IDD Services
Provider
Manual
Fiscal year 2012/2013
Table of Contents
INTRODUCTION/MISSION STATEMENT AND VALUES 1
ORGANIZATIONAL STRUCTURE 3
IMPORTANT POINTS TO REMEMBER 4
CREDENTIALING OF PROVIDER EMPLOYEES AND AGENTS 5
COORDINATION WITH MHMRTC GR SERVICE COORDINATOR 6
GR REFERRAL AND AUTHORIZATION PROCESS 7
TxHmL REFERRAL AND AUTHORIZATION PROCESS 8
GR/TXHML/OBRA SERVICES 9
HCS REFERRAL AND AUTHORIZATION PROCESS 10
HCS SERVICES 11
COORDINATION WITH MHMRTC ICF-MR QIDP 12
ICF-ID REFERRAL AND AUTHORIZATION PROCESS 13
ICF-ID SERVICES 14
DOCUMENTATION 15
CLAIMS AND BILLING 18
CONTACT NOTIFICATION SHEET 21
STAFF TRAINING 23
COMPLAINTS 25
MEDICATIONS 26
QUALITY MANAGEMENT/CONTRACT MONITORING 27
SANCTIONS, APPEALS AND CONTRACT TERMINATION 28
REQUISITE RULES & REGULATIONS 29
FORMS 30
· Employee Credentialing Requirements
· Provider Credentialing Requirements
· Monthly Summary Non-billable note
· Employee /Volunteer Background Checks
· Provider Requests
· Local Appeal Request
· IDD Restraint Checklist
· Contractor Incident Reporting Form
· Personal Reference Questionnaire
· MHMRTC Competency Assessment
· Consent to Background Information
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Introduction
W
elcome to Mental Health Mental Retardation of Tarrant County (MHMRTC). We are pleased to recognize you as a member of our Provider Network and look forward to enjoying a long and mutually satisfying contractual relationship with you.
The purpose of this Provider Manual is to educate you about the policies and procedures of MHMRTC. We ask that you read this material carefully and discuss any questions you may have with Provider Relations at (817) 569-4456. As a contractor you and your staff are responsible for knowing and abiding by the MHMRTC policies.
MHMRTC is staffed by a team of highly dedicated professionals experienced in the provision of services for persons who are diagnosed with Mental Retardation/Intellectual Developmental Disorders. MHMRTC is dedicated to providing high quality, innovative, and cost-effective management of mental retardation services.
Our philosophy is propelled by a strong commitment to service excellence supported by management flexibility and accountability. Our on-going objective is to continually refine our system so that we can excel in the delivery of quality services as we balance the best interests of our consumers, providers, and employees. We are also committed to contracting with community providers to offer consumer provider choices and a wider array of options.
MHMRTC clearly understands that open communication must exist between our service providers and our organization in order for us to be able to provide individuals in our community with the best possible care. We, therefore, invite you to share your perceptions, needs, and suggestions with our Director of Contracts Management/Provider Relations, Kevin McClean, who will also, from time to time, ask you to respond to surveys to help us identify other opportunities to improve our services and to assess your satisfaction as a member of our provider network.
We will do all that we can to support your entry into our system and assure that your continued participation in our network will be beneficial for all concerned.
In this Provider Manual, references may be made to consumers and clients. Both of these terms are to be considered interchangeable. Other references that are used interchangeably are MHMRTC and Local Authority (LA), and Texas Department of Aging and Disability Services (DADS) and State Authority (SA).
Mission Statements & Values
Mission Statement of
MHMR of Tarrant County:
To help the people of Tarrant County overcome the problems associated with the disabilities of mental illness, mental retardation, autism, addictive behaviors, and early childhood developmental delays by ensuring the availability of quality services.
Mission Statement of
IDD Services:
MR/IDD Services of Tarrant County expands opportunities for people
to participate actively in the community.
Values
Each person is respected and valued.
Services are developed around the individual needs, values, and opinions of each person served.
Success is demonstrated in terms of outcome for each person served.
Services enhance dignity through participation and choice.
Services encourage and support growth, independence, and integration into the community.
Quality services are provided in a safe, ethical, and cost effective manner, and provide the best value to the person served.
Programmatic and administrative best practices are recognized and valued.
A seamless system of services is realized through the coordination and collaboration of providers in the community.
Families are valued and respected for their critical importance in a person’s support system and are given the opportunity to have an active role in treatment planning and the delivery of services.
Organizational Structure
The organizational structure of MHMRTC includes the Mental Health and IDD Community Advisory Committees (CAC). These two committees are composed of individuals from the community, including consumers, who have a vested interest in assuring that quality services are readily available to our consumers. These committees are empowered to provide input into the planning process that will lead our organization into the future. Both of these committees report to our Board of Trustees.
Our Chief Executive Officer is accountable to our Board of Trustees and oversees the administrative duties of our organization. Chiefs who report directly to the Chief Executive Office are the Chief of Early Childhood Intervention, Chief Financial Office, Chief of Human Resources/Governmental Affairs, Chief of IDD Authority, Chief of IDD Provider and the Managing Director of Information Services.
Currently, MHMRTC has providers in the areas of Mental Health Services, IDD Services, Addiction Services, and Early Childhood Intervention Services. We anticipate continued growth in expanding our service providers from the community.
Important Points to Remember
It is the provider’s responsibility to render services to MHMRTC consumers in accordance with the terms of the contract and according to Home and Community Based Services (HCS)/Texas Home Living (TxHmL)/Intermediate Care Facilities for the Intellectual Disability (ICF – ID) rules as applicable. www.dads.state.tx.us (HCS - Title 40; Part 1 Chapter 9 Subchapter D. TxHmL – Title 40; Part 1 Chapter 9 Subchapter N. ICF/ID – Title 40; Part 1 Chapter 9; Subchapter E.) The provider is required to render these services to MHMRTC consumers in the same manner, adhering to the same standards, and within the same time availability as offered to all other consumers.
MHMRTC does not guarantee that a MHMRTC consumer or any number of MHMRTC consumers will utilize any particular provider. Each consumer is given information regarding all providers in the provider network and then makes the choice of provider(s).
MHMR is committed to providing our consumers with ethically sound, efficient and effective quality services. It is your duty to assist in the prevention, detection and correction of any instances of noncompliance with applicable federal, state and private health care plans. Call to report your compliance concerns to the
§ Compliance Action Line:
1-800-500-0333
Providers are required to inform consumers that they have the right to report any complaints about the services they are receiving to the
§ Consumer Complaint Reporting Line:
(817) 569-4367
or
1-888-636-6344 (toll free)
All provider complaints and/or suggestions are to be communicated to
§ Provider Relations:
(817) 569-4456.
Within one hour of witnessing or becoming aware of possible abuse/neglect/exploitation each staff person is responsible for reporting the incident to the
§ Texas Department of Family and Protective Services
1-800-647-7418 or www.txabusehotline.org
Credentialing of Provider Employees and Agents
Local Authority will review and credential all of the Provider staff, employees and agents at the professional level (i.e. licensed staff). Providers holding professional licenses and/or certifications must maintain those licenses and/or certifications in good standing with their respective licensing/certifying bodies. Provider will submit completed credentialing application forms to the Local authority for each licensed professional providing services to MHMRTC consumers. Local Authority will notify Provider of any individual not meeting the credentialing criteria. If Provider has its own credentialing process that meets or exceeds standards set forth by Local Authority’s Credentialing Committee, credentialing of staff may, upon prior approval by the Local Authority, be delegated to the Provider.
Non-licensed Provider Qualifications
All service providers must have a high school education (or GED), or equivalent, be 18 years of age, and not have been convicted of a crime relevant to a person’s duties including (1) criminal homicide, (2) kidnapping and unlawful restraint, (3) indecency with a child, (4) sexual assault, (5) aggravated assault, (6) injury to a child, elderly individual, or disabled individual, (7) abandoning or endangering a child, (8) aiding suicide, (9) agreement to abduct from custody, (10) sale or purchase of a child, (11)arson, (12) robbery, (13) aggravated robbery, (14) indecent exposure, (15) improper relationship between educator and student, (16) improper photography or visual recording, (17) deadly conduct, (18) aggravated sexual assault, (19) terroristic threat, (20) online solicitation of a minor, (21) money laundering, (22) Medicaid fraud, (23) cruelty to animals, and (24) a conviction which occurred within the previous five years for: (A) assault that is punishable as a Class A misdemeanor or as a felony; (B) burglary; (C) theft that is punishable as a felony; (D) misapplication of fiduciary property or property of a financial institution that is punishable as a Class A misdemeanor or felony; or (E) securing execution of a document by deception that is punishable as a Class A misdemeanor or a felony. (F) false identification as peace officer, and/or (G) disorderly conduct. Provider is required to provide external audit reports, if any, related to accreditation, licensure or certification. Programs must meet the requirements of those licenses, certifications or accreditations with regard to medication storage, handling, administration and documentation.
Provider is required to provide copies of each staff person’s high school diploma, GED, or an equivalent. Educational equivalency requires the submission of 3 letters of reference (required Personal Reference Questionnaire form attached), and a competency exam (form attached).
Provider is also required to provide copies of each staff person’s driver’s license, consent for Criminal History Background Checks and Employee Misconduct/Nurse’s Aide Registry Verifications. MHMRTC will prior to contracting and annually thereafter check the Client Abuse and Neglect Reporting System (CANRS) records from the state database on all direct contact staff. Staff persons with a record on the CANRS system may or may not be eligible for work with MHMRTC consumers depending upon program requirements and/or severity of offense.
Initial/annual updates of Criminal History Background Checks, Employee Misconduct, Nurse’s Aide Registry and CANRS checks will either be completed or verified by MHMRTC staff. MHMRTC will conduct the background checks for owners/managers for our Providers that do not have a designated person to conduct these checks. All background checks must be completed through The Texas Department of Public Safety. In the event a staff person has resided outside of the State of Texas within five years prior to employment/contracting with MHMRTC, a fingerprint criminal history background check will be performed at a cost to the provider.
Coordination with MHMRTC GR Service Coordinator
The primary contact person regarding any MHMRTC GR consumer will be the MHMRTC Service Coordinator. The MHMRTC Service Coordinator is responsible for assisting the consumer with accessing medical, social, educational, and other appropriate services and supports that will help a consumer achieve a quality of life and community participation acceptable to the consumer. The MHMRTC Service Coordinator is responsible for the overall coordination of services to the individual. All issues regarding an MHMRTC consumer must be brought to the attention of the MHMRTC Service Coordinator for assistance in resolution. MHMR of Tarrant County recognizes that a team effort is needed to successfully provide services to consumers. For this reason, the Provider is seen as a valuable member of the team, having insight into successes or problems as they occur. Providers are encouraged to ask questions of the MHMRTC Service Coordinator as the Person Directed Plans are developed to ensure those specific areas most important to the consumer are included at that time. It is expected that regular communication will occur between the Provider, consumer, and MHMRTC Service Coordinator, and that roles and responsibilities are tailored to meet the Consumers needs. All questions/concerns regarding GR Service Coordination should be directed to the Director of Service Coordination at 817-569-5654.
Each Provider will receive a copy of the PDP for each consumer served; this includes the initial/annual PDP as well as any revisions that are relevant to that Provider.
General Revenue (GR)
Referral and Authorization Process
Referral Process
There is no guarantee that a Provider will be used by an MHMRTC consumer or any number of MHMRTC consumers. The MHMRTC Service Coordinator will offer the consumer a choice of providers from the list of contracted Providers. Consumer’s choice will be documented. Once the consumer has decided upon a provider the service coordinator will make the referral to the appropriate provider. No services should be provided for any MHMRTC consumer without possession of a written Letter of Authorization (LOA). In the case of an emergency where a service is needed to be provided without a LOA, the Provider should only respond to a verbal request made by their designated program contact.
The LOA will be sent to the Provider chosen following the development and approval of a Person Directed Plan (PDP). The PDP will specify the services to be provided for the consumer. The PDP will be consumer specific; however, the Provider should not solely rely on the PDP for all pertinent information regarding the consumer. The Provider is encouraged to contact the Service Coordinator if assistance is needed to obtain guardianship information, doctor’s orders, current medications, etc.
The consumer may change Providers at any time. Whenever a change of providers is requested within the service plan year a notice will be sent to the Provider in the form of a lapsed LOA which will specify the date services are to end. After the LOA is lapsed the Provider is no longer expected to provide services and will not continue to be paid for services rendered.
Authorization of Services
The MHMRTC Service Coordinator will anticipate the type and amount of service needed to meet the consumer’s needs. The PDP will outline the outcome for each service authorized. An Authorization Letter will be sent to the chosen Provider which includes the consumer’s name, the date services are authorized to begin, the quantity of services authorized, the lapse date for the Authorization (by when the services must be provided or will no longer be authorized), and the Authorization Number.