RE-Certification for Being a TreatFirst Agency

1) Introduction to Re-Certification

2) RE-Certification Attestation Form

3) Data Collection Training Request Form

4) Downloadable Forms

Introduction to Re-Certification

This module is only relevant to those agencies who currently hold a Certificate as a Treat First Agency. At the bottom of your certificate, there is a ‘Period of Certification.’ It indicates when the period of your agency’s particular Certification ends.

In this talk, I am going to go over the steps for those of you need to apply for RE-certification. You are encouraged to electronically submit your RE-Certification forms before the end of your certification period. There are only two forms required for recertification:

Steps to Re-Certification

Use the earlier modules in this website to re-orient your organization to the Treat First Approach; and to train those new staff who will be implementing Treat First. If your staff have not been trained in the TxF modules within the last six months, you will be asked in this form to attest to their having a refresher training in the modules.
Review the RE-Certification Attestation Form. This will allow you to modify and bring up-to-date the information we have on file for your contact information, your agency’s street address, City and State, Zip for your main offices as well as any additional Names/Location of other clinics that are participating in Treat First. You will need to complete the Medicaid ID and the NPI for each clinic, even if they are the same as your main facility. Once you complete the from, please have the authorized person sign it attesting to the statements in the form.Again, you can either submit the form directly from the webpage, or download it and email it to treat.first@hsd.nm.gov.
Submit the RE-Certification Data Collection Training Request Form to Falling Colors at support@bhsdstar.org. They will work with you directly to schedule a date in which they will train you on registration and data collection system. Insert that date in your Re-Certification Attestation Form.
Upon receipt and approval of your Re-Certification Forms, a signed Certificate of Acknowledgement will be sent to your agency by the state.
The state will notify both Falling Colors staff and the Medical Assistance Division designated staff who will update your Provide Profile that you are recertified as a Treat First Provider.

RE-Certification Attestation Form

List all your agency’s sites that are/will be participating in Treat First:*
Name/Location of Facility Site Medicaid ID NPI

Insert more if needed
The Provider Agency attests to the following activities:
Is familiar with, and is following, the procedures as clarified and defined in the Treat First Model for specialized behavioral health services as used in: Medicaid Behavioral Health Policy & Billing Manual*
Follow this link for the Medicaid Behavioral Health Policy & Billing Manual
- Yes
- No
Has participated in, or scheduled, a RE-Certification session with the state to discuss any changes or modifications from the Agency's original Certification.*
- Yes
- No, or Date Scheduled
Has registered or scheduled registration for their agency and any changes in relevant staff in the BHSDstar.org web-based data collection system.*
Follow this link for the BHSDstar.org website.
- Yes
- No, or Date Scheduled
Will post the required data on a timely basis.*
- Yes
- No
Will utilize the Self Check-In and Session Check-Out Instruments with all participating clients.*
- Yes
- No
Will participate in the scheduled Treat First Learning Community meetings.*
- Yes
- No
All staff new to Treat First have been/will be trained in the modules contained in https://TreatFirst.org. Existing staff not trained in the module within the last 6 months will have a refresher training of the same modules.*
- Yes
- No
Follow this link for the TreatFirst.org website.
I attest to the accuracy of the above statements.
Signature*
Authorized Name*
First Last
Authorized Title*
Telephone Number
Email
Date*
MM slash DD slash YYYY
Lead Treat First Contact (if different than above)
Name
First Last
Email
Phone
If you are downloading this form and intend to email it (instead of submitting it directly on the Treatfirst.org website) send the signed and completed Attestation form to treat.first@hsd.nm.gov

Send the Data Collection Training Request form directly to support@bhsdstar.org

Data Collection Training Request Form

Please send this form to Falling Colors. However, the process will be that once you have received your Certificate of Acknowledgement and the Certificate has been forwarded by the state directly to Falling Colors, Falling Colors will contact you about scheduling training.

Data Collection Training Request Form

Lead Contact Name
First Last
Lead Contact Phone
Lead Contact Email
List all your agency's sites that are/will be participating in Treat First
Name/physical address of Facility Site Medicaid ID NPI

(Insert more if needed)
When are you requesting that your staff be trained on the data collection system?
Month
Day
Year
Number of staff attending training
Please enter a number greater than or equal to 1.
Signature
Name and Title
Email
Date
Month
Day
Year

Downloadable Forms

RE-Certification Attestation Form
RE-Certification Attestation Form
RE-Certification Data Collection Training Request Form
RE-Certification Data Collection Training Request Form

Name/Location of Facility Site	Medicaid ID	NPI

Name/physical address of Facility Site	Medicaid ID	NPI

Introduction to Re-Certification

Steps to Re-Certification

RE-Certification Attestation Form

RE-Certification Attestation Form

The Provider Agency attests to the following activities:

I attest to the accuracy of the above statements.

Lead Treat First Contact (if different than above)

Data Collection Training Request Form

Data Collection Training Request Form

Downloadable Forms

RE-Certification Attestation Form

RE-Certification Data Collection Training Request Form