Kitsap HS SBHO - Policies & Procedures

SBHO - Policies & Procedures

Chapter 1 - Introduction

Chapter 1
1.01	Introduction, Mission
1.02	SBHO Comprehensive Organization 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 Behavioral Health Service Map

Chapter 2 - Administration/Information Policies

Chapter 2
2.01	Sentinel Events
2.01a	Sentinel Events Reporting Form - Print Version
2.01b	Sentinel Events Report Form - Electronic Version
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 Member Handbook
2.07b	SBHO Member Handbook, Spanish
2.07c	SBHO Parent Initiated Treatment Brochure
2.07d	Peninsula Crisis Clinic and 211 Brochure
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/Enrollee Rights
2.11a	SBHO Individual/Enrollee Rights
2.11b	SBHO Individual/Enrollee Rights - 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

Chapter 3
3.01	Availability of Services
3.02	Culturally Competent Services
3.02a	Directory of Specialists/Consultants
3.02b	Directory of Bilingual Agency Staff
3.02c	Directory of Evidence Based Practices
3.03	SBHO External Specialist Consultation Services
3.04	Service Provider Selection
3.05	Service Provider Licensing Procedures - Application & Approval
3.06	Service Provider Staff Qualifications
3.07	Notification of Network Agency Termination
3.08	Designation of Designated Crisis Responders (DCRs)
3.09	DCRs Accessing EMR Protocol

Chapter 4 - Management Information Services Policies

Chapter 4
4.01	Loading of State Enrollment Data
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

Chapter 5

5.01

Compliance and Privacy

5.01a

Kitsap County HIPAA Resolution

5.02

HIPPA Management Information and Confidentiality

5.03

Privacy Administrative Requirements for Implementation and Maintenance

5.03a

SBHO 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 - HIPAA and 42 CFR Part 2

5.16

Breach Notification

5.16a

Breach Analysis Form

5.17

Fraud and Abuse Compliance Reporting Standard

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

5.19a

Credentialing Packet

5.20

SBHO Protected Internal Email

5.20a

Kitsap County IT Policies for Email Classifications

5.21

Business Associates

5.21a

Business Associate Addendum

5.22

Removal of PHI from Office

5.23

Code of Conduct

5.24

Records Retention

Chapter 6 - Grievances and Appeals Policies

Chapter 6
6.01	Grievance, Appeal, and Fair Hearing General Requirements
6.01a	SBHO Grievance Brochure
6.02	Grievances
6.02a	SBHO Grievance Form
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 Determination 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
6.05d	Notice of Determination for Non-Medicaid Individuals Letter Template, Spanish
6.06	Procedure for Filing a Complaint Against the SBHO
6.07	Grievance Oversight and Recordkeeping
6.08	Grievance Reporting Instructions

Chapter 7 - Utilization Management Policies

Chapter 7
7.01	Enrollment for Outpatient Services based on Medical Necessity
7.02	Provision of Services - Independence from Financial Incentives
7.03	Behavioral Health Levels of Care (LOC)
7.04	Intake Assessment and Evaluation Service Standards
7.04a	Outpatient Appointment Standards Grid
7.05	Utilization Management Plan 2018 -2019
7.06	Over and Under Utilization Project
7.06a	Provider Facility Notice Initial Certification
7.07	Substance Use Disorder Service Description
7.08	Substance Use Disorder Authorization Request Instructions
7.08a	Residential Treatment Authorization Request
7.08b	Substance Use Disorder Treatment Extension Authorization Request
7.08c	Substance Use Disorder Out of Network Residential Treatment Authorization Request
7.08d	Data Codes for Residential Treatment Authorization Request
7.08e	Absence from Residential Treatment

Chapter 8 - Fiscal Management Policies

Chapter 8
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

Chapter 9
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 Behavioral Health Chart Review Tool FY 2018 -2019
9.03d	Substance Use Disorder 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 & T Facilities
9.06	Periodic Reviews of Residential Treatment Facilities
9.07	Periodic Reviews of Triage Facilities
9.08	Standard Chart Reviews
9.09	Quality Review Team (QRT)
9.09a	QRT Onsite Review Activities
9.10	Provider and Subcontractor Non-Compliance Penalties
9.11	Corrective Action Plans

Chapter 10 - Quality Management Plan

Chapter 10
10.01	Quality Management Plan Table of Contents
10.02	Quality Management Plan
10.03	Performance Improvement Projects
10.04	Quality Management Organizational Chart

Chapter 11 - Clinical Policies and Procedures

Chapter 11
11.01	Access to Service, 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 - Crisis
11.05	Individual Service Plan/Treatment Plan Standards
11.06	Mental Health Crisis Prevention Plan Standards
11.07	Crisis Response - Safeguarding Individuals Property
11.08	EPSDT Coordination Plan and Requirements
11.09	Employment Services
11.10	Housing Services
11.10a	SBHO Housing Plan - FY 2019
11.11	Homeless Individuals, Providing Services
11.12	Criminal Justice Coordination Services
11.13	Behavioral Health Practice Guidelines
11.13a	SBHO Clinical Practice Guidelines
11.14	Use of Evidence Based Practices
11.15	Option to Choose a Behavioral Health Care Provider
11.16	Provider Purchasing Out of Network Services - Medicaid Only
11.17	Primary Medical Care Provider and Hospital Emergency Rooms, Coordination of Care
11.18	Special Healthcare Needs - Services and Coordination of Care
11.19	Use of Seclusion and Restraint
11.20	Engagement and Outreach Services
11.21	Outpatient Behavioral Health Discharge Planning
11.22	Uniform Inpatient and Outpatient Inter-BHO Transfer Protocol
11.22a	Inter-BHO Transfer Agreement Form
11.22b	Request for Inter-BHO Transfer Form
11.22c	Request for Inter- BHO Transfer Form - Line
11.23	Medication Only Services - Prohibited (Mental Health)
11.24	Tobacco Use "Ask and Record" Policy
11.25	Monitoring Orders for Treatment

Chapter 12 - Inpatient Process

Chapter 12
12.01	Voluntary Psychiatric 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 for 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	SBHO DCR Involuntary Psychiatric Unit Call List
12.08	Children's Long-Term Inpatient Program (CLIP) Coordination
12.08a	Children's Long-Term Inpatient Program (CLIP) Requirements
12.09	Western State Hospital Program Coordination 2018
12.10	Intra-BHO WSH Transfer Protocol
12.10a	Intra-BHO WSH Transfer Agreement Form 2017

Chapter 13 - Advocacy and Support Programs

Chapter 13
13.01	Behavioral Health Care Professional Advocacy
13.02	Ombuds Services
13.02a	Ombuds Brochure

Chapter 14 - SBHO Cross System Working Agreements

Chapter 14
14.01	Cross System Working Agreement
14.02	Medicaid Managed Care Organization Coordination Policy

SBHO - Policies & Procedures

Table of Contents

​Chapter 1 - Introduction

​ ​Chapter 2 - Administration/Information Policies

​Chapter 3 - Network Management Standards ​

​ Chapter 4 - Management Information Services Policies ​

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

​ Chapter 6 - Grievances and Appeals Policies ​

​ ​Chapter 7 - Utilization Management Policies

​ ​Chapter 8 - Fiscal Management Policies

Chapter 9 - Provider Monitoring Policies​ ​

​ Chapter 10 - Quality Management Plan