Required Staff/Providers. The Health Plan shall submit contracted and subcontracted staffing information by position, name and FTE for all behavioral health direct service positions on a quarterly basis in accordance with Table 14, Required Staff/Providers, below. REMAINDER OF PAGE INTENTIONALLY LEFT BLANK Table 13 Required Staff/Providers Plan Name: Plan 7-Digit Medicaid ID#: As of Date (3rd Month of the Qtr/Year): AHCA Area: Positions Total Non-Clinical Specialties Therapeutic Specialty Areas With 2 Years Clinical Experience Bi-Lingual Expert Witness Court Ordered Evals Adoption/ Attachment Issues Post Traumatic Stress Syndrome Dual Diagnosis (Mental Disorder / Substance Abuse) Gender / Sexual Issues Geriatrics / Aging Issues Separation, Grief & Loss Eating Disorders Adolescent/ Children's Issues Sexual/ Physical Abuse-Child Sexual/ Physical Abuse-Adult Domestic Violence-Child Domestic Violence-Adult Adult Psychiatrists Child Psychiatrists Other Physicians Psychiatric ARNPs Psychologists Master Level Clinicians (LCSW, LMFT, LMHC, MFCC) Bachelor Level Unduplicated Totals This report provides a snapshot of the required staff/providers on a day in the 3rd month of the quarter: March, June, September, and December. The report is due within 45 days at the end of the quarter: May 15th, August 15th, November 15th, and February 15th.
Required Staff/Providers. The provider shall submit contracted and subcontracted staffing information by position, name, and FTE for all direct service positions on a quarterly basis in accordance with section 10.11.9 and the draft format in Table G, Required Staff/Providers, attached hereto and made a part of the contract.
Required Staff/Providers. The Health Plan shall submit contracted and subcontracted staffing information by position, name and FTE for all behavioral health direct service positions on a quarterly basis in accordance with Table 12, Required Staff/Providers, below. 130. Attachment II, Medicaid Reform Fee-For-Service Provider Service Network Model Contract, Section XII, Reporting Requirements, Item T., FARS/CFARS, Table 13, is hereby deleted in its entirety and replaced with the following: REMAINDER OF PAGE INTENTIONALLY LEFT BLANK TABLE 13 FUNCTIONAL ASSESSMENT RATING SCALE/CHILDREN’S FUNCTIONAL ASSESSMENT RATING SCALE REPORTING O***YY06.txt (January through June, due August 15) OR O***YY12.txt (July through December, due February 15) Data Element Name Length Start Column End Column Description Recipient Identification Number 9 1 9 9-Digit Medicaid Identification Number of Enrollee. Recipient Date of Birth 10 10 19 Enrollee’s date of birth in CCYYMMDD format, e.g., 20010101. Recipient First Name 15 20 35 Enrollee’s first name. Recipient Last Name 15 36 50 Enrollee’s last name. Provider Identification Number 9 51 59 9-Digit Medicaid Plan Identification Number. Contractor Identification Number 10 60 70 10-digit Federal Tax Identification Number or National Provider Identifier (NPI) of the provider conducting the assessment. Contract Number 5 71 76 Up to 5-digit alphanumeric number of the Department of Children and Families contract responsible for serving the enrollee being evaluated through FUNCTIONAL ASSESSMENT RATING SCALE or CHILDREN’S FUNCTIONAL ASSESSMENT RATING SCALE. If the provider does not have a contract, enter “00000”. Assessment Type 1 77 77 1-digit code to designate the type of functional assessment that was done, i.e., “F” = FUNCTIONAL ASSESSMENT RATING SCALE or “C” = CHILDREN’S FUNCTIONAL ASSESSMENT RATING SCALE Assessment Purpose 1 78 78 1-digit code to designate the purpose for doing the assessment, i.e., “1” = Initial assessment at time of admission into provider agency; “2” = every 6-month after admission, or “3” = assessment at time of discharge from provider agency Assessment Date 8 79 86 Date of assessment in CCYYMMDD format, e.g., 20060812. Data Element Name Length Start Column End Column Description Disability Score 2 87 88 Sum of the assessment scores for all the scales in the Disability domain. Emotionality Score 2 89 90 Sum of the assessment score for all the scales in the Emotionality domain. Relationship Score 2 91 92 Sum of the assessment score for all t...
