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CHAPTER 1 - INTRODUCTION |
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Introduction, Mission |
1.01 |
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PRSN Organizational Overview Chart |
1.02 |
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Definitions and Common Language |
1.03 |
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Acronym Listing |
1.04 |
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General Duties and Responsibilities |
1.05 |
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Governance Structure and Community Accountability |
1.06 |
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CHAPTER 2 ADMINISTRATION/INFORMATION
POLICIES |
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Sentinel Events |
2.01 |
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Sentinel Events Incident Reporting Form |
2.01a |
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Advance Directives |
2.02 |
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PRSN Advance Directive Brochure |
2.02a |
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Requirements with Changes to State Law |
2.03 |
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Medicaid Enrollment in the PRSN |
2.04 |
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Comprehensive Information Plan for PRSN Delivery System and Services |
2.05 |
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General Information Requirements |
2.06 |
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PRSN Handbook |
2.06a |
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Medicaid/TXIX Eligibility Verification |
2.07 |
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Rehabilitative and Integrated Mental Health Treatment for Children,
Adults and Older Adults |
2.08 |
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Provision of Priority State Funded Services |
2.09 |
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Provision of Additional State Funded Services |
2.10 |
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Enrollee Rights |
2.11 |
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Consumer Rights and Consent for Treatment |
2.12 |
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PRSN Client Rights Statement (out patient) Form |
2.12a |
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Second Opinions |
2.13 |
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Interpreter Services & Assistance |
2.14 |
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DSHS Interpreter Services Brochure |
2.14a |
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Consumer Rights in Braille |
2.15 |
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Special Needs Accommodation Process |
2.16 |
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Special Populations Coordination of Care for Children |
2.17 |
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Special Populations Coordination of Care for Older Adults |
2.18 |
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Special Populations Coordination of Care for Persons with
Disabilities |
2.19 |
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Special Populations Coordination of Care for Ethnic Minorities |
2.20 |
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Promoting Recovery and Resiliency |
2.21 |
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Protections Against Retaliation |
2.22 |
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Disaster Planning |
2.23 |
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CHAPTER 3 NETWORK MANAGEMENT STANDARDS |
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Availability of Services |
3.01 |
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Culturally Competent Services |
3.02 |
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Culturally Competent Service Structure |
3.03 |
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PRSN Directory of PRSN Specialists/Consultants |
3.03a |
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PRSN Directory of Tribal Specialists/Consultants |
3.03b |
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PRSN External Specialist Consultation Services |
3.04 |
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Attachment A PRSN Special Population Evaluation Form |
3.04a |
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Attachment B PRSN Special Population Evaluation Form Instructions |
3.04b |
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Tribal External Specialist Consultation Services |
3.05 |
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Attachment A- PRSN Tribal Invoice Forms |
3.05a |
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Service Provider Selection |
3.06 |
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Service Provider Licensing Procedures Application & Approval |
3.07 |
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Service Provider Staff Qualifications |
3.08 |
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Service Provider MHP Staff Exceptions |
3.09 |
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Subcontractual Delegation &Assessment Plan |
3.10 |
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Subcontractual Delegation & Assessment Tool ASO |
3.10a |
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Subcontractual Delegation & Assessment Tool IS |
3.10b |
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Notification of Network Agency Termination |
3.11 |
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Notification of Primary Mental Health Care Provider Termination |
3.12 |
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Option to Choose Mental Health Care Provider |
3.13 |
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Appointment of DMHPs |
3.14 |
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CHAPTER 4 MANAGEMENT INFORMATION
SERVICES POLICIES |
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Loading of MHD Enrollment Data |
4.01 |
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Data Transfer to the MHD |
4.02 |
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IS Processing Procedures |
4.03 |
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IS Encounter Submission |
4.04 |
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Data Error Resolution |
4.05 |
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Acceptance of Late MIS Data |
4.06 |
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Data System Backup and Recoverability |
4.07 |
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Management Attestation of Accuracy of Data |
4.08 |
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CHAPTER 5 HIPAA AND MEDICAID
COMPLIANCE STANDARDS |
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HIPAA Compliance & Privacy |
5.01 |
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Kitsap County HIPAA Resolution |
5.01a |
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HIPAA Management Information and Confidentiality |
5.02 |
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HIPAA Administrative Requirements for Implementation & Maintenance
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5.03 |
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HIPAA Policies Maintenance Plan |
5.03a |
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HIPAA Administrative Simplification Definitions |
5.04 |
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HIPAA Agency Staff Training |
5.05 |
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HIPAA PRSN Staff Training Plan for Privacy and Security |
5.06 |
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HIPAA Confidentiality, Use, Disclosure of Protected Health Information |
5.07 |
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Confidentiality and Security Agreement |
5.07a |
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Business Associate Addendum |
5.07b |
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HIPAA Consumer Protected Health
Information Rights |
5.08 |
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HIPAA Administrative Requirements -
Documentation Procedure |
5.09 |
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HIPAA Password Protection Procedure |
5.10 |
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HIPAA Workstation and Portable Computer
Use Procedure |
5.11 |
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HIPAA E-Mail and Internet Security
Policy |
5.12 |
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HIPAA Use of Fax Machines |
5.13 |
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HIPAA Designated Record Set |
5.14 |
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HIPAA Complaint Procedure |
5.15 |
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Fraud and Abuse Compliance Reporting
Standards |
5.16 |
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PRSN Compliance Plan, FY 2008 |
5.16a |
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PRSN Compliance Plan Checklist, FY
2007-2008 |
5.16b |
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PRSN or Agency Use of Federally Excluded Providers |
5.17 |
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CHAPTER 6 COMPLAINTS, GRIEVANCES AND
APPEALS POLICIES |
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Complaint, Grievance, Appeal and Fair Hearing General Requirements |
6.01 |
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PRSN Grievance Brochure |
6.01a |
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Complaint and Grievance |
6.02 |
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PRSN Grievance Form |
6.02a |
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PRSN Grievance Acknowledgement Letter Template |
6.02b |
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PRSN Grievance Resolution Letter Template |
6.02c |
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Appeal Process |
6.03 |
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Fair Hearing |
6.04 |
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Notice of Action Requirements |
6.05 |
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Notice of Action (NOA) Form Letter Template |
6.05a |
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NOA Tracking Log |
6.05b |
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Grievance-Complaint Filing Procedure for PRSN for Providers |
6.06 |
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Grievance Oversight and Recordkeeping. |
6.07 |
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Exhibit N Report Instructions |
6.08 |
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Exhibit N Grievance Medicaid Reporting Form |
6.08a |
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Exhibit N Grievance Non-Medicaid Reporting Form |
6.08b |
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Exhibit N Appeals Medicaid Reporting Form |
6.08c |
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CHAPTER 7 UTILIZATION MANAGEMENT
POLICIES |
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Authorization for Outpatient Services based on Medical Necessity |
7.01 |
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PRSN Authorization Notification Letter Example |
7.01a |
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PRSN Letter of Ineligibility Template |
7.01b |
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Authorization of Services Independence from Financial Incentives |
7.02 |
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LOC: Condensed Version |
7.03 |
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MHD Access Diagnosis - Adult & Older Adult |
7.03a |
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MHD Access Diagnosis - Children & Youth |
7.03b |
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Intake Assessment and Evaluation Services Standards |
7.04 |
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Access & Authorization Standards Grid |
7.04a |
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Peninsula Regional Assessment Tool (PRAT) |
7.05 |
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PRAT All Ages Form |
7.05a |
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PRAT Extension Form |
7.05b |
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Peninsula Authorization for Residential Services (PARS) Form |
7.05c |
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Utilization Management Plan |
7.06 |
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UM Monthly Report Template |
7.07 |
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Over and Under UM Project, see 11.09 High Utilization of InPt)
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CHAPTER 8 FISCAL MANAGEMENT POLICIES |
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Enrollee Liability for Payment |
8.01 |
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Financial Management |
8.02 |
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Third Party Liability & Coordination of Benefits |
8.03 |
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Management Attestation of Accuracy of Fiscal Reports |
8.04 |
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Fiscal Monitoring of Network |
8.05 |
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Fiscal Monitoring Tool |
8.05a |
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CHAPTER 9 PROVIDER MONITORING POLICIES |
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Monitoring Contractor and Subcontractor Sufficiency |
9.01 |
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Monitoring of Contractors |
9.02 |
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PRSN Monitoring Table |
9.02a |
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Provider and Subcontractor Administrative Review |
9.03 |
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Administrative Review Tool |
9.03a |
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Administrative Review Personnel Checklist |
9.03b |
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BRIDGES Ombuds & Parent Voice Administrative Review Tool |
9.03c |
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Periodic Reviews of the E&T Facilities |
9.04 |
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Standard Chart Reviews |
9.05 |
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Standard Chart Review Tool |
9.05a |
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Crisis Chart Review Tool |
9.05b |
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Quality Review Team (QRT) |
9.06 |
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QRT Onsite Reviews Activities |
9.06a |
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Family & Consumer Forum Protocols |
9.06b |
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Ancillary Provider Interviews Protocols |
9.06c |
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Ancillary Provider Interview Worksheet |
9.06d |
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Agency On-site Visit Protocols |
9.06e |
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Agency On-site Visit Interview Worksheet |
9.06f |
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QRT Code of Conduct |
9.06g |
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Quality Review Team Retaliation |
9.07 |
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Provider and Subcontractor Non-compliance Penalties |
9.08 |
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Corrective Action Plans |
9.09 |
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CHAPTER 10 QUALITY MANAGEMENT PLAN |
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Quality Management Plan Table of Contents |
10.00 |
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Quality Management Plan |
10.01 |
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Performance Improvement Projects |
10.02 |
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Quality Indicators |
10.03 |
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Quality
Improvement Work Plan |
10.04 |
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Quality Management Organizational Chart |
10.05 |
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CHAPTER 11 CLINICAL POLICIES AND
PROCEDURES |
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Access to Services, Timely |
11.01 |
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Access to Services Prior to Intake Assessment Medicaid Only |
11.02 |
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Service Modalities Outpatient |
11.03 |
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Service Modalities Crisis |
11.04 |
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Individual Service Plan/Treatment Plan Standards |
11.05 |
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ISP Form |
11.05a |
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Crisis Prevention Plan Standards |
11.06 |
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Crisis Prevention Plan Form (optional) |
11.06a |
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Crisis Response Safeguarding Consumers Property |
11.07 |
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EPSDT Coordination Plan and Requirements |
11.08 |
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EPSDT Cross System Coordination Plan Form (optional) |
11.08a |
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High Utilization of Inpatient Services |
11.09 |
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High Utilization Chart Review Tool |
11.09a |
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PACT Stakeholders Advisory Board |
11.10 |
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Employment Services |
11.11 |
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Housing Services |
11.12 |
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Homeless Individuals, Providing Services |
11.13 |
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Criminal Justice System, Providing Services |
11.14 |
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Practice Guidelines |
11.15 |
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Schizophrenia Condensed Guidelines |
11.15a |
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Bi-polar Disease Condensed Guidelines |
11.15b |
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Bi-polar Practice Guidelines Chart Review Tool |
11.15c |
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Schizophrenia Practice Guidelines Chart Review Tool |
11.15d |
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Option to Choose a Mental Health Care Provider/Clinician |
11.16 |
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Notification of Primary Mental Health Care Provider Termination
Medicaid Only |
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