SBHO - Policies & Procedures

 Table of Contents

Table of Contents

 ​Chapter 1 - Introduction

Chapter 1​ ​


​Introduction, Mission


SBHO Comprehensive Organization Overview Chart


Definitions and Common Language


Acronym Listing


General Duties and Responsibilities


Governance Structure and Community Accountability


​SBHO Behavioral Health Service Map

​ ​Chapter 2 - Administration/Information Policies

Chapter 2​


​Sentinel Events


Sentinel Events Reporting Form - Print Version


Sentinel Events Report Form - Electronic Version

​Advance Directives


SBHO Advance Directive Brochure


​DSHS Mental Health Advance Directive Brochure


​Requirements with Changes to State Law


​Medicaid Enrollment in the SBHO


​Medicaid/TXIX Eligibility Verification


Comprehensive Information Plan for SBHO Delivery System and Services


​General Information Requirements


​SBHO Member Handbook


​SBHO Member Handbook, Spanish


​SBHO Parent Initiated Treatment Brochure


​Peninsula Crisis Clinic and 211 Brochure


​DSHS Medicaid Booklet


​Rehabilitative and Integrated Mental Health Treatment for Children, Adults, and Older Adults


​Provision of Priority State Funded Services


Provision of Additional State Funded Services


Individual/Enrollee Rights


SBHO Individual/Enrollee Rights


​SBHO Individual/Enrollee Rights - Spanish


​Consent for Treatment


​Second Opinions


Interpreter Services and Assistance


​Individual Rights in Braille


​Special Needs Accommodation Process


​Special Populations - Coordination of Care for Children


​Special Populations - Coordination of Care for Older Adults


​Special Populations - Coordination of Care for Persons with Disabilities


​Special Populations - Coordination of Care for Ethnic Minorities


​Promoting Recovery and Resiliency


Protections Against Retaliation


Disaster Planning

 ​Chapter 3 - Network Management Standards ​

Chapter 3​ ​


Availability of Services


Culturally Competent Services


Directory of  Specialists/Consultants


Directory of Bilingual Agency Staff


Directory of  Evidence Based Practices


SBHO External Specialist Consultation Services


Service Provider Selection


Service Provider Licensing Procedures - Application & Approval


Service Provider Staff Qualifications


​Notification of Network Agency Termination


Designation of Designated Crisis Responders (DCRs)


​DCRs Accessing EMR Protocol

​ Chapter 4 - Management Information Services Policies ​

Chapter 4​ ​


Loading of State Enrollment Data


Data Transfer to DSHS and ProviderOne


IS Data Submission Procedures


Acceptance of Late MIS Data


Management Attestation of Accuracy of Data


SBHO Disaster Recovery and Business Continuity

​ Chapter 5 - HIPAA 42 CFR Part 2 and Medicaid Compliance Standards ​

Chapter 5​ ​


Compliance and Privacy


Kitsap County HIPAA Resolution


HIPPA Management Information and Confidentiality


Privacy Administrative Requirements for Implementation and Maintenance


SBHO Maintenance Plan for Privacy and Security Policies


​HIPAA Administrative Simplification Definitions


HIPAA and Privacy Agency Staff Training


SBHO Staff Training Plan for Privacy and Security


Confidentiality, Use, Disclosure of Protected Health Information


SBHO Privacy Notice, English


Confidentiality and Security Agreement


SBHO Release of Information


SBHO Oath of Confidentiality


Individual Protected Health Information Rights


Administrative Requirements - Documentation Procedure


Password Protection Procedure


Workstation and Portable Computer Use Procedure


Protected Health Information Data, E-Mail, and Internet Security Policy


Use of Fax Machines


​Designated Record Set


​Complaint Procedure - HIPAA and 42 CFR Part 2


Breach Notification


Breach Analysis Form 


Fraud and Abuse Compliance Reporting Standard


SBHO Compliance Plan


SBHO Compliance Plan Checklist


Fraud and Abuse Tracking Log Template


Fraud: Local and MCFU Reporting Hotline Flyer


SBHO Compliance Committee Charter


​SBHO or Agency Use of Federally Excluded Providers


Credentialing and Recredentialing of Providers


Credentialing Packet

SBHO Protected Internal Email


Kitsap County IT Policies for Email Classifications


Business Associates


Business Associate Addendum


Removal of PHI from Office


Code of Conduct


Records Retention

​ Chapter 6 - Grievances and Appeals Policies ​

Chapter 6​ ​


Grievance, Appeal, and Fair Hearing General Requirements


​SBHO Grievance Brochure




SBHO Grievance Form


​SBHO Grievance Acknowledgement Letter Template


SBHO Grievance Resolution Letter Template


SBHO Grievance Combination Letter Template


Appeal Process


CommCare Appeal Request Acknowledgement Letter Template


Notice of Appeal Resolution Letter Template


​Fair Hearing


​Notice of Adverse Benefit Determination Requirements


Notice of Adverse Benefit Determination  (NOABD) Letter Template


​Notice of Adverse Benefit Determination (NOABD) Letter Template, Spanish


Notice of Determination for Non-Medicaid Individuals Letter Template


​Notice of Determination for Non-Medicaid Individuals Letter Template, Spanish

Procedure for Filing a Complaint Against the SBHO


Grievance Oversight and Recordkeeping


Grievance Reporting Instructions

​ ​Chapter 7 - Utilization Management Policies

Chapter 7​ ​


Enrollment for Outpatient Services based on Medical Necessity


Provision of Services - Independence from Financial Incentives


Behavioral Health Levels of Care (LOC)


Intake Assessment and Evaluation Service Standards


Outpatient Appointment Standards Grid


Utilization Management Plan 2018 -2019


Over and Under Utilization Project


Provider Facility Notice Initial Certification


Substance Use Disorder Service Description


Substance Use Disorder Authorization Request Instructions


Residential Treatment Authorization Request


Substance Use Disorder Treatment Extension Authorization Request


Substance Use Disorder Out of Network Residential Treatment Authorization Request


Data Codes for Residential Treatment Authorization Request


Absence from Residential Treatment

​ ​Chapter 8 - Fiscal Management Policies

Chapter 8​ ​


​Enrollee Liability for Payment


Financial Management


Third Party Liability And Coordination of Benefits


Management Attestation of Accuracy of Fiscal Reports


Fiscal Monitoring of Network


​PATH Monitoring Protocols


​Cost Allocations


Revenue and Expense Reports

 Chapter 9 - Provider Monitoring Policies​ ​

Chapter 9​ ​


Monitoring Contractor and Subcontractor Sufficiency


​Monitoring of Contractors


SBHO Monitoring Table


Provider and Subcontractor Administrative Review


SBHO Administrative Review Tool


SBHO BRIDGES Ombuds Administrative Review Tool


SBHO Behavioral Health Chart Review Tool FY 2018 -2019


Substance Use Disorder Residential Review Tool


Subcontractual Delegation and Assessment Plan


SBHO Data Security Checklist


Items of Delegation


Periodic Reviews of the E & T Facilities


Periodic Reviews of Residential Treatment Facilities


Periodic Reviews of Triage Facilities


Standard Chart Reviews


Quality Review Team (QRT)


QRT Onsite Review Activities


Provider and Subcontractor Non-Compliance Penalties

​Corrective Action Plans

​ Chapter 10 - Quality Management Plan

Chapter 10​ ​


Quality Management Plan Table of Contents


​Quality Management Plan


Performance Improvement Projects


Quality Management Organizational Chart

 Chapter 11 - Clinical Policies and Procedures

Chapter 11​

Access to Service, Timely


​Access to Services Prior to Intake Assessment - Medicaid Only


​Services Modalities - Outpatient


​WISe Manual


​Services Modalities - Crisis


​Individual Service Plan/Treatment Plan Standards


​Mental Health Crisis Prevention Plan Standards


Crisis Response - Safeguarding Individuals Property


EPSDT Coordination Plan and Requirements


Employment Services


Housing Services


​SBHO Housing Plan - FY 2019


Homeless Individuals, Providing Services


Criminal Justice Coordination Services


​Behavioral Health Practice Guidelines


SBHO Clinical Practice Guidelines

​Use of Evidence Based Practices


​Option to Choose a Behavioral Health Care Provider


​Provider Purchasing Out of Network Services - Medicaid Only


​Primary Medical Care Provider and Hospital Emergency Rooms, Coordination of Care


Special Healthcare Needs - Services and Coordination of Care


​Use of Seclusion and Restraint


​Engagement and Outreach Services


​Outpatient Behavioral Health Discharge Planning


Uniform Inpatient and Outpatient Inter-BHO Transfer Protocol


​Inter-BHO Transfer Agreement Form


Request for Inter-BHO Transfer Form


Request for Inter- BHO Transfer Form - Line


​Medication Only Services - Prohibited (Mental Health)


Tobacco Use "Ask and Record" Policy


​Monitoring Orders for Treatment

 Chapter 12 - Inpatient Process

Chapter 12​ ​


Voluntary Psychiatric Inpatient Gatekeeping


Voluntary Hospital Certification Process for Children


​Voluntary Hospital Certification Process for Adults


​Voluntary Inpatient Denials


Network Assignment for Inpatient Costs - ITA and Voluntary


​Inpatient Bill Assignment - Frequently Asked Questions


Inpatient Hospital Claim Dispute and Reassignment Form

Authorizing Inpatient Administrative Days


​Admission and Discharge Coordination from Inpatient Care


​Emergency Services Transportation


Single Bed Certification Approval


​SBHO DCR Involuntary Psychiatric Unit Call List


Children's Long-Term Inpatient Program (CLIP) Coordination


​Children's Long-Term Inpatient Program (CLIP) Requirements


Western State Hospital Program Coordination 2018


Intra-BHO WSH Transfer Protocol


Intra-BHO WSH Transfer Agreement Form 2017

 ​Chapter 13 - Advocacy and Support Programs ​

​ ​Chapter 13


Behavioral Health Care Professional Advocacy


​Ombuds Services


Ombuds Brochure

 ​Chapter 14 - SBHO Cross System Working Agreements ​

Chapter 14​ ​


Cross System Working Agreement


Medicaid Managed Care Organization Coordination Policy