24 Miss. Code. R. 2-2.8 - Application Process - New/Interested Agency Providers

A. New agency providers (i.e., Interested Agency Providers) who are not already certified by DMH and who desire to become a DMH-certified provider of mental health, IDD, and/or substance use disorder (SUD) services should review the current DMH Operational Standards.

B. Following review of the DMH Operational Standards, an agency interested in becoming a new DMH-certified provider must begin the application process by successfully completing DMH Interested Agency Provider Orientation, per the instructions outlined in the Interested Agency Provider Orientation Portal. As part of the Interested Agency Provider Orientation, DMH Interested Agency Providers will submit attestation that the provider has reviewed the current DMH Operational Standards, along with other attestations required during the application process.

C. The DMH Interested Agency Provider Orientation is made available via a web-based portal on the DMH website.

D. Following successful completion of the DMH Interested Agency Provider Orientation, the DMH Interested Agency Provider seeking DMH certification must submit the required DMH application and supporting documentation and adhere to the timelines and procedures for application. The initial application packet (including all required materials) must be submitted through the Interested Agency Provider portal, per the instructions outlined in the portal.

E. The complete Interested Agency Provider application packet must contain all required application submissions, as outlined in the Orientation portal, and these items must be complete, as determined by DMH.

F. DMH initial certification for new Interested Agency Providers is a two-step process:

1. First, an Interested Agency Provider must receive DMH Agency Provider Certification (i.e., initial certification of the agency) which is the agency's overall DMH certification and includes the certification of the services/supports the organization plans to provide. This process begins with the submission of the complete Interested Agency Provider application packet, as outlined in this chapter.

2. Second, upon approval of the Interested Agency Provider application packet, the new DMH initially certified agency provider must also apply for DMH certification of the physical service location(s) at which the services are to be provided.

G. A complete Interested Agency Provider application packet must contain the following application items in a complete manner, as determined by DMH (Note: additional application items may be added through the Interested Agency Provider portal; this is not an exhaustive list):

1. DMH Interested Agency Provider Application which is complete.

2. Evidence of incorporation from the Mississippi Secretary of State's Office, as applicable.

3. Governing and Professional Authority Structures, including names and positions and a signed statement of Governing Authority and Executive Director (ED) assurances.

4. Organizational chart which identifies agency leadership by position and name with delineated lines of authority.

5. Attestation Form denoting agreement to adhere to DMH's data submission requirements (i.e., Data Submission Requirements Agreement), as applicable based on provider type and services provided.

6. The name and contact information of the person associated with the agency who will be the point of contact for DMH pertaining to matters regarding DMH provider certification.

7. Signed releases of information, as may be required by DMH.

8. Official transcripts, verifiable copies of required professional credentials, and/or completed DMH verification of experience forms to verify that education, credentialing, and/or experience requirements have been met for identified positions.

9. Agency policies and procedures that address applicable DMH Operational Standards general rules chapters and program-specific chapters, as identified via the application submission process.

10. Proof of criminal background checks for each position outlined in the Interested Agency Provider Orientation, submitted in the manner prescribed for in the Orientation, with no disqualifying events, as determined by DMH.

11. Evidence of current licensure and/or certification from all other states/entities in which the agency provider/business operates.

12. Three (3) professional references from entities/individuals that maintain a business relationship with the applicant; if the provider is or has been licensed/credentialed in another state, then the verification status should be from the current or previous out-of-state licensure/credentialing entity.

13. A signed statement of assurance from the agency Executive Director (or top-level administrator) that the ED/top-level administrator has read all applicable sections of the DMH Operational Standards and agrees that certification issuance/maintenance is contingent upon compliance with the DMH Operational Standards. As part of this statement of assurance, Interested Agency Providers must attest to the understanding and implementation of the rights of people served by the agency and ethical and professional conduct, as indicated in Chapter 14.

14. Executive Director (or top-level administrator) full-time employment attestation form.

15. Requested agency job descriptions.

16. Signed Business Associate Agreement, as applicable, based on provider type and services provided.

17. Proposed budget and documentation of three (3) months of operating expenses based on the proposed budget submitted.

18. Other fiscal requirements for the application packet, as outlined below:

(a) Applicants must provide evidence of systems in place (for entities in operation, planned systems for those not currently in operation) which provide for the control of accounts receivable and accounts payable; and, for the handling of cash, credit arrangements, discounts, write-offs, billings, and, where applicable, individual accounts.

(b) Entities currently in operation must submit the following to document average reserves of three (3) months of operating expenses:

i. Most recent six (6) months of bank statements; and

ii. Audited financial statements which include an unqualified opinion from a Certified Public Accountant (CPA).

(c) Entities not currently in operation must submit Proforma Financial Statements compiled by a CPA and documentation of planned resources to provide for reserves for three (3) months of operating expenses as noted in these financial statements.

(d) For both entities currently in operation and those not currently in operation, other fiscal resources (e.g., lines of credit and/or access to funding from affiliated organizations, if in place) will be considered. DMH retains the right to verify reported resource(s).

19. Additional application items may be required through the Interested Agency Provider application submission process.

H. If the Interested Agency Provider application packet is incomplete, DMH will notify the provider that the application is incomplete and request the required information. This is a one (1)-time notice provided as a courtesy; subsequent notices will not be provided. For the application to proceed, the provider must submit the required information; this information must be received by DMH no later than 30 calendar days following the notification by DMH. If the requested information is not submitted within this timeline, then the application packet will be voided. Interested providers are limited to two (2) voided applications. After the Interested Provider Application has been voided twice, the provider must wait one (1) year from the date the application was voided to submit a new application for certification.

I. Complete initial Interested Agency Provider application packets are reviewed to determine if provider eligibility requirements are met. Once a complete application packet is reviewed by DMH, if additional information and/or revisions are needed to render a decision, then the application will be held pending by DMH. In this instance, the provider will be notified by DMH within 30 business days of receipt of the application about the information/revision(s) needed to render a decision.

1. When an Interested Agency Provider application packet is held pending due to the need for additional information and/or revisions, the additional information/revisions must be received by DMH within 30 business days of the notification by DMH. If the requested information is not received by DMH by the prescribed deadline, the application packet will be voided.

2. Upon submission of the required additional information/revisions (i.e., second submission) of an application packet which has been held pending, DMH will either approve the second submission, if eligibility requirements are met, or require the agency to receive technical assistance from DMH. Required technical assistance must be completed by the Interested Agency Provider within 30 calendar days of DMH's notification of such to the provider. (Note: If the additional information/revisions received in the second submission are determined to be entirely inadequate by DMH, then DMH may categorize the application as an incomplete application, notify the submitting agency of such, and the application will be voided).

3. If DMH requires the new Interested Agency Provider to undergo technical assistance: After the required technical assistance, the agency must resubmit a second revision of the deficient information in strikethrough and underline revision format (noting the deletions and additions to the original submission). This information must be received by DMH within 30 calendar days of the notice from DMH requesting this information.

4. DMH will either approve the second revision of a held pending Interested Agency Provider application (i.e., third submission) or deny the application.

J. If the Interested Agency Provider's application packet is approved, then an initial certification award notice will be issued to the provider which includes information on next steps, including scheduling an on-site initial Health and Safety inspection and application(s) to add a new program(s) as applicable. However, the award notice stipulates that full award to the agency provider of DMH initial certification is contingent upon a successful initial Health and Safety inspection(s) by DMH.

Notes

24 Miss. Code. R. 2-2.8

Miss. Code Ann. § 41-4-7

Amended 7/1/2016 Amended 9/1/2020 Amended 11/1/2024