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Senate Bill 58 Comprehensive Service ProviderCREDENTIALING & ONGOING SERVICE DELIVERY PROCESS MAPSSHP 20207131
IntroductionThis process map is meant to serve as a tool and resource in considering and understanding the requirements ofbecoming a comprehensive service provider and delivering the related services. This tool does not cover everypossible step, but rather serves as an outline to understand key milestones for consideration. Senate Bill 58allows for non local mental health authority (LMHA) providers to deliver community based services and theservices historically rendered by the LMHA. This process map is the culmination of a collaboration betweenSuperior HealthPlan, Texas Alliance of Child and Family Services and several current providers including CKFamily Services, Pathways Youth and Family Services, DePelchin Children’s Center, Deblin Health Concepts, andArrow. We appreciate all of the participants who have worked to develop this resource.We have provided the most current information at the time of development, and you should always confirm themost current HHSC requirements when considering if you would like to become a comprehensive care provider.We also want to call attention to the need for a full business plan when considering the decision to become thistype of provider. There are many details and aspects to this type of work that we recommend thinking throughboth in deciding to become a provider and during the on-going delivery of services. We hope you find thisresource useful.*While this was created in conjunction with Superior HealthPlan, please check with other MCO’s to verify their processes.SuperiorHealthPlan.comNovember 12, 20202
Credentialing Process (1/2 slides)Becoming anSB58 ProviderBusiness StructurePOTENTIAL BARRIERS Lengthy Delay betweenMedicaid Enrollment andFinalized Credentialing(approximately 1-2 years) Staffing Shortages Administrative Burdens Rate Changes Funding Difficulties Political & Policy Changes Limited Slots for SpecificEvidence-Based Services suchas Wraparound Covering Salaries during StaffTraining (3-4 months) andThen Ramp Up PeriodBusiness PlanTHINGS TO CONSIDER Mission Statement Population Served (Adults/Children/Both) Need for Providers Geographical Servicing Area Outline Technology Investments Hardware/Software Needs &Compatibility Electronic Health Record/Assessments,Treatment Notes, Progress Notes Billing Technology/Claims/ClearingHouse State Reporting Required Trainings Project LeaderHire LPHAMedicaid Provider& NPI ApplicationsCMS MedicareMedicaidMCOApplicationsTHINGS TO CONSIDER Meet Enrollment Criteria Obtain HHSC Approval for Enrollment/Enter into Written Provider Agreement Submit Texas Medicaid EnrollmentApplication to TMHP (online or paper) Issued Medicaid Provider Number PTAN Required for Medicare Services Submit Contracting Documents withState Credentials VerificationOrganizationID RequiredTrainings &ResourcesTRAINING REQUIREMENTShttps://hhs.texas.gov HHSC UNIFORM MANAGED CAREMANUAL 15.3(evidence-based) UTILIZATION MANAGEMENTGUIDELINES & MANUAL(provider specific) SUPERIOR HEALTHPLAN TRAININGRESOURCESPlease contact Superior Healthplandirectly to confirm current courses andavailability. WRAP AROUND TRAINING SERIESSuperiorHealthPlan.comNovember 12, 20203
Credentialing Process (2/2 slides)Review Hiring &Training PlanTHINGS TO CONSIDER Expect Delays Have State RequirementsChanged? Layout Delivery of ServicesModel (Referral to Conclusion)Hire Staff(Cohort Groups ifpossible)Train StaffCommunityRe-EngagementSubmit Attestationto MCO’s & CMBHSApplication ProcessTHINGS TO CONSIDERTHINGS TO CONSIDERTHINGS TO CONSIDER Community Service Specialist Qualified Mental HealthProfessional-Community Services Family Partners Start With Current Clients toEnsure Process is Smooth andGood Understanding of ClaimsCredentialsReceived Establish relationship with MCORepresentative Written documentation of MCOprocesses and requirements Peer ProvidersSuperiorHealthPlan.comNovember 12, 20204
Service Delivery ProcessReferral ReceivedProcess ReferralRender AssessmentSubmit to CMBHS(Columbus) forLevel of CareRender ServicesTimely ClaimSubmissionsOngoing cycle that is continuously reassessedTHINGS TO CONSIDER Verify Eligibility (CMBHS, MCO) Verify Client Age Verify Appropriate Diagnosis Diagnostic Assessment Needed ifNo Diagnosis (Verify if priorauthorization is needed fromMCO)SuperiorHealthPlan.comNovember 12, 20205
both in deciding to become a provider and during the on-going delivery of services. We hope you find this resource useful. *While this was created in conjunction with Superior HealthPlan, please check with other MCO's to verify their processes. . Submit Texas Medicaid Enrollment Application to TMHP (online or paper) .
