SBHO - Policies & Procedures

 Table of Contents

Table of Contents

 ​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