Occupational Therapists, or Occupational Therapist Assistants Physical therapists, or Physical Therapist Assistants Speech Pathologists Page 1 of 8

2 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 All health care professional must possess a current license or certification to practice in the State of Michigan, where required. Organizations which employ practitioners, as above, to provide services as outlined in Definitions/Requirements for Credentialing and Competency Review, Attachment B are also covered by this procedure. Except where otherwise noted by service qualifications, organizations employ persons who by license/certification may practice independently in the State of Michigan. Appropriate supervision is granted to non-licensed or paraprofessional staff. SERVICE AREAS/PRIVILEGES Definitions of Privileges/Service Areas are contained in Definitions/Requirements for Credentialing and Competency Review, Attachment B. Categories of and criteria for clinical service areas are reviewed at least annually by LifeWays Credentialing Committee. Based on the Committee s recommendations, categories of and criteria for clinical privileges/service areas are revised and/or renewed not less than annually. ORGANIZATIONAL PROVIDER APPLICATION Organizations must, through written application, apply for initial credentialed status and ongoing recredentialed status by completing an Organizational Provider Network application. The application shall contain sufficient information concerning the organization's qualifications and competency including, but not limited to: licensure and certification, accreditation, geographic location and hours of operation, cultural/ethnic competence, staff credentials and clinical specialties, malpractice coverage and claims history, sanction activity, verification applicant has not been excluded from Medicare or Medicaid, and professional references. Applicants must demonstrate the capacity to maintain distinct program features, such as, identified staff, program descriptions, resources and schedules, when applying for more than one service. The organization shall submit with the application policies and procedures on credentialing/privileging of staff that are directly employed or subcontractors and provide direct services. Credentialing of staff shall be in accordance with LifeWays requirements. Organizations must also maintain procedures to monitor paraprofessionals/non-licensed staff providing direct service to ensure they are qualified to perform their job. Signature on the application and agreement binds the organization to the validity of the information provided; signifies agreement to abide by LifeWays Policies, Procedures, Provider Manual; authorizes the LifeWays Chief Executive Officer/designee to consult with references, supervisors and agencies with which the organization has been associated or others who may have information bearing on the organization s competence, professionalism, clinical and ethical qualifications; and signifies willingness to appear for interviews in regard to the application. Page 2 of 8

3 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 The organization agrees to release from any liability, all representatives of the LifeWays Managed Care Organization for acts performed in good faith and without malice concerning the organization s competence, ethics, character, and other qualifications for network appointment and confidential information. PRACTITIONER APPLICATION Applicants must, through written application, apply for credentialed status. Applicants seeking reappointment shall be required to show continued evidence of competency. The application shall contain sufficient information concerning the applicant's qualifications including, but not limited to: education and training, licensure and certification, professional staff affiliations, fiveyear work history, geographic location, malpractice coverage, cultural ethnic competence, clinical specialties, malpractice coverage and claims history, professional sanctions, verification applicant has not been excluded from Medicare or Medicaid, lack of present illicit drug use, any reasons for inability to perform the essential functions of the position, and references. Signature on the application and agreement binds the applicant to the validity of the information provided; signifies agreement to abide by LifeWays Policies, Procedures, Provider Manual, and Ethical Standards (Attachment A); authorizes the LifeWays' Chief Executive Officer/designee to consult with references, supervisors and agencies with which the individual has been associated or others who may have information bearing on the applicant's competence, character and ethical qualifications; and signifies willingness to appear for interviews in regard to the application. The applicant agrees to release from any liability all representatives of the LifeWays Managed Care Organization for acts performed in good faith and without malice concerning the applicant's competence, ethics, character, and other qualifications for staff appointment and confidential information. SUPPORTING DOCUMENTATION REQUIREMENTS FOR TEMPORARY PROVISIONAL MEMBERSHIP All applicants both organizations and practitioner, must meet the following requirements in order for temporary provisional membership: A. A signed application that attests to lack of present illegal drug use B. The Disciplinary Actions Section of the application must be completed with any supporting documentation as required to report history of adverse actions taken on licensure, registration or certification, felony charges, and or loss or limitation of privileges or disciplinary action C. A summary of the providers work history for the prior five years D. Attestation by applicant of the correctness and completeness of the application E. Primary source verification completed by LifeWays for the following: 1. Licensure or certification; 2. Education/degree completion for private practitioners via official transcripts; 3. Board certification if applicable or the highest level of credential attained; and Page 3 of 8

4 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/ American Medical Association and National Practitioner Data Bank verification of credentials for Physician; and 5. Medicare/ Medicaid Sanctions SUPPORTING DOCUMENTATION REQUIREMENTS FOR FULL MEMBERSHIP All applicants, both organizations and practitioners, must submit appropriate supporting documentation as required and requested: A. Liability coverage appropriate to the privileges/service areas requested and as required by contract. B. For practitioners, appropriate licensure, certification or registration as applicable to the credentials for disciplinary practice. For organizations, appropriate licensure, certification, or accreditation as applicable to the service areas provided. C. For practitioners, achievement of required qualifications, as delineated by scope of practice and detailed in "Definitions/Requirements for Credentialing and Competency Review (Attachment B). Educational requirements are met by submission of original transcripts for the highest degree earned sent directly from the educational institution. Organizations assure, through their own credentialing process, that staff meet required qualifications and submit information in summary format on the application. D. For practitioners, current competency in privileged practice areas, as evidenced by competency in requested privileges, "Definitions/Requirements for Credentialing and Competency Review (Attachment B). Organizations assure that qualified staff are competent in privileged areas through their own credentialing process. Organizations also demonstrate competency in service areas by demonstrating evidence of appropriately qualified staff and validated with references. E. Summary of training and experience for both practitioners and organizations. F. Two (2) Peer Recommendations: For initial appointments, peer recommendations are provided by the applicant s latest supervisor and a peer familiar with the applicant s practice. For reappointment, peer recommendations must be from licensed independent practitioners actively practicing in the network or from outside practitioners within the same scope of practice. Organizations are also required to provide two references who are familiar with the work of the organization. G. Adherence to the ethics of their profession, or as established by statutes or governmental unit policies and reflected in the general ethical standards of LifeWays (Attachment A). H. Provider profile/performance appraisal/performance results at the satisfactory level (re-appointment only). I. For practitioners, participation in a minimum of sixteen (16) hours of clinically related continuing education every two (2) years. All continuing education must be related to privileges, age and diagnostic categories served. For members serving children/adolescents, participation in a minimum of twenty-four (24) hours of clinical and age-related continuing education every two years. Organizations assure that staff meet the requirement for continuing education through their own credentialing process. (Re-appointment only) J. Adherence to Standards and Best Practice Guidelines established by the governing body (reappointment only). Page 4 of 8

5 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 K. Timely application for renewal of privileges [two (2) months prior to expiration date] to the Provider Network Management Team Designee (re-appointment only). L. Identification and report of any unethical or incompetent actions, and any sanction activity. M. For practitioners, evidence of good moral character. For organizations, evidence that the organization s procedures for staff credentialing include obtaining this information. N. Applicant is at least eighteen years of age. O. Applicant demonstrates professionalism in communication, cooperation and practice with LifeWays during the credentialing process. OUT-OF NETWORK PROVIDERS/ DEEMED STATUS LifeWays maintains a closed network for Medicaid recipients within the service area. Typically, providers of service are credentialed prior to the delivery of service or the issuance of a contract. This practice is not feasible when a) a consumer presents in crisis in another service area; b) a Jackson/Hillsdale county resident is placed in a residential setting in another county, or c) A consumer is in urgent need of a service not available through LifeWays network of providers. Out-of Network Inpatient Referral: When a consumer is referred for Out-of-Network Inpatient services the designated Utilization Manager shall verify that the treating facility is Joint Commission Accredited and may authorize services at the Medicaid rate. The Utilization Manager shall notify Provider Network Management Designee that an out-of-network authorization was issued and shall monitor the case through discharge. Out-of-Network Service Referral: When a consumer is referred for Out-of-Network services the designated Utilization Manager shall assess the feasibility/availability of the services being provided within LifeWays Network of Providers. If it is determined that the out-of-network referral is the most feasible/appropriate placement, the designated Utilization Manager shall seek notify Provider Network Management Designee that an out-of-network authorization was issued and shall monitor the case through discharge. Deemed Status: Some Out of Network Inpatient and Service Referrals, also provide services to more than one Pre-paid Inpatient Health Plan (PIHP). LifeWays may recognize and accept credentialing activities conducted by any other PIHP in lieu of completing their own credentialing activities. In those instances where LifeWays chooses to accept the credentialing decision of another PIHP, a copy must be maintained of the credentialing decision in their contract folder. VERIFICATION Verification with the primary source is completed by the LifeWays Provider Network Management Designee for independent practitioner applicants credentials and for organizational applicants license and accreditation. Organizational providers are required to have a Credentialing process within their own organization which meets all of the standards outlined in LifeWays Standards and Best Practice Page 5 of 8

6 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 guidelines and is consistent with LifeWays policy Provider Network Membership. Organizational providers, therefore, are required to perform primary source verification for their employees. The purpose of primary source verification is to ensure that the information submitted in the application is factual. Any information found to vary from the application will be reported to the applicant in writing prior to proceeding with the application process. An applicant shall have 10 days to respond with corrected information or the application will be denied. Original transcripts sent directly from the educational facility are required to verify education or continuing education of independent practitioners. Proof of Residency completion or Board certification is sufficient for physician applicants. Licensure and/or certification is verified directly with the state licensing board. The applicant is also required to supply a copy of the current license or certification. A photocopy of the DEA license or visual inspection of the original is acceptable. Peer recommendations must be from licensed independent practitioners actively practicing in the network or from outside practitioners within the same scope of practice. For initial appointments, one recommendation must be from the most recent supervisor of the practitioner applicant. Peer recommendations (Form #1146) will be sent directly to the persons indicated on the application for both practitioner and organizational applicants. A five (5) year history of malpractice claims are requested on the application and are verified with an appropriate source as necessary (i.e., directly with the carrier, with the National Practitioner Data Bank, etc.). Review of Medicaid and/or Medicare sanction activity shall be reviewed and monitored for all providers at least monthly or upon notice of alleged sanction. For physicians only, the National Practitioner Data Bank (NPDB) and the American Medical Association (AMA) shall be queried. Once all primary source verification has been completed, the verification checklist (Form #444), shall be completed and signed by the Provider Network Management Designee, verifying that all evidence is complete and meets requirements for credentialed status. The Provider Network Management Designee may grant temporary provisional membership upon review that the application meets the minimum requirements identified above. Temporary status expires 150 days after the effective date or the date of the Credentialing Committee's decision effective date, whichever comes first. The credentialing file is then forwarded to the Chairperson of the Credentialing Committee for review and action. CHANGES IN CREDENTIALED STATUS Organizational providers are required to update LifeWays when staff changes occur. For personnel changes or information updates, LifeWays should be notified within seven (7) business days. For changes in credentialed status (i.e., any revocation or restriction), LifeWays must be notified within one (1) business day. Independent practitioners are required to update the Provider Network Management Designee of any changes in credentialed status, including but not limited to, changes in scope of license, changes in privileged status at other organizations, pending malpractice claims, etc. INTERVIEW An applicant interview may be conducted to further ascertain any additional relevant information. An interview can occur by phone or in person with a member of the Provider Network Management Page 6 of 8

7 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 Designee or a member of the Credentialing Committee. An interview summary will be completed and placed in the applicant's file following the interview. APPLICANT RIGHT TO REVIEW Any applicant for network provider membership may review the information submitted in support of their credentialing application upon request EXCEPT review of confidential references solicited of persons for the purpose of determining clinical and professional competency. All information gathered during the credentialing process will be held confidentially, except as otherwise required by law. SITE REVIEWS Organizational providers which are not accredited by an accepted accrediting organization are subject to a site review at the time of initial appointment. The site review shall evaluate compliance to Standards and Best Practice Guidelines, and will include: medical records review, environmental/facilities review, credentialing review, financial review and recipient rights review. Performance on the initial site review shall be at the Partial Compliance level or above, with an acceptable plan for bringing all areas to Substantial Compliance within 30 days of the review. A subsequent review will occur within six months to ensure Substantial Compliance in all areas. Applicants who are unable to comply with this requirement may voluntarily withdraw their application at this time, otherwise the application will be denied. Site reviews shall occur at least every two (2) years thereafter, or when the organization relocates services, performance is below threshold, or significant adverse actions are identified. Organizations which are accredited and serve a high volume of LifeWays members (20 or more members at one time) or have substantial adverse actions are also subject to review. Practitioners who are not under the auspices of an accredited organization shall receive a site review at the time of initial appointment. The site review will evaluate compliance to Standards and Best Practice Guidelines, and will include, a medical records review, environmental/facilities review, and a review of office practices. Performance on the initial site review shall be at the Partial Compliance level or above, with an acceptable plan for bringing all areas to Substantial Compliance within 30 days of the review. A subsequent review will occur within six months to ensure Substantial Compliance in all areas. Applicants who are unable to comply with this requirement may voluntarily withdraw their application at this time, otherwise the application will be denied. Individual practitioners will be reviewed every two years thereafter or when the practitioner re-locates services, performance is below threshold, or significant adverse actions are identified. ADDITIONAL PRIVILEGES/SERVICE AREAS Providers (practitioner and organizational) may request additional service areas during the period of open enrollment. This enrollment period is opened based on an identified need and through the Network Capacity Evaluation process. Providers will need to complete portions of the Provider Network Application that indicate the additional privileges/service areas being requested and that describe the provider's qualifications in the additional areas. Supporting documentation of qualifications may be necessary if it is not already evident in the Credentialing file. Evidence of distinct service features will be Page 7 of 8

8 LifeWays Operating Procedures CHAPTER GOVERNING POLICY Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 necessary when applying for more than one service. A signed applicant statement will also be required along with the application for additional privileges/service areas. RE-CREDENTIALING All members of the LifeWays Provider Network must apply for re-credentialing above. In addition, continuing education, evidence of competency with the populations and service areas, and satisfactory performance as indicated on performance appraisals or provider profiles are considered. REFERENCES Attachments A Ethical Standards B Credentialing Appendix: Definitions/Requirements for Credentialing and Competency Review Forms Application for Private Practitioner, Provider Network Participation and Privileged Staff Membership (#490) Organizational Provider, LifeWays Provider Network Application (#492) Credentialing Verification Checklist (#444) Organizational Evaluation (#1146) Practitioner Peer Evaluation (#1146) HISTORY Effective 10/01/97 Rev. 06/99, 01/00, 08/00, 03/01,01/03, 08/04, 05/07, 04/08, 09/09 Page 8 of 8

9 ATTACHMENT A ETHICAL STANDARDS Members of LifeWays Provider Network, staff and contractors, are expected to adhere to ethical standards held in common by each discipline. Minimally, members must abide by the following basic principles: 1. Members must respect the dignity and worth of each individual, striving for the protection and preservation of fundamental human rights and rights to mental health treatment per Public Act 258 of 1974, as amended. 2. Members shall not engage in activities that seek to meet the member s need at the expense of the consumer. Dual/exploitative relationships with consumers must be avoided, such as providing service to relatives and/or friends, engaging in sexual intimacy, or borrowing money. The vulnerability of a consumer shall not be exploited. Members shall not befriend, lend money, provide gifts or engage in personal social activities with current LifeWays consumers. Such relationships with former consumers are prohibited prior to one (1) year post-discharge and are discouraged thereafter. 3. Members shall accurately represent their competence, education, training and experience. Members shall reflect the commitment of their profession s values and to act ethically. 4. Members shall make a continuous effort to improve professional skills by: submitting to supervision, review and evaluation; being guided by the findings; participating in inservice/continuing education; seeking consultation/supervision when their skill level or personal objectivity is questionable or the scope of practice is exceeded. 5. Members shall not compromise or reduce the public trust in mental health professionals. Practices that are inhumane, are illegal or discriminatory are not permissible. Members shall be of good moral character. 6. Members shall not misrepresent their services, qualifications or position to consumers. They shall fully inform consumers as to the purpose, nature, scope and progress of treatment seeking the consumer s full participation in the process. 7. Members shall respect the confidentiality of information as defined in Michigan Law and LifeWays Board policies, taking special care to protect the best interest of the consumer. Members shall not access confidential information of relatives, friends, acquaintances, etc. When a consumer s condition indicates a clear and imminent danger to the consumer or others, the member must take reasonable action by notifying authorities. 8. Members shall neither give nor receive personal remuneration from consumers for any reason except as established in LifeWays Board policy. 9. Members shall demonstrate a regard for their colleagues through understanding areas of competence of other professionals, making use of all professional and technical resources that serve the best interests of the consumer, assigning proper 1

10 ATTACHMENT A credit to the professionals involved in an action, and by reporting known ethical violations of other staff/colleagues to the LifeWays Recipient Rights Office. 10. Therapy techniques which are not approved by LifeWays or are considered experimental are not permitted. Research is not permitted outside the parameters of LifeWays Board policy and Standards and Best Practice Guidelines. 11. It is unethical to use the LifeWays affiliation to recruit consumers for a private practice or for church or political party membership. 12. Members must inform LifeWays of conditions that may be potentially disruptive or damaging, or limiting to clinical effectiveness. 13. Members shall strive to assist LifeWays in the provision of quality services. 14. Acceptance of a contact or employment implies that the member is in agreement with the general policies, Standards and Best Practice Guidelines and ethical standards of the LifeWays Board. 15. Members in supervisory positions shall not engage in dual/exploitative relationships with staff they are supervising. Supervisory staff shall not lend money, share housing, or engage in sexual activity with staff he/she supervises. 16. Members in supervisory positions must be aware of the limitations of staff they are supervising, helping them to acquire knowledge and skills for their professional development. Supervisory staff shall not ask staff to carry out responsibilities outside those they are privileged, trained, or licensed to perform. 17. Staff, contractors, and members shall protect the integrity of the clinical decisions made in consumers' treatment, by ensuring that decisions are made independent of any financial compensation/risk. All decisions are made based on findings of the biopsychosocial assessment. Revised 11/07/01 08/26/04 Reviewed 01/30/03 05/28/07 [Click here to return to Procedure text] 2

11 Attachment B CREDENTIALING APPENDIX Qualifications for Credentialing Membership by Profession I. General Requirements for All Applications: Evidence of Competency A. Current licensure, certification and/or registration. B. Peer recommendations. C. Satisfactory supervisory evaluations. (Re-appointment only) D. Continuing education or training. E. Relevant Quality Improvement findings (Re-appointment only). F. Adherence to the by-laws, rules, regulations of the governing body and of the professional staff. G. Evaluation of consumer outcome data indicates normal trends or a satisfactory plan of correction is provided. H. Length of stay and continued stay reviews indicate normal trends, or a satisfactory plan of correction is provided. II. REQUIREMENTS FOR APPLICANTS WORKING WITH SPECIALTY POPULATIONS A. Adults with Mental Illness Relevant training on symptomatology, treatment modalities, relapse prevention and recovery. Possesses the ability to associate interpersonal relationships, work, family and community to treatment planning. Applicant must have a minimum of one-year experience with the population. B. Persons with Developmental Disabilities Relevant training on symptomatology, developmental stages, treatment modalities, and principles of self-determination and person-centered care. Demonstrates ability to modify communication to accommodate hearing, visual, and cognitive impairments. Applicants must have a minimum of one year experience with the population. C. Children With Mental Illness Relevant training on symptomatology, treatment modalities, developmental stages, and family dynamics. Applicants must have a minimum of one-year experience with the population. D. Elderly and Disabled - Relevant training on symptomatology, treatment modalities for working with the geriatric and or physically disabled population, including modification of communication to accommodate hearing, visual and cognitive impairments. Demonstrates ability to assess losses and limitations associated with advancing age. Applicants must have a minimum of one-year experience with the population. E. Persons with Substance Abuse Disorders Relevant training related to diagnosis and treatment of substance abuse disorders. Applicants must have a minimum of

12 Attachment B CREDENTIALING APPENDIX one-year experience with the population and possess or be working under the supervision of a Certified Addictions Counselor. F. Employee Assistance Services All individuals, including affiliates, who provide EAP services, must have training in and understanding of EAP practice, alcohol and other drug problems, mental health issues, human resource and labor relations issues, and organizational dynamics. Applicants must have a minimum of one-year experience with the population. III. Definitions of Qualifications for Credentialed Status by Profession A. Dietitian 1. Definition: "Practice of dietetics" means the promotion and maintenance of health and treatment of disease by integrating knowledge of individual and group nutrient needs with knowledge of food composition and with economic, psychological, medical and social factors which affect food intake. It includes, but is not limited to, assessment of nutritional status; development, implementation, and evaluation of nutritional care plans for meeting nutritional needs; nutrition counseling and education; and development of recommendations for appropriate modifications of food and nutrient intake and route of administration. The dietician works with consumers in individual group homes, private and other settings to teach them to purchase good food, prepare it, and serve it properly; good sanitation practices are also taught. 2. General Qualifications: a. Possession of a Bachelor's Degree in Nutrition and Dietetics from an accredited university; b. Registered with the American Dietetic Association (RD); c. A minimum of one (1) year (2,080 hours) supervised experience with the population group for which approval is requested. B. Nurse 1. Definition: "Practice of nursing" means the systematic application of the nursing process which is derived from the biological, physical and behavioral sciences to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury or disability. 2. General Qualifications a. Possession of an Associate's or Bachelor's Degree in Nursing. b. Licensed as a Registered Professional Nurse in the State of Michigan in accordance of Public Act 368 of 1978, as amended. Licensed Practical Nurse: An individual who is licensed by the State of Michigan to practice as a Licensed Practical Nurse under the supervision of a Registered Nurse, physician, or dentist under Part 172 of Michigan Public Act 368 of 1978, as amended. c. A minimum of one (1) year (2,080 hours) supervised experience with the population group for which approval is requested.

13 Attachment B CREDENTIALING APPENDIX C. Nurse Practitioner: 1. Definition: In addition to provision of nursing privileges above, Nurse practitioners can perform primary psychiatric services in uncomplicated cases (i.e., medication prescriptions, labs, medication reviews, and psychiatric evaluations, counseling and crisis services. They may also order other types of treatment ad admit to Crisis Residential under physicians supervision. 2. General Qualifications: a. Possession Has a Bachelors of Science degree, or higher degree, in nursing. b. Currently licensed to practice nursing in the State of Michigan in accordance with Public Act 368 of c. Has successfully completed a formal advanced program for nurse practitioners that consists of a combination of didactic and clinical training with a minimum of 120 hours or 30% of the programs hours, whichever is less, devoted to classroom theory and a minimum of 360 hours or 30% of the programs hours, whichever is less, devoted to supervised clinical practice in the specialty area. D. Occupational Therapy 1. Definition: Occupational therapy is a method of treatment assigned to improve the strength, range of motion and physical endurance to restore mental health. It is the process of assisting active involvement of the consumer in specifically designed therapeutic activities. The therapist assists the consumer in improving function and learning to apply these skills to the demands of daily living. The therapist assists disabled consumers limited by disease/injury in developing adaptive skills, behaviors and/or aids to manage daily living activities (including work) optimally. 2. General Qualifications a. Possession of a Bachelor's Degree in Occupational Therapy. b. Registered as an Occupational Therapist by the American Occupational Therapy Association. c. Licensure as a Certified Occupational Therapy Assistant (COTA) and working under the supervision of and OTR. d. A minimum of one (1) year (2,080 hours) supervised experience with the population group for which approval is requested. E. Substance Abuse Counseling 1. Definition: The LifeWays Board accepts the American Medical Model philosophy that addiction is a disease. Through individual, group, collateral and didactic counseling, problems of chemical dependency are treated. The LifeWays Board acknowledges addiction to be a family disease, and as such actively attempts to engage family members in treatment whenever possible. Also, supportive services are offered through referrals to Alcoholics Anonymous, Cocaine Anonymous, Narcotics Anonymous, Adult Children of Alcoholics, Al-Anon and Al- Ateen.

14 Attachment B CREDENTIALING APPENDIX 3. General Qualifications: a. Certified Addiction Counselor CAC M b. Certified Clinical Supervisor CCS-M c. Certified Prevention Specialist CPS-M d. Certified Prevention Consultant CPC-M e. Certified Advanced Addiction Counselor CAAC F. Pharmacy Services 1. Definition: "Practice of pharmacy" is a health service, the clinical application of which includes the encouragement of safety and efficiency in the prescribing, dispensing, administering, and use of drugs and related articles for the prevention of illness and the maintenance and management of health. 2. General Qualifications: a. Possession of a Degree in Pharmacy. b. Licensed to practice as a Pharmacist in the State of Michigan in accordance with Public Act 368 of c. A minimum of one (1) year (2,080 hours) supervised experience with the population for which approval is requested. G. Physical Therapy 1. Definition: "Practice of physical therapy" means the evaluation or treatment of an individual by the employment of effective properties of physical measures and by the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting, or alleviating a physical or mental disability upon the prescription of an individual holding other than a subfield license issued under Parts 170, 175 or 180 of Public Act 368. It includes Person Centered Planning, performance of tests and measurements, interpretation of referrals from physicians, instruction, consultative services and supervision of personnel. Physical measures may include: massage, mobilization, heat, cold, air, light, water, electricity and sound. 2. General Qualifications: a. Possession of a Bachelor's Degree in Physical Therapy.

15 Attachment B CREDENTIALING APPENDIX b. Licensed as a Physical Therapist (PT) in the State of Michigan in accordance with Public Act 368 of c. Licensed as a Physical Therapist Assistant (PTA) working under the supervision of a PT. d. A minimum of one (1) year (2,080 hours) supervised experience with the population group for which approval is requested. H. Psychology 1. Definition: "Practice of psychology" means the rendering to individuals, groups, organizations, or the public of services involving the application of principles, methods, and procedures of understanding, predicting and influencing behavior for the purposes of the diagnosis, assessment related to diagnosis, prevention, amelioration, or treatment of mental or emotional disorders, disabilities, or behavioral adjustment problems by means of psychotherapy, counseling, behavior modification, hypnosis, biofeedback techniques, or psychological tests. 2. General Qualifications a. Licensed Psychologist 1. Possession of a Doctoral Degree in Psychology or a closely related field which includes education and training in preparation for the professional practice of health service psychology. 2. Licensed to practice psychology in the State of Michigan in accordance with Public Act 368 of A minimum of one (1) year (2,080 hours) experienced with the population group for which approval is requested. b. Limited Licensed Psychologist 1. Possession of a Master's Degree in Psychology or a closely related field which includes education and training for the practice of health service psychology. 2. Hold a limited license to practice psychology in the State of Michigan in accordance with Public Act 299 of Receive appropriate supervision from a licensed psychologist. 4. A minimum of one (1) year (2,080 hours) experience with the population group for which approval is requested. b. Temporary Limited Licensed Psychologist 1. Possession of a Master's Degree in Psychology or a closely related field which includes education and training for the practice of health service psychology. 2. Hold a temporary limited license to practice psychology in the State of Michigan in accordance with Public Act 299 of Receive appropriate supervision from a licensed psychologist. 4. A minimum of one (1) year (2,080 hours) experience with the population group for which approval is requested. I. Social Work 1. Definition: Social work is a professional activity which assists individuals, families, groups and communities to enhance, maintain, or restore their capacity

16 Attachment B CREDENTIALING APPENDIX for social functioning and which is concerned with the creation of societal conditions favorable to this goal. Social work practice is based on a body of knowledge, principles and values. It consists of the professional application of same through social work methods and techniques. Clinical social work shares with all social work the above goals and the person-in-situation perspective. Clinical social work practice is the professional application of social work theory and methods to the treatment and prevention of psychosocial dysfunction, disability or impairment, including emotional and mental disorders. Clinical social work includes interventions directed to interpersonal interactions, intrapsychic dynamics, and life support and management issues. 2. General Qualifications a. Licensed Master s Social Worker LMSW 1. A Master's Degree and/or Doctorate in social or related behavioral science field from an accredited University. 2. A minimum of one (1) year (2,080 hours) experience with the population group for which approval is requested. 3. Licensed as a Master s Social Worker in the State of Michigan per Public Act 299 of b. Licensed Bachelor s Social Worker LBSW 1. Possession of a Bachelor's Degree in Social Work or a related field from an accredited University. 2. A minimum of one (1) year (2,080 hours) experience with the population group for which approval is requested. 3. Currently licensed as a Bachelors Social Worker with the State of Michigan per Public Act 299 of c. Registered Social Service Technician RSST 1. One (1) year (2,080 hours) experience with the population group for which approval is requested, under supervision. 3. Registered as a Social Service Technician with the State of Michigan per Public Act 299 of J. Rehabilitation Services 1. Definition: "Rehabilitation Services" is the use of a service or program which is provided on a systematic, organized basis for the purpose of achieving maximal function and adjustment and to prepare a person physically, mentally, socially and vocationally to maximize abilities. 2. General Qualifications: a. A Master's Degree in Vocational Rehabilitation (counseling, evaluation, adjustment, etc.) or a vocationally related field such as occupational therapy. b. Eligible for membership in the National Rehabilitation Counseling Association or the American Rehabilitation Counseling Association [professional or certified by the Commission on Rehabilitation Counselor Certification (RCC)]. c. A minimum of one (1) year (2,080 hours) experience with the population for which approval is requested.

17 Attachment B CREDENTIALING APPENDIX K. Speech Language Pathology/Audiology 1. Definition: The practice of speech and language pathology means the application of principles, methods, or procedures of measurement, examination, diagnosis, prognosis, counseling, consultation, and rehabilitation related to development and disorders of speech and language for the purpose of modifying speech and language or for prevention of disorders. 2. General Qualifications a. Possession of a Master's Degree in Speech and Language Pathology from a university accredited by the American Speech, Language & Hearing Association (ASLHA). b. Possession of a Certificate of Clinical Competence in speech and language pathology or audiology from American Speech, Language & Hearing Association. c. A minimum of one (1) year (2,080 hours) supervised experience, including credit for experience toward the Certificate for Clinical Competence. L. Medicine 1. Definition: "Practice of medicine" means the diagnosis, treatment, prevention, cure or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do any of these acts. 2. General Qualifications a. Primary Care Medicine 1. Currently licensed to practice medicine in the State of Michigan in accordance with Public Act 368 of Board Certified or eligible in Family Practice, Emergency, or Internal Medicine. 3. A minimum of one (1) year (2,080 hours) supervised experience with the population group for which approval is granted. b. Psychiatry 1. Currently licensed to practice medicine in the State of Michigan in accordance with Public Act 368 of Certified or eligible for certification by the American Board of Psychiatry and Neurology. 3. A minimum of one (1) year (2,080 hours) supervised experience practicing as a psychiatrist. This may include residency experience. 3. General Privileges for Physicians a. Perform psychiatric evaluations b. Diagnosis of mental and emotional disorders or disabilities c. Order diagnostic and therapeutic services d. Provide consultations to other physicians e. Child and adolescent psychiatric consultation

18 Attachment B CREDENTIALING APPENDIX f. Individual/ medical psychotherapy of adults psychiatric patients g. Continuing treatment planning and care management for population credentialed. M. Physicians Assistants 1. Definition: Physician Assistants are health care professionals licensed to practice medicine with physician supervision. Within the physicians PA relationship, physician assistants exercise the autonomy in medical decision making and provide a broad range of diagnostic and/or therapeutic services and may also include education, research, and administrative services. This scope of practice includes providing any medical service which is delegated by the supervising physician. Services may include prescribing, dispensing and administering medications: assessment & diagnosis of psychiatric conditions, medical consultation and referral, treatment planning, monitoring and discharge from services; and conducting, interpreting, and/or supervising AIMS testing. 2. Qualifications: a. PA licensed to practice in the State of Michigan certified by the National Commission on Certification of Physician Assistants (NCCPA). b. Supervised by a physician (psychiatrist) who has appropriate credentials. N. Psychology 1. Definition: "Practice of psychology" means the rendering to individuals, groups, organizations, or the public of services involving the application of principles, methods, and procedures of understanding, predicting and influencing behavior for the purposes of the diagnosis, assessment related to diagnosis, prevention, amelioration, or treatment of mental or emotional disorders, disabilities, or behavioral adjustment problems by means of psychotherapy, counseling, behavior modification, hypnosis, biofeedback techniques, or psychological tests. 2. General Qualifications a. Licensed Psychologist 1. Possession of a Doctoral Degree in Psychology or a closely related field which includes education and training in preparation for the professional practice of health service psychology. 2. Licensed to practice psychology in the State of Michigan in accordance with Public Act 368 of A minimum of one (1) year (2,080 hours) experienced with the population group for which approval is requested. 3. General Privileges for Psychologists a. Individual assessment b. Family assessment

19 Attachment B CREDENTIALING APPENDIX c. Develop treatment plans d. Diagnosis of mental and emotional disorders or disabilities e. Provide consultation to other psychologists f. Testing IV. Competency Standards for Cross Training Mental Health & Substance Abuse Staff A. Substance Abuse Staff 1. Demonstrates competence in administering mental status exam 2. Demonstrates understanding of major psychiatric medications. 3. Demonstrates competence in differential diagnosis for mental health and substance abuse. 4. Demonstrates understanding of LifeWays screening/assessment, authorization and referral processes. 5. Demonstrates basic understanding of LifeWays Behavioral Health Connections, and LifeWays provider network (including overall organization, population served, eligibility criteria) B. Mental Health Staff 1. Demonstrates basic understanding of common drugs of abuse 2. Demonstrates basic understanding of substance abuse versus dependence. 3. Demonstrates understanding of Mid South s screening/assessment processes (BSAP, DSM-IV considerations) 4. Demonstrates understanding of Mid South s authorization and referral processes, including the use of ASAM criteria. 5. Demonstrates basic understanding of the process of detoxification and how it differs for individual substances. 6. Demonstrates basic knowledge of Mid South, Central Diagnostic and Referral Service, and Mid South s provider network ( including overall organization, population served, eligibility criteria) 7. ASAM Revised: 07/31/08 [Click Here to Return to Procedure text]