Chelan-Douglas Regional Support Network/
Prepaid Health Plan

For Mental Health

1.0	Introduction and Administrative Policies
1.1	Purpose and Authority
1.2	Manual Revision
1.3	RSN: County Department Specific Policies
1.3.1	Governance and Community Accountability
1.3.2	Douglas County Department Specific Financial Policies
1.3.3	Job Descriptions and Titles
1.4	Prepaid Health Plan
1.4.1	Adherence to HIPAA Privacy Regulations
1.4.2	HIPAA Definitions
1.4.2.1	Right to Access Protected Health Information
1.4.2.2	Administrative Requirements for the Implementation of HIPAA
1.4.2.3	Complaint, Grievance, Appeal, and Fair Hearing Policy
1.4.2.4	Right to Confidential Communication
1.4.2.5	Confidentiality
1.4.2.6	Copying and Printing Protected Health Information
1.4.2.7	De-identification and Limited Data Sets
1.4.2.8	Designated Record Set
1.4.2.9	Disposal of Protected Health Information
1.4.2.10	Documentation
1.4.2.11	Individual’s Right to Amend Protected Health Information
1.4.2.12	Marketing
1.4.2.13	Minimum Necessary
1.4.2.14	Opportunity to Agree or Object
1.4.2.15	Privacy Practice
1.4.2.16	Right to an Accounting of Disclosures
1.4.2.17	Right to Restrict Uses and Disclosures of Protected Health Information
1.4.2.18	Safeguarding Protected Health Information
1.4.2.19	Training of the Workforce
1.4.2.20	Uses and Disclosures: Authorizations
1.4.2.21	Uses and Disclosures for Research Purposes
1.4.2.22	Uses and Disclosures for Treatment, Payment, and Health Care Operations
1.4.2.23	Uses and Disclosures – Business Associate
1.4.3	Governing Board
1.4.4	Advisory Board
1.5	Guiding Principles
1.5.1	Administrative Oversight & General Provisions
1.6	Mental Health Provider Network: Provider Selection
1.6.1	Mental Health Provider - Roles and Responsibilities
1.6.2	Marketing of Mental Health Services to Medicaid Eligible Persons
1.6.3	Access Standards: Availability of Services
1.7	Awareness of Services
1.8	Staff Qualifications and Mental Health Professional Waiver Request
1.8.1	Staff Qualifications and Mental Health Specialists
1.9	Individually Tailored, Culturally Competent Services
1.9.1	Culturally and Linguistic Competency:  Standard
1.10	Continuity of and Coordination of Care
1.10.1	Access Standards: Culturally Competent Services
1.10.2	Access Standards: Coordination of Care
1.10.3	Access Standards: Furnishing of Services: Timely Access
1.11	Client (Consumer) Enrollment
1.12	Utilization Management
1.13	Disenrollment
1.14	Structure and Operations Standards: Sub-contractual Relationships and Delegation
1.15	Emergency and Post-Stabilization Services
2.0	Managed Care Services
2.1	Medical Necessity
2.1.1	Access to Care
2.1.3	Priority State Funded Services
2.1.4	Additional State Funded Services
2.2	Mental Health Assessment
2.2.1	Mental Health Assessment and Intake Evaluation
2.2.1.1	Access to Medicaid Services Prior to Intake Evaluation
2.2.2	Mental Health Screening for Children
2.2.3	Client Request for Second Opinion
2.2.4	Choice of Primary Care Provider
2.2.5	Special Populations Assessment and Ongoing Consultation
2.2.5.1	Special Populations
2.3	Case Management Services
2.4	Community Support Services
2.5	Plan of Care
2.5.1	Services Facilitate Progress Toward Recovery and Resiliency, and to Promote Linkages to Formal and Informal Supports
2.6	Risk Management/Crisis Prevention Plans
2.7	Service Level Determination and Authorization and Coverage of Services
2.7.1	Service Authorization
2.7.2	Managed Care Services
2.8	Reauthorization for Level of Care Services
2.9	Residential Level of Care Authorization for RSN-Funded Residential Facilities/Services
2.10	Client Employment Services
2.11	Special Consumer (Also Flex) Funds
2.12	Service Level/Residential Level of Care Change
2.13	Appeal of CDRSN/PHP Care Management Decision
2.14	Change To and From Inactive Status
2.15	Transferring Consumer Services
2.16	Termination of Services
2.17	Suspension/Termination of Services - Notice and Hearing Process
2.18	Evidenced Based Practices
2.19	Frequent Service Users or High Utilizers with Complex Care Needs
2.20	Coordination of Care with Primary Care Provider and Emergency Rooms
2.23	General Information Requirements
2.24	Recovery and Resiliency
2.25	Inpatient and Community Care Services
2.26	Consumer Rights/Monitoring of 2nd Opinion, Consumer Involvement in Treatment, and Consumer Access to PHI
2.27	Delegation Agreements
3.0	Crisis Response and Stabilization Services
3.1	Introduction and Purpose
3.2	County Wide Crisis Telephones - Services, Resources
3.3	Crisis Triage Services
3.4	Crisis Intervention Teams – Response
3.5	Crisis Intervention Teams - Stabilization Services and Referral for Ongoing Services
3.7	Geriatric Evaluation and Outreach Services (GEOS)
3.8	Children’s Crisis Stabilization Services, Assessment and Stabilization Services in Remann Hall, Children’s Crisis Respite Services
3.9	Other Specialized Services (DD, MICA, HIV/AIDS, PATH)
3.10	Individual Crisis Plans, Case Consultation and Coordination
3.11	Disaster Mental Health Services
3.12	Critical Incidents
4.0	Residential Services
4.1	Residential Pre-Admission Authorization and Facility Placement
4.2	Discharge and Transfer
4.3	Consumer Participation and Reimbursement for Residential Services
4.4	Consumer Benefits and Calculating Participation
4.5	Supported Living Services--Regular and Intensive
4.6	Transitional Housing
4.7	Housing Contingency Funds
4.8	Adult Family Homes
4.9	Supervised Living Services
4.10	Long-Term Rehabilitative Services
4.11	Subcontract Requirements
5.0	Inpatient Management
5.1	Introduction and Purpose
5.2	Inpatient Services
5.3	Hospitals
5.4	Certification of Providers of Involuntary Services
5.5	Inpatient Hospitalization Management Procedure
5.6	Inpatient Hospitalization Process for Community Mental Health Professionals
5.7	Involuntary Commitment Services
5.8	Inpatient Tracking
5.9	Management of Inpatient Psychiatric Hospitalizations
5.10	Children’s Long-term Inpatient Program
5.11	Community Inpatient claims Re-assignment Process
6.0	Management Information System
6.1	Health Information Systems
6.1.1	System Administrators Responsibilities
6.1.2	CDRSN/PHP MIS Compliance
6.1.3	Outpatient Services Authorization Process
6.1.4	Health Information Systems - Encounter Validation
6.2	Security
6.2.1	Security And Confidentiality
6.2.2	Adherence to HIPAA Security Regulations
6.2.2.1	Acceptable Encryption
6.2.2.2	Acceptable Use
6.2.2.3	Analog/ISDN Line Security
6.2.2.4	Guidelines on Anti-Virus Process
6.2.2.5	Application Service Providers (ASP)
6.2.2.6	Acquisition Assessment
6.2.2.7	ASP Security Standards
6.2.2.8	Audit
6.2.2.9	Automatically Forwarded Email
6.2.2.10	Data Base Password
6.2.2.11	Dial-In Access
6.2.2.13	Email Retention
6.2.2.14	Chelan-Douglas Regional Support Network Ethics
6.2.2.15	Extranet
6.2.2.16	Complying with Security Standards
6.2.2.17	Information Sensitivity
6.2.2.18	Internal Lab Security
6.2.2.20	Lab Anti-Virus
6.2.2.21	Password
6.2.2.22	Remote Access
6.2.2.23	Risk Assessment
6.2.2.24	Router Security
6.2.2.25	Server Security
6.2.2.26	THIRD PARTY CONNECTION AGREEMENT
6.2.2.27	Virtual Private Network (VPN)
6.2.2.28	Wireless Communication
6.2.2.30	Acceptable Use
6.3	Data
6.3.1	Providers And Reporting Units
6.3.2	Entry Of Demographic & Service Data
6.3.3	Enrolled Consumer Data Requirements
6.3.4	Required Data
6.3.5	Provider Data Corrections & Editing
6.3.5.1	Management Certification of Accuracy of Information Submitted to MHD
6.3.6	Exit Of Consumers
6.3.7	Activity Code Rules
6.3.8	Standard Hours Conversion Ratios
6.3.9	Recording Services Activity Time
6.3.10	Recording Mis Data For County Jail And Juvenile
6.3.11	Common Activity Codes
6.3.12	Medicare Activity Codes
6.3.13	Data - Encounter Submission
6.3.14	Data-Recoverability and Backups
6.3.15	Loading of MHD MMIS Eligibility File
6.3.16	Electronic Data Submission
6.3.17	Data - Consumer First Contact
6.4	Error Reports
6.4.1	Mental Health Division Error Reports
6.4.2	Exception Reports
6.5	CMLS
6.5.1	CMLS Requirements
7.0	Quality Assurance and Utilization Review
7.1	Quality Assessment & Performance Improvement Program
7.1.1	General Rules: Measurement & Improvement Standards
7.1.2	Measurement & Improvement Standards: Performance Indicators
7.1.3	Measurement & Improvement Standards: Performance Data
7.1.4	Measurement & Improvement Standards:  Performance Indicators
7.2	Clinically Appropriate Care / Utilization Management
7.2.1	Chart Review
7.2.2	Quality Improvement Review
7.3	Access Standards: Utilization Management Decision Notification Timelines
7.3.1	Inter-Rater Reliability Auidit
7.4	Evaluation, Monitoring, And Improvement System
7.5	Provider Quality Assurance/ Improvement Plan
7.6	CDRSN/PHP Quality Management Plan
7.7	Measurement and Improvement: Practice Guidelines
7.8	Allied System Coordination Plan
8.0	Consumer Driven Mental Health System Evaluation
8.1	Consumer Rights
8.1.1	Enrollee Rights and Protections: Enrollee Rights and Information Requirements
8.1.2	Quality Assessment & Performance Improvement: Structure & Operations: Enrollee Information and Confidentiality
8.1.3	Rights and Protections: Enrollee Rights & Advance Directives
8.1.4	Enrollee Rights and Protections: Enrollee Rights & Provider / Enrollee Communications
8.1.5	Community Support Services
8.1.6	Posted Rights for Involuntary Person (LRA)
8.1.7	Rights for Inpatient Adults
8.1.8	Rights of Inpatient Minors
8.1.9	Enrollee Rights and Protections: Physician Incentive Plans
8.2	Ombuds Service
8.3	Quality Review Team Services
9.0	Complaints, Conflicts, and Disputes
9.1	Grievance Systems
9.1.1	Grievance System:  Medicaid Fraud and Abuse
9.1.2	Grievance System:  Statutory Basis and General Requirements
9.1.3	Grievance System:  Notice of Action
9.1.3.1	Expedited Authorization Decisions
9.1.4	Grievance System:  Handling of Grievances and Appeals
9.1.5	Grievance System:  Resolution and Notification
9.1.6	Grievance System:  Continuation of Benefits
9.2	CDRSN/PHP Conflict Resolution
9.3	Provider Complaints
9.4	Ombuds, Quality Review Team and Advisory Board Disputes and Retaliation Issues