Provider Enrollment Checklist for Behavioral Health Direct Service Provider
Updated 05/26/2020 Provider Enrollment Checklist
pv 10/15/2019 Page 2 of 4
Provider Type 14:
Qualified Mental Health Professional (QMHP), Specialty 300
_____ Provider Standards (MSM Chapter 400)
All providers must:
1. Provide medically necessary Medicaid covered services;
2. Adhere to the regulations prescribed in Chapter 400 and all applicable Division chapters;
3. Provide only those services within the scope of their [the provider’s] practice and expertise;
4. Ensure care coordination to recipients with higher intensity of needs;
5. Comply with recipient confidentiality laws and Health Insurance Portability and Accountability Act (HIPAA);
6. Maintain required records and documentation;
7. Comply with requests from the Quality Improvement Organization (QIO)-like vendor [Nevada Medicaid’s
fiscal agent];
8. Ensure client’s [recipient’s] rights; and
9. Cooperate with Division of Health Care Financing and Policy’s (DHCFP’s) review process.
_____ Rehabilitative Mental Health Services (MSM Chapter 400)
Qualified Mental Health Professionals (QMHPs) may provide Basic skills Training (BST), Program for Assertive
Community Treatment (PACT), peer-to-peer support, Psychosocial Rehabilitation (PSR) and Crisis Intervention (CI)
services. Day Treatment services may be requested and reimbursed for Provider Type 14 groups who are enrolled
with Specialty 308 and have a Day Treatment Model approved by the DHCFP. Day Treatment may not be
performed or reimbursed by individuals enrolled as a Provider Type 14 with specialties 300, 305, 306 and 307.
_____ Clinical Supervision (MSM Chapter 400)
Clinical Supervisors must assure the following:
1. An up to date (within 30 days) case record is maintained on the recipient; and
2. A comprehensive mental and/or behavioral health assessment and diagnosis is accomplished prior to
providing mental and/or behavioral health services (with the exception of Crisis Intervention services);
and
3. A comprehensive and progressive treatment plan is developed and approved by the Clinical Supervisor
and/or a Direct Supervisor, who is a QMHP, LCSW, LMFT or CPC; and
4. Goals and objectives are time specific, measurable (observable), achievable, realistic, time limited,
outcome driven, individualized, progressive, and age and developmentally appropriate; and
5. The recipient and their family/legal guardian (in the case of legal minors) participate in all aspects of care
planning, that the recipient and their family/legal guardian (in the case of legal minors) sign the
treatment plan, and that the recipient and their family/legal guardian (in the case of legal minors) receive
a copy of the treatment plan; and
6. The recipient and their family/legal guardian (in the case of legal minors) acknowledge in writing that
they understand their right to select a qualified provider of their choosing; and
7. Only qualified providers provide prescribed services within scope of their practice under state law; and
8. Recipients receive mental and/or behavioral health services in a safe and efficient manner.
Note: Interns/Psychological Assistants are excluded from functioning as Clinical Supervisors.
