Program Requirement Six (6): Organizational Authority, Governance, and

Program Requirement Six (6): Organizational Authority, Governance, and Accreditation – Organizational Authority A. The CCBHC is considered part of a local government behavioral health authority when a locality, county, region, or state maintains authority to oversee behavioral health services at the local level and utilizes the clinic to provide those services. The CCBHC maintains documentation establishing the CCBHC conforms to at least one (1) of the following statutorily established criteria: 1. Is a non-profit organization, exempt from tax under the applicable section of the United States Internal Revenue Code. 2. Is part of a local government behavioral health authority. 3. Is operated under the authority of the Indian Health Service, an Indian tribe, or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act. 4. Is an urban Indian organization pursuant to a grant or contract with the Indian Health Service under Title V of the Indian Health Care Improvement Act. B. To the extent CCBHCs are not operated under the authority of the Indian Health Service, an Indian tribe, or tribal or urban Indian organization, CCBHCs shall reach out to such entities within their geographic service area and enter arrangements with those entities to assist in the provision of services to tribal members and to inform the provision of services to tribal members. To the extent the CCBHC and such entities jointly provide services, the CCBHC and those collaborating entities shall satisfy the requirements of these criteria. C. An independent financial audit is performed annually by an independent auditor (Certified Public Accountant) for the duration that the clinic is designated as a CCBHC in accordance with federal audit requirements, and, where indicated, a corrective action plan is submitted addressing all findings, questioned costs, reportable conditions, and material weakness cited in the Audit Report. D. CCBHCs must publish and distribute the Office of the Attorney General Medicaid Fraud Control Unit’s informational brochure on the CCBHC’s website, at CCBHC facilities, and to all CCBHC engaged clients. E. Establish written policies, procedures, and standards of conduct that articulate the CCBHC’s commitment to comply with all applicable federal and state rules and laws subject to approval by DMH. F. Comply with all federal and state requirements regarding Fraud, Waste, and Abuse including but not limited to the applicable section(s) of the Social Security Act and applicable federal laws. G. Not knowingly be owned by, hire or contract with an individual who has been debarred, suspended, or otherwise excluded from participating in federal procurement activities or has an employment, consulting, or other Agreement with a debarred individual for the provision of items and services that are related to the entity’s contractual obligation with the State, in accordance with 42 C.F.R. § 438.610. H. The CCBHC shall assign a staff member who reports directly to the Chief Executive Officer and/or the board of directors, to: 1. Be responsible for all fraud and abuse detection activities, including the fraud and abuse compliance plan. 2. Participate in meetings of the DOM Office of Program Integrity. 3. Notify the DOM Office of Program Integrity in writing within 30 days of the discovery of any overpayments made by Medicaid caused by billing errors, system errors, human error, etc. 4. Serve as contact for CCBHC staff who want to report any concerns with fraud, waste, and abuse. 5. Be available for onsite DMH and DOM reviews, investigations related to suspected provider Fraud, Waste, and Abuse cases, and comply with requests from DOM to supply documentation and record. I. Annually review and submit an updated Fraud, Waste, and Abuse compliance plan to DMH for approval. The CCBHC must submit its compliance plan, including Fraud, Waste, and Abuse policies and procedures to the Medicaid Office of Program Integrity for written approval within 30 days before those plans and procedures are implemented. The compliance plan must include: 1. Policies and procedures for completing annual Fraud, Waste, and Abuse training and education for the CCBHC staff. 2. Designated compliance staff and reporting procedures. 3. Procedures that the CCBHC will take to monitor, audit and respond to compliance issues as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements. 4. Effective annual training and ongoing education. (Reference Source: Medicaid Program Integrity Educational Resources - CMS.) 5. Lines of communication and reporting. 6. Internal monitoring and auditing procedures, including service verification letters issued, collected, and analyzed for 5% of Medicaid and non-Medicaid clients served. 7. Enforcement of standards through well-publicized disciplinary guidelines. 8. Prompt response to detected problems through corrective actions.