SFY15-16 Contract Renewal Letter to Providers



March 21, 2014

Dear Fee For Service Contract Provider,

The Division of Mental Health and Addiction Services (DMHAS) is pleased to announce that applications to renew Substance Use Disorder Treatment Initiatives Fee For Service (FFS) contracts for SFY 2015 and 2016, a two-year contract period (July 1, 2014 through June 30, 2016), are now being accepted. This is an application for contract renewal only. Therefore, agencies may not add new sites, levels of care, or new initiatives to their new contract at this time, however, agencies may add enhancements. At a future date, DMHAS will invite agencies to expand network participation by site, level of care, and/or initiative under a separate Open Enrollment invitation.

Agency sites without an active substance abuse facility license issued by the Department of Human Services (DHS) Office of Licensing (OOL) may not provide services under this contract and are subject to network suspension. Residential facilities must be licensed to provide adult services at contracted sites to provide services under this contract.

A number of important changes have been made to the Annex A contract documents since the last contract renewal, therefore, it is critical that you review each document carefully before signing.

As a result of the State of New Jersey’s decision to expand Medicaid coverage to include low-income consumers effective January 1, 2014, and to include a broad array of behavioral health services in the Medicaid benefit package available for the “expansion” population, the Department of Human Services, Division of Mental Health and Addiction Services (DMHAS), has determined that contracted agencies providing Medicaid-covered services to Medicaid-eligible consumers are required to enroll in NJ FamilyCare, New Jersey’s Medicaid program, and to assist consumers to apply for and obtain NJ FamilyCare coverage, in order to maximize Federal revenues to offset costs currently borne by the State.

If your agency is not currently enrolled as a NJ FamilyCare provider, DMHAS requires that you enroll into the NJ FamilyCare program and obtain an active NJ FamilyCare provider number(s). The provider number will allow your agency to bill NJ FamilyCare program. We are asking that you complete this process as soon as possible, but not later than September 30, 2014. Additionally, beginning as soon as possible but no later than July 1, 2014, DMHAS contracted service providers are required to screen consumers for NJ FamilyCare eligibility at the time of admission and to assist consumers who are not enrolled in NJ FamilyCare to complete the on-line application available at . Additionally, providers are expected to monitor client NJ FamilyCare enrollment status throughout treatment and to seek reimbursement through NJ FamilyCare for covered services and consumers.

Please follow the instructions below to complete the contract application process. The contract application components are to be received by DMHAS no later than April 4, 2014. Failure to meet this deadline may result in the contract application not being processed for a July 1, 2014 contract start.

The SFY 2015-2016 Contract Application is organized in three sections. The documents described in each section are to be reviewed, completed, signed and submitted to DMHAS and/or retained at the agency in order to complete renewal of your agency’s FFS contract.

Section #1: DMHAS FFS Network Contract Renewal Application SFY 2015-2016

Section #2: Department of Human Services (DHS) Service Contract Requirements

Section #3: DMHAS Annex As and Site Summary

FFS Contract Requirements are included in the body of this application letter, below. Bulleted items identify all hard copy documents that must be submitted to DMHAS to complete Sections #1, #2, and #3 of the application. Contract renewal application forms are available on the NJSAMS website at the link below.



Go to Documents, open Contract/FFS Documents, and open Contract Renewal SFY 2015–2016 folder. All of the required documents to complete Sections #1, #2, and #3 are posted in this folder with the exception of your agency’s FFS Site Summary which is enclosed in this correspondence. Please refer to the following instructions to prepare your agency’s contract renewal application.

Section #1 – FFS Network Contract Renewal Application SFY 2015-2016

Please submit signed original or, where indicated, copy of the following documents:

• Agency Administrative Information and Contract Application Signature Page (complete all requested information; two copies with original signature; blue ink required on both).

• Attach copy of current, signed 211 Affiliation Agreement (a photocopy is acceptable).

• Attach a copy of your CURRENT Affiliation Agreement APPROVAL letter from the Intoxicated Driving Program (IDP) certifying that your IDRC/IDP Affiliation Agreement has been approved (DUII Treatment Providers ONLY).

Section #2 – (DHS) Service Contract Requirements

Please submit signed original and copy of the following documents:

• DHS Standard Language Document (two copies with original signatures; blue ink required on both);

Please enter effective dates July 1, 2014 through June 30, 2016.

• Business Associate Agreement (two copies with original signatures; blue ink required on both);

• Standardized Board Resolution Form (original signature; blue ink required);

• Public Law 2005, Chapter 51, Chapter 271 and Executive Order 117 (original signature; blue ink required) Note: Non-profit organizations are exempt from this requirement.

• N.J.S.A. 52:34-13.2 Source Disclosure Certification Form (formerly Public Law 2005, c.92/Executive Order 129) (original signature; blue ink required) Note: Public entities are exempt from this requirement.

• W-9 Vendor Questionnaire (original must be on file with NJ Department of Treasury; send copy of original to DMHAS) If your organization is in the process of a merger or acquisition, please contact JoAnn DeLay, Contract Administrator, for further instructions.

• Schedule G - Certification Regarding Debarment and Suspension (original signature; blue ink required);

• Schedule I – Certification Sheet for Application for Contract Funds (original initials; blue ink required);

Please submit a copy of the following documents:

• Certification of Employee Information Report-AA302 or photo copy of yellow copy sent from Treasury.

• Certificate of Liability Insurance (must name State of NJ as additionally insured);

• Certificate of Incorporation;

• Charitable Registration Status (copy of 501c letter), applies to Non-profits only;

• Sliding Fee Scale Policy and Procedure and Fee Schedule;

• Subcontractor/Consultant Agreement(s), (if applicable);

• Dated current Board Members list with addresses;

• Business Registration Certificate from NJ Department of Treasury. Note: Required only from For-profit entity applicants; the For-Profit applicant must obtain a Business Registration from the NJ Department of Treasury prior to the time the contract is awarded.



• Latest Audited Financial Statements or, if not applicable, the Latest Financial Statements;

Section #3: DMHAS Annex As and Site Service Summary

Please carefully review the Annex A, A-1, A-2, A-3 contract documents as there have been many changes since your last contract renewal. These Annexes outline the contract requirements to which the agency is agreeing. Additionally, the agency will be subject to programmatic monitoring under the terms set forth in these Annexes.

The signature page of each Annex A section must be signed and dated. Also, on the signature page of the A-1, A-2, and A-3, you are to initial the appropriate box corresponding to the approved level/s of care, initiatives, and enhancements for which the agency is renewing based on the SFY2013 - 2014 Fee for Service Site Summary. The agency’s FFS Site Summary is enclosed with this correspondence.

Please review the Site Summary document for accuracy. If no corrections are to be made, please sign the bottom of the Site Summary and submit it as part of Section #3 of the renewal documents. If corrections are to be made to the Site Summary, please footnote the changes on the bottom of the form; scan and email to Susan Parris at Susan.Parris@dhs.state.nj.us for verification; and a revised Site Summary will be issued for your review and signature. Refer to the original acceptable (or revised) Site Summary to complete the Annex A-1, A-2, A-3 by initialing the corresponding levels of care, initiatives, and enhancements for which the agency has been approved and intends to continue under the renewal contract. Only those services initialed will signify the services to be provided in this contract period. Agencies interested in adding enhancements are to contact Cathy Vahey at Catherine.Vahey@dhs.state.nj.us for further instructions.

The following signature pages are to be submitted as part of the contract application:

• Annex A Fee for Service Network Agreement (one signed original in blue ink and one copy)

• Annex A-1 ASAM Service Descriptions (one signed original in blue ink and one copy)

• Annex A-2 Initiative Specific Annex A’s (one signed original in blue ink and one copy) Note: Agencies enrolled in the DUII, MATI, RRI, and SJI Initiatives must be approved for the Co-occurring Network.

• Annex A-3 Enhancement Packages Service Descriptions (one signed original in blue ink and one copy)

• FFS Site Summary document (For each licensed site, one signed original in blue ink and one copy)

Contracts will not be processed without these initialed and signed Annex A documents and signed Site Summary document.

Submit all required documents (bulleted items in Sections #1, #2, and #3) in hard copy to:

NJ Division of Mental Health and Addiction Services

222 South Warren Street

P.O. Box 700

Trenton, NJ 08625-700

Attention: JoAnn DeLay, FFS Contract Administrator, 5th floor

DMHAS must receive Section #1, Section #2 and Section #3 contract application components by close of business on April 4, 2014. Failure to submit the application by this date may result in the application not being processed for July 1, 2014 contract start.

Once a completed application package has been received, DMHAS will review the contract renewal application; confirm the FFS Initiative(s); and respective service package(s) for which your agency is enrolled. Once the application is approved, the agency will receive notice that the SFY 2015-2016 contract has been executed. The notification will contain the agency’s assigned contract number and delineate the Initiative(s) and service package(s) for which the agency is approved to request prior authorizations and submit claims for services provided to FFS clients.

Please be advised that prior authorizations cannot be issued for services on or after July 1, 2014, unless DMHAS approves your agency’s contract renewal application. A delay in submitting the requested documents may result in a denial of prior authorizations and/or denial of claims for services after July 1, 2014.

Thank you for your attention to the FFS contract renewal processes as well your participation as a contracted provider in the DMHAS FFS Initiatives Networks.

Sincerely,

Mollie Greene

Assistant Division Director

Office of Care Management

c: Susanne Rainier

Valerie Larosiliere

Roger Borichewski

Nancy Hopkins

Elaine Welsh

JoAnn DeLay

Catherine Vahey

Susan Parris

Kathy Goat-Delgado

Adam Bucon

Carmine Centanni

Andrea Connor

Chad Williams

Christine Scalise

Steve Fishbein

Kathleen Russo

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