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{"sheet":"Instructions","index":0,"n_rows":10,"n_cols":10,"rows_kept":10,"cut":false,"hidden":false,"merged":[[5,9,5,19],[8,0,8,7],[9,0,9,7],[7,0,7,7],[0,0,0,7],[1,0,1,7],[4,0,4,7],[5,0,5,7],[6,0,6,7],[2,0,2,7],[3,0,3,7]]}
["School District Behavioral Health Implementation Plan"]
["Instructions For Use"]
["READ BEFORE STARTING: This file uses VBA Macros to streamline functionality. If you see SECURITY WARNING banner (yellow), click \"Enable Content\" (see Figure 1) and proceed to step 1."]
["If you see a SECURITY RISK banner (red) at the top of this file, go to “Manually Enabling Macros” tab for further instructions."]
["1. On the District Info tab, fill out the cells highlighted in blue with the requested information about the school district. Consult the \"Glossary\" tab if there are any questions about a particular field."]
["2. On the \"School Info\" tab, fill out the cells highlighted in blue with the requested information about the first school. Note that some responses will trigger follow-up fields to appear.",null,null,null,null,null,null,null,null,"Figure 1: SECURITY WARNING banner with \"Enable Content\" button"]
["3. At the bottom of the \"School Info\" tab is a field requesting the number of individual providers that will be at the school. After inputting the number, the form will create the specified number of sections for each provider. Fill out the requested details for each individual."]
["4.When the \"School Info\" tab is complete, click the COMPLETE button to the right of the form. Be sure the form is fully completed before clicking. All data will output to the \"Provider Info\" and \"SCDHHS Use\" tabs, and the \"School Info\" tab will clear. The \"District Info\" tab will remain unchanged."]
["5. Fill out the same information on the \"School Info\" tab for the next school. Click COMPLETE when that school is finished. Note that the \"Schools Completed\" counter above the button will track the number of schools that have been completed."]
["6. Repeat this process until all schools are complete. Send this workbook and any required documentation to State_Contracts@scdhhs.gov."]

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["Manually Enabling Macros"]
["Follow these steps first to enable VBA macros."]
["A. Open your computer's File Explorer."]
["B. Navigate to the location this file was downloaded."]
["C. Right-click the file and click \"Properties.\""]
["D. At the bottom of the \"General\" tab, check the \"Unblock\" box (see Figure 2)."]
[]
[]
[null,null,null,null,null,null,null,"Figure 2: Check \"Unblock\" in the file's Properties menu to allow macros"]
[]
[]
["If you experience any problems, please contact Deborah Munchmeyer at Deborah.Munchmeyer@scdhhs.gov"]

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["School District Behavioral Health Implementation Plan"]
["Glossary of Requested Fields"]
["District Info:"]
["School District Name:",null,null,"Name of the school district"]
["Mailing Address:",null,null,"School district administrative office address"]
["City:",null,null,"Administrative office city"]
["State:",null,null,"Administrative office state"]
["Zip:",null,null,"Administrative office zip code"]
["Medicaid Provider ID:",null,null,"School district's SCDHHS-assigned provider ID code"]
["Medicaid Coordinator Email:",null,null,"Email of district's assigned Medicaid coordinator"]
["Telehealth Offered?",null,null,"Yes/No; Indicates whether the school district offers telehealth service for behavioral health"]
["Vendor:",null,null,"If Yes, list the district's telehealth vendor for behavioral health"]
["Barriers to Telehealth?",null,null,"If No, list any barriers preventing the district from offering telehealth"]
["School Info:"]
["School Name:",null,null,"Name of the school"]
["Mailing Address:",null,null,"Mailing address of the school"]
["City:",null,null,"City of the school"]
["Zip:",null,null,"Zip code of the school"]
["School ID:",null,null,"SC Department of Education-assigned School Identification Number (SIDN)"]
["Medicaid Coordinator Email:",null,null,"Email of school's assigned Medicaid coordinator"]
["Absolute Total Care:",null,null,"Enrolled/Not Enrolled/Enrollment in progress; indicates the school's enrollment status with this Managed Care Organization"]
["First Choice by Select Health:",null,null,"Enrolled/Not Enrolled/Enrollment in progress; indicates the school's enrollment status with this Managed Care Organization"]
["Healthy Blue by Bluechoice Healthplan:",null,null,"Enrolled/Not Enrolled/Enrollment in progress; indicates the school's enrollment status with this Managed Care Organization"]
["Humana Benefit Plan of SC:",null,null,"Enrolled/Not Enrolled/Enrollment in progress; indicates the school's enrollment status with this Managed Care Organization"]
["Molina Healthcare of SC:",null,null,"Enrolled/Not Enrolled/Enrollment in progress; indicates the school's enrollment status with this Managed Care Organization"]
["Staffing Model:",null,null,"Direct Hire/Subcontractor (DMH)/Subcontractor (LIP)/Subcontractor (RBHS); indicates the school's chosen model of behavioral health staffing"]
["Billing Method:",null,null,"Internal/Third Party Billing; indicates the school's method of billing for behavioral health services"]
["Provider Schedule:",null,null,"10-month/12-month; indicates the work schedule length of the school's behavioral health provider(s)"]
["Third Party Billing Agent:",null,null,"If Staffing Model is Direct Hire and Billing Method is Third Party Billing, list the name of the agent that will be responsible for billing activities"]
["Third Party Point of Contact:",null,null,"If Staffing Model is Direct Hire and Billing Method is Third Party Billing, list the name of the Third Party Billing Agent's point of contact for the school"]
["Point of Contact Phone:",null,null,"If Staffing Model is Direct Hire and Billing Method is Third Party Billing, list the point of contact's phone number"]
["Point of Contact Email:",null,null,"If Staffing Model is Direct Hire and Billing Method is Third Party Billing, list the point of contact's email address"]
["Third Party Medicaid ID:",null,null,"If Staffing Model is Direct Hire and Billing Method is Third Party Billing, list the SCDHHS-assigned provider ID of the billing agent"]
["Group Name:",null,null,"If Staffing Model is RBHS, list the name of the group contracted by the school"]
["Number of Individual Providers:",null,null,"The number of individual providers that will be working for/at the school"]
["Provider Name:",null,null,"Name of individual provider"]
["Licensed:",null,null,"Yes/No; Indicates whether the provider is licensed"]
["Enrolled In Medicaid:",null,null,"Yes/No; Indicates whether the provider is enrolled with Medicaid"]
["Start Date:",null,null,"Indicates the provider's start date with the school"]
["Provider Practice:",null,null,"List the practice that employs the provider"]
["License Number:",null,null,"If licensed, list the provider's license number"]
["Provider ID:",null,null,"If enrolled with Medicaid, list the provider's SCDHHS-assigned provider ID"]
["Provider Phone:",null,null,"List the provider's contact phone number"]
["Provider Email:",null,null,"List the provider's contact email address"]

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["School District Behavioral Health Implementation Plan"]
[]
[]
["General Information"]
[]
["School District Name:"]
["Mailing Address:",null,"City:"]
["State:",null,"Zip:"]
[]
["Medicaid Provider ID:"]
["Medicaid Coordinator Email:"]
[]
["Telehealth Offered?"]
[{"$f":"IF(B13=\"\",\"\",IF(B13=\"Yes\",\"Vendor:\",\"Barriers to Telehealth?\"))","v":""}]

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["School District Behavioral Health Implementation Plan"]
[]
[null,null,null,null,null,"Schools Completed:",null,null,0]
["General Information"]
[]
["School Name:"]
["Mailing Address:",null,"City:"]
["State:",null,"Zip:"]
[]
["School ID:"]
["Medicaid Coordinator Email:"]
[]
[]
["MCO Enrollment"]
[]
["Absolute Total Care:"]
["First Choice by Select Health:"]
["Healthy Blue by Bluechoice Healthplan:"]
["Humana Benefit Plan of SC:"]
["Molina Healthcare of SC:"]
[]
[]
["Behavioral Health Information"]
[]
["Staffing Model:",null,{"$f":"IF($B$25=\"\",\"\",IF($B$25=\"Subcontractor (RBHS)\",\"Group Name:\",IF($B$25<>\"Direct Hire\",\"\",IF($B$26=\"Third Party Billing\",\"Third Party Billing Agent:\",\"\"))))","v":""}]
["Billing Method:",null,{"$f":"IF($B$25=\"\",\"\",IF($B$25<>\"Direct Hire\",\"\",IF($B$26=\"Third Party Billing\",\"Third Party Point of Contact:\",\"\")))","v":""}]
[null,null,{"$f":"IF($B$25=\"\",\"\",IF($B$25<>\"Direct Hire\",\"\",IF($B$26=\"Third Party Billing\",\"Point of Contact Phone:\",\"\")))","v":""}]
["Provider Schedule:",null,{"$f":"IF($B$25=\"\",\"\",IF($B$25<>\"Direct Hire\",\"\",IF($B$26=\"Third Party Billing\",\"Point of Contact Email:\",\"\")))","v":""}]
[{"$f":"IF(B25=\"\",\"\",IF(B25<>\"Direct Hire\",\"*Attach all new provider subcontracts and/or amendments for current provider subcontracts to this document.\",\"\"))","v":""},null,{"$f":"IF($B$25=\"\",\"\",IF($B$25<>\"Direct Hire\",\"\",IF($B$26=\"Third Party Billing\",\"Third Party Medicaid ID:\",\"\")))","v":""}]
[]
["Individual Provider Information"]
[]
["Number of Individual Providers:"]
[]
[{"$f":"IF($B$33=\"\",\"\",\"Provider Name:\")","v":""},null,{"$f":"IF(A35=\"\",\"\",\"Provider Practice:\")","v":""}]
[{"$f":"IF($B$33=\"\",\"\",\"Licensed:\")","v":""},null,{"$f":"IF($B36=\"\",\"\",IF($B36=\"No\",\"\",\"License Number:\"))","v":""}]
[{"$f":"IF($B$33=\"\",\"\",\"Enrolled In Medicaid:\")","v":""},null,{"$f":"IF($B37=\"\",\"\",IF($B37=\"No\",\"\",\"Provider ID:\"))","v":""}]
[{"$f":"IF($B$33=\"\",\"\",\"Provider Phone:\")","v":""},null,{"$f":"IF($B$33=\"\",\"\",\"Start Date:\")","v":""}]
[{"$f":"IF($B$33=\"\",\"\",\"Provider Email:\")","v":""}]

{"sheet":"Provider Info","index":5,"n_rows":1,"n_cols":11,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["school_name","school_id","provider_practice","provider_name","prov_licensed","prov_license_num","mc_enrolled","provider_id","prov_start_date","prov_phone","prov_email"]

{"sheet":"SCDHHS Use","index":6,"n_rows":1,"n_cols":30,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["district_name","district_address","district_city","district_state","district_zip","district_prov_id","district_coord_email","district_telehealth","district_th_vendor","district_th_no","school_name","school_address","school_city","school_state","school_zip","school_id","school_coord_email","staff_model","bill_method","dh_agent_name","dh_agent_contact","dh_agent_email","dh_agent_phone","dh_agent_mid","rbhs_groupname","atc_enrolled","fcsh_enrolled","bchp_enrolled","mch_enrolled","mhp_enrolled"]