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Table of Contents

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
1.4.2.12	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
1.4.2.24	Breach Notification
1.4.2.25	Information Systems Security
1.4.2.26	Private Pay PHI
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
1.10.1	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
1.16	Fraud and Abuse Compliance Plan
1.17	Code of Ethical Conduct
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
2.13	Appeal of CDRSN/PHP Care Management Decision
2.15	Transferring Consumer Services
2.16	Termination of Services
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
2.27	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
3.9	Other Specialized Services (DD, MICA, HIV/AIDS, PATH)
3.11	Disaster Mental Health Services
3.12	Critical Incidents
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
6.2.2.1	Acceptable Encryption
6.2.2.4	Guidelines on Anti-Virus Process
6.2.2.5	Application Service Providers (ASP)
6.2.2.7	ASP Security Standards
6.2.2.8	Audit
6.2.2.9	Automatically Forwarded Email
6.2.2.13	Email Retention
6.2.2.17	Information Sensitivity
6.2.2.18	Internal Lab Security
6.2.2.21	Password
6.2.2.22	Remote Access
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
6.3.5.2	Provider Management Certification of Accuracy of Information Submitted to CDRSN
6.3.5.3	Decertification of Data Form Submitted to CDRSN/PIHP by Contracting Provider
6.3.6	Exit Of Consumers
6.3.8	Standard Hours Conversion Ratios
6.3.9	Recording Services Activity Time
6.3.11	Common Activity Codes
6.3.12	Medicare Activity Codes
6.3.13	Data - Encounter Submission
6.3.14	Data Backup and Disaster Recovery
6.3.15	Loading of MHD MMIS Eligibility File
6.3.16	Electronic Data Submission
6.3.17	Data - Consumer First Contact
6.3.18	Request for Service Time Frame
6.3.19	MIS Quality Control and Assurance Plans
6.6	Official Health Record
6.6.1	Official Health Record
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
9.1.2	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
10.0	Managed Care Financial Policies
10.1	Eligibility Documentation
10.4	Spend-down Monitoring/Reporting
10.6	Cost Allocation Plan
10.7	Reserve Accounts
10.8	Risk Management
10.9	Funds Disbursement
10.10	Financial Management
10.11	Client or Advocate Run Services
10.12	Disclosure of Public Records, and Exemptions to Disclosure
10.13	Third Party Liability and Coordination of Benefits
10.14	Program Transfer to Private Pay

 

Crisis Line - 509-662-7105 or 1-800-852-2923