Salish Behavioral Health Organization
Human Services
614 Division Street, MS-23
Port Orchard, WA,  98366
Phone: 360-337-7185 * FAX: 360-337-5721
 
Last Updated:  January 23, 2017

KITSAP COUNTY DEPARTMENT OF HUMAN SERVICES

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1/10th of 1% Mental Health-Chemical Dependency-Therapeutic Courts Tax

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SALISH BEHAVIORAL HEALTH ORGANIZATION

Salish Behavioral Health Organization Advisory Board

 
POLICIES & OPERATIONS MANUAL

TABLE OF CONTENTS
 
CHAPTER 1 - INTRODUCTION
1.01 Introduction, Mission
1.02 SBHO Comprehensive Organizational Overview Chart
1.03 Definitions and Common Language
1.04 Acronym Listing
1.05 General Duties and Responsibilities
1.06 Governance Structure and Community Accountability
1.07 SBHO Service Map
CHAPTER 2 - ADMINISTRATION/INFORMATION POLICIES
2.01 Sentinel Events
2.01a Sentinel Events Reporting Form
2.02 Advance Directives
2.02a SBHO  Advance Directive Brochure
2.02b DSHS Mental Health Advance Directive Brochure
2.03 Requirements with Changes to State Law
2.04 Medicaid Enrollment in the SBHO
2.05 Medicaid/TXIX Eligibility Verification
2.06 Comprehensive Information Plan for SBHO Delivery System and Services
2.07 General Information Requirements
2.07a SBHO Handbook
2.07b SBHO Handbook, Spanish (2016)
2.07c SBHO Parent Initiated Treatment Brochure
2.07d Peninsula Crisis Clinic and 211 Brochure (2017)
2.07e DSHS Medicaid Booklet
2.08 Rehabilitative and Integrated Mental Health Treatment for Children, Adults and Older Adults
2.09 Provision of Priority State Funded Services
2.10 Provision of Additional State Funded Services
2.11 Individual Rights
2.11a SBHO Individual Rights Statement (out patient) Form - English
2.11b SBHO Individual Rights Statement (out patient) Form - Spanish
2.12 Consent for Treatment
2.13 Second Opinions
2.14 Interpreter Services - and Assistance
2.15 Individual Rights in Braille
2.16 Special Needs Accommodation Process
2.17 Special Populations - Coordination of Care for Children
2.18 Special Populations - Coordination of Care for Older Adults
2.19 Special Populations - Coordination of Care for Persons with Disabilities
2.20 Special Populations - Coordination of Care for Ethnic Minorities
2.21 Promoting Recovery and Resiliency
2.22 Protections Against Retaliation
2.23 Disaster Planning
CHAPTER 3 - NETWORK MANAGEMENT STANDARDS
3.01 Availability of Services
3.02 Culturally Competent Services
3.03 Culturally Competent Service Structure
3.03a Directory of SBHO Specialists/Consultants
3.03b Directory of SBHO Bilingual Agency Staff
3.03c Directory of SBHO Evidence Based Practices
3.04 SBHO External Specialist Consultation Services
3.05 Service Provider Selection
3.06 Service Provider Licensing Procedures - Application & Approval
3.07 Service Provider Staff Qualifications
3.08 Service Provider MHP Staff Exceptions
3.09 Notification of Primary Behavioral Health Care Provider Termination
3.10 Appointment of DMHPs
3.11 DMHPs Accessing Profiler Protocol
3.12 Appointment of Designated Chemical Dependency Specialists
CHAPTER 4 - MANAGEMENT INFORMATION SERVICES POLICIES
4.01 Loading of State Enrollment Data (2017)
4.02 Data Transfer to DSHS and ProviderOne
4.03 IS Data Submission Procedures
4.04 Acceptance of Late MIS Data
4.05 Management Attestation of Accuracy of Data
4.06 SBHO Disaster Recovery and Business Continuity
CHAPTER 5 - HIPAA, 42 CFR PART 2, AND MEDICAID COMPLIANCE STANDARDS
5.01 Compliance and Privacy
5.01a Kitsap County HIPPA Resolution
5.02 HIPPA Management Information and Confidentiality
5.03 Privacy Administrative Requirements for Implementation and Maintenance
5.03a SBHO Policies Maintenance Plan for Privacy and Security Policies
5.04 HIPAA Administrative Simplification Definitions
5.05 HIPAA and Privacy Agency Staff Training
5.06 SBHO Staff Training Plan for Privacy and Security
5.07 Confidentiality, Use, Disclosure of Protected Health Information
5.07a SBHO  Privacy Notice, English
5.07b Confidentiality and Security Agreement
5.07c SBHO Release of Information
5.07d SBHO Oath of Confidentiality
5.08 Individual  Protected Health Information Rights
5.09 Administrative Requirements - Documentation Procedure
5.10 Password Protection Procedure
5.11  Workstation and Portable Computer Use Procedure
5.12 Protected Health Information Data, E-Mail, and Internet Security Policy
5.13 Use of Fax Machines
5.14 Designated Record Set
5.15 Complaint Procedure - HIPPAA and 42 CFR Part 2
5.16 Breach Notification
5.16a Breach Analysis, Form
5.17 Fraud and Abuse Compliance Reporting Standards
5.17a SBHO Compliance Plan
5.17b SBHO Compliance Plan checklist
5.17c Fraud and Abuse Tracking Log Template
5.17d Fraud: Local and MCFU Reporting Hotline Flyer
5.17e SBHO Compliance Committee Charter
5.18 SBHO or Agency Use of Federally Excluded Providers
5.19 Credentialing and Recredentialing of Providers
5.20 SBHO Protected Internal Email
5.20a Kitsap County IT Policies for Email Classifications
5.21 Business Associates
5.21a Business Associates Addendum
5.22 Removal of PHI from Office
5.23 Code of Conduct
5.24 Records Retention
CHAPTER 6 - GRIEVANCES AND APPEALS POLICIES
6.01 Grievance, Appeal and Fair Hearing General Requirements
6.01a SBHO Grievance Brochure (effective 7-1-17)
6.02 Grievances
6.02a SBHO Grievance Form, Optional
6.02b SBHO Grievance Acknowledgement Letter Template
6.02c SBHO  Grievance Resolution Letter Template
6.02d SBHO Grievance Combination Letter Template
6.03 Appeal Process
6.03a Commcare Appeal Request Acknowledgement letter, template
6.03b Notice of Appeal Resolution Letter Template
6.04 Fair Hearing
6.05 Notice of Adverse Benefit Requirements
6.05a Notice of Adverse Benefit Determination (NOABD) Letter Template
6.05b Notice of Adverse Benefit Determination (NOABD) Letter Template Spanish
6.05c Notice of Determination for Non-Medicaid Individuals Letter Template
6.06 Procedure for Filing a Complaint against the SBHO
6.07 Grievance Oversight and Recordkeeping
6.08 Grievance Reporting Instructions
6.08a DBHR Grievance System Instruction Reporting Guidelines
6.08b SBHO Grievance Medicaid Reporting Form
6.08c SBHO Grievance Non-Medicaid Reporting Form
6.08d SBHO Notice of  Adverse Benefit Determination Appeals Reporting Form
CHAPTER 7 - UTILIZATION MANAGEMENT POLICIES
7.01 Authorization for Outpatient Services based on Medical Necessity
7.01a SBHO Authorization Notification Letter Example
7.01b SBHO Authorization Notification Letter Example, Spanish
7.02 Authorization of Services - Independence from Financial Incentives
7.03 Mental Health Levels of Care (LOC)
7.04 Intake Assessment and Evaluation Services Standards
7.04a Outpatient Access and Authorization Standards Grid
7.05 Peninsula Regional Assessment Tool (PRAT)
7.05a PRAT Form
7.05b PARS Form
7.06 Utilization Management Plan (2017-2018)
7.06a Provider Facility Notice Initial Certification CommCare
7.07 Over and Under Utilization Projects
7.08 Substance Use Disorder Levels of Care - LOC
7.09 Substance Use Disorder Authorization Process
7.09a Outpatient Treatment Authorization Request
7.09b Residential Treatment Authorization Request
7.09c SUD Treatment Extension Authorization Request
7.09d SUD Withdrawal Management Treatment Authorization Request
7.09e SUD Out of Network Residential Treatment Authorization Request
7.09f Absence from Residential Treatment
7.09g Data Codes for Residential Treatment Authorization Request
7.09h Substance Use Disorder Outpatient Treatment Request Form
CHAPTER 8 - FISCAL MANAGEMENT POLICIES
8.01 Enrollee Liability for Payment
8.02 Financial Management
8.03 Third Party Liability and Coordination of Benefits
8.04 Management Attestation of Accuracy of Fiscal Reports
8.05 Fiscal Monitoring of Network
8.05a PATH Monitoring Protocols
8.06 Cost Allocations
8.07 Revenue and Expense Reports
CHAPTER 9 - PROVIDER MONITORING POLICIES
9.01 Monitoring Contractor and Subcontractor Sufficiency
9.02 Monitoring of Contractors
9.02a SBHO Monitoring Table
9.03 Provider and Subcontractor Administrative Review
9.03a SBHO Administrative Review Tool
9.03b SBHO BRIDGES Ombuds Administrative Review Tool
9.03c SBHO WISe Clinical Review Tool
9.03d SBHO Review of Care Review Tool
9.03e SBHO Crisis Review Tool
9.03f SBHO E and T Review Tool
9.03g SBHO Intake Review Tool
9.03h Practice Guideline Review Tool
9.03i SBHO Re-Authorization Review Tool
9.03j SBHO Residential Review Tool
9.03k SBHO SUD Clinical Review Tool
9.03l SUD Residential Review Tool
9.03m Supported Employment Review Tool
9.03n SBHO Zero Prat Review Tool
9.03o SBHO Mental Health Residential Review Tool
9.04 Subcontractual Delegation and Assessment Plan
9.04a SBHO Data Security Checklist
9.04b Items of Delegation
9.05 Periodic Reviews of the E and T Facilities
9.06 Periodic Review of Residential Treatment Facilities
9.07 Standard Chart Reviews
9.08 Quality Review Team (QRT)
9.08a QRT Onsite Reviews Activities
9.09 Provider and Subcontractor Non-compliance Penalties
9.10 Corrective Action Plans
CHAPTER 10 - QUALITY MANAGEMENT PLAN
10.00 Quality Management Plan Table of Contents
10.01 Quality Management Plan
10.02 Performance Improvement Projects
10.03 Quality Management Organizational Chart
CHAPTER 11 - CLINICAL POLICIES AND PROCEDURES
11.01 Access to Services, Timely
11.02 Access to Services Prior to Intake Assessment - Medicaid Only
11.03 Services Modalities - Outpatient
11.03a WISe Manual
11.04 Services Modalities - Mental Health Crisis
11.05 Individual Service Plan/Treatment Plan Standards
11.06 Mental Health Crisis Prevention Plan Standards
11.07 Crisis Response - Safeguarding Individual's Property
11.08 EPSDT Coordination Plan and Requirements
11.09 PACT Stakeholders Advisory Group
11.10 Employment Services
11.11 Housing Services
11.11a SBHO Housing Plan
11.12 Homeless Individuals, Providing Services
11.13 Criminal Justice System, Providing Services
11.14 Mental Health Practice Guidelines
11.14a Schizophrenia Condensed Guidelines
11.14b Bi-polar Disorder Condensed Guidelines
11.15 Use of Evidence Based Practices
11.16 Option to Choose a Mental Health Care Provider/Clinician
11.17 Provider Purchasing Out of Network Services - Medicaid Only
11.18 Primary Medical Care Provider and Hospital Emergency Rooms, Coordination of Care
11.19 Individuals with Special Healthcare Needs
11.20 Special Healthcare Needs - Direct Care, Treatment Planning and Access to Mental Health and Chemical Dependency Professionals
11.21 Special Healthcare Needs - Mechanisms to Assess Quality and Appropriateness of Care
11.22 Use of Seclusion and Restraint
11.23 Engagement and Outreach Services
11.24 Outpatient Discharge Planning
11.25 Uniform Inpatient and Outpatient Inter-BHO Transfer Protocol
11.25a Inter-BHO Transfer Agreement Form
11.25b Request for Inter-BHO Transfer Form
11.26 Medication Only Services - Prohibited Mental Health
11.27 Tobacco Use Ask and Record Policy
11.28 Assisted Outpatient Treatment LRA Orders
CHAPTER 12 - INPATIENT POLICIES
12.01 Voluntary Inpatient Gatekeeping
12.01a Voluntary Hospital Certification Process for Children
12.01b Voluntary Hospital Certification Process for Adults
12.02 Voluntary Inpatient Denials
12.03 Network Assignment of Inpatient Costs - ITA and Voluntary
12.03a Inpatient Bill Assignment - Frequently Asked Questions
12.03b Inpatient Hospital Claim Dispute and Reassignment Form
12.04 Authorizing Inpatient Administrative Days
12.05 Admission and Discharge Coordination from Inpatient Care
12.06 Emergency Services Transportation
12.07 Single Bed Certification Approval
12.07a Hospital List for Single Bed Certification
12.08 Children's Long-Term Inpatient Program Coordination
12.08a CLIP Admission Procedure
12.09 Western State Hospital Program Coordination
12.10 Intra-BHO WSH Transfer
12.10a Intra-BHO WSH Transfer Agreement Form
CHAPTER 13 - ADVOCACY AND SUPPORT PROGRAMS/POLICIES
13.01 Behavioral Health Care Professional Advocacy
13.02 Ombuds Services
13.02a Ombuds Brochure (2017)
CHAPTER 14 - SBHO CROSS SYSTEM WORKING AGREEMENTS
14.01 Cross System Working Agreement
14.02 Medicaid Managed Care Organization Coordination Policy
 
Working Agreements (not included in paper version of manual)
DDD (Division of Developmental Disabilities) - Adult
DDD (Division of Developmental Disabilities) - Child
DCFS (Division of Child and Family Services)
WSH (Western State Hospital)
CLIP (Children's Long-term Inpatient Program)
Long Term and Aging
7.01 Bi-Annual Plan and Yearly Update
JRA (Juvenile Rehabilitation Administration)
 

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