Essential Safety Net Provider Overview with Andy Rose

Khara is joined by Andy Rose to talk about the ESNP application and parameters for Colorado Medicaid Mental Health Providers!
Engage with the BHA and apply for Essential Safety Net provider status. (pronounced"e-snip")
Many Medicaid outpatient psychotherapy clinics do not need to have the BHE (Behavioral Health Entity) license to participate.
If you have 10 or more "fully licensed, full time" providers you are required to obtain the "BHE" (Behavioral Health Entity), which means complying with Chapter 2 of the rules and having policies and procedures ("P&Ps") for the Chapter 2 rules.
Here are Model Policies and Procedures in one document. This doc has Chapters 2,4,8,12
Everyone has "comment" privileges for this document. If you want a conversation about any part of these policies, go ahead and comment on the document itself.
Please do not just copy and paste. Read these closely and the comments as well. You do not need to create original language but you must understand what you are submitting.
(Note Sept 2024, BHA is no longer requiring that all P&Ps get uploaded into LADDERS. BHA requires that you affirm that you have P&Ps and can produce them on demand, and that your clinic follows the rules).
COMBINE also hosts a working document to discuss the ESNP tasks in order to stay in compliance.
You can read and comment here: docs.google.co...
Current areas of concern are :
Confirming operation in appropriate zoning.
Linguistic Competence
Record Maintenance
Office concerns
Clinic Website
Personnel and Training
Fingerprinting/ Background checks
Quality Improvement
Treatment Planning
Client Screening and Referral Management for SDOH and Health Related Social Needs
Comprehensive Assessment
No Refusal requirements
Start here:
File a "Letter of Intent".
It is actually not a letter and you don't have to write anything, just go to this URL and fill out the form.
socgov06.my.sa...
At the bottom you will see the Services widget. Select Chapter 4 (Outpatient) and click arrow to move it to Chosen. Also select Chapter 12 (Safety Net). Select Chapter 8 if you see kids/families.
Then:
"After your submission is reviewed, the “Primary Contact” entered in this form will receive an email from BHA with a username and access to the LADDERS Online System. Your agency may proceed with the initial application directly in LADDERS from there."
You will get a LADDERS account. You will also get a person from BHA who is your person for this process.
You must then provide the Policies and Procedures for the following sections:
For Provisional Approval Focus:
12.3.2.B.3 - Crisis Response
12.3.2.B.9 - Critical Incident Reporting
12.3.3 - Care Coordination
12.4.3 (Essential)/12.5.3 (Comprehensive) - Screening, Triage, & Care Coordination in alignment with No Refusal
12.4.4 (Essential)/12.5.5 (Comprehensive) - Governance
So... you go into your LADDERS account and you upload those P & Ps.
Then you let your person know, and wait for the approval.
When you get the approval certificate, which is an email attachment, you then upload it to HCPF on this form.
docs.google.co...
Then "within 3-5 business days" HCPF will "approve" what BHA already approved, and HCPF will transmit your status to the RAEs. Then either you contact the RAE or the RAE contacts you about "amending your contract" with the new rates.
The more of us that get ESP status the better. We need a critical mass of clinics so that we can respond to the program as an informed group.
More resources:
hcpf.colorado....
ESNP reimbursement rates are public, transparent, and do not vary by RAE.
The rates are published in the State Billing Manual
hcpf.colorado....
Information about COMBINE, a 501c4 non profit trade association representing Medicaid behavioral health independent clinics
combinebh.org
Example Policies and Procedures: docs.google.co...
ESNP Tasks (Working Doc COMBINE): docs.google.co...