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Policies and Procedures/Provider Network Manual

Recognizing and dealing with my issues and learning how to deal with them in a healthier way. The Schema group is absolutely awesome!
-Mecosta County

Community Mental Health for Central Michigan

Provider Network Manual

Table of Contents


INTRODUCTION

CHAPTER 1  BOARD STRUCTURE AND ORGANIZATION
CHAPTER 2  SERVICES ADMINISTRATION
CHAPTER 3  PROVIDER NETWORK MANAGEMENT
CHAPTER 4  HUMAN RESOURCES
CHAPTER 5  GENERAL ADMINISTRATION, QUALITY MANAGEMENT, SAFETY / HEALTH ENVIRONMENT
CHAPTER 7  RECIPIENT RIGHTS


 

CHAPTER 1 – BOARD STRUCTURE AND ORGANIZATION

SECTION 100 – GENERAL STRUCTURE AND ORGANIZATION

001   Mission, Vision, and Values

SECTION 200 – GENERAL MANAGEMENT STRUCTURE AND ORGANIZATION

001   Agency Management Structure - Guideline

 

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CHAPTER 2 – SERVICES ADMINISTRATION

SECTION 100 – CONCERNS, COMPLAINTS, DISPUTES, GRIEVANCES, AND APPEALS

001   Overview
002   Recipient Dispute Resolution and Grievance Systems
002A Requests for State Level Hearings - Guideline
003   Requests for Second Opinions

SECTION 200 – BEHAVIOR SERVICES

001   Behavior Treatment

SECTION 300 – DIRECT SERVICES

001   Crisis Services
002   Individual Plan of Service
002A Case Coordination/Primary Clinician - Guideline
003   Self-Determination
005   Access to Services
006   Service Delivery
007   Alternatives to Hospitalization & Hospitalization
008   Pharmaceutical Practices
008C Look Alike - Sound Alike Drugs - Guideline
009   Respite Services - Guideline
012   Cultural Competence and Limited English Proficiency
015   Person-Centered Planning
016   Service Planning and Documentation
019   Advance Directive & Crisis Plans of Action
023   Licensed Residential Placement Protocol
024   Duty to Warn

SECTION 400 – UTILIZATION MANAGEMENT

001A Service Authorization Process - Guideline

 

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CHAPTER 3 – PROVIDER NETWORK MANAGEMENT

SECTION 100 – PROVIDER NETWORK DEVELOPMENT

001  Provider Network General Guidelines
002  Appeals
004  Provider Recognition
005  Corporate Compliance and Ethical Standards
        Contact Information for Suspected Compliance Violations
006  Out of Network Providers

SECTION 200 – PROCUREMENT OF SERVICES

001   Application
         Provider Network Application
002   Requests for Proposals/Quotes
004   Residential Provider Enrollments - Guideline

SECTION 300 – CONTRACTOR QUALIFICATIONS

001   Clinical Credentialing and Privileging
          Clinical Privileges Application
002   Credentialing of Organizations
003   Training Reciprocity Guideline

SECTION 400 – CONTRACT MANAGEMENT

001   Negotiation and Execution of Contracts
003   Claims Processing 

 

 

SECTION 500 – MONITORING AND PROFILING

001   General Guidelines
002   Provider Site Review
003   Event Verification

          Provider Site Review Tool – Case Management

          Provider Site Review Tool – Clubhouse/Drop-In

          Provider Site Review Tool – Community Living Support

          Provider Site Review Tool – Outpatient Clinic

          Provider Site Review Tool – Residential Services

          Provider Site Review Tool – Vocational Services

          Provider Documentation/Requirements

 

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CHAPTER 4 – HUMAN RESOURCES

        Human Resource Practices

 

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CHAPTER 5 – GENERAL ADMINISTRATION/QUALITY MANAGEMENT/SAFETY, HEALTH & ENVIRONMENT

SECTION 100 – GENERAL ADMINISTRATION

005   Acronym/Abbreviation List - Guideline

SECTION 300 – QUALITY MANAGEMENT

002   Customer Services
004   Quality Assessment and Performance Improvement

SECTION 600 – SAFETY, HEALTH & ENVIRONMENT

001   Infection Control & Risk Reduction
001A Infection Control Plan
003   Tobacco-Free Environment

SECTION 700 – MANAGEMENT OF INFORMATION SYSTEMS

001   Agency Network, Email, and Internet
002   Data Security & Confidentiality

 

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CHAPTER 6 – This Chapter intentionally left blank

 

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CHAPTER 7 – RECIPIENT RIGHTS

SECTION 100 – GENERAL ADMINISTRATION

001   Establishment of Recipient Rights Office
002   Service Animals
003   Recipient Rights Advisory Committee
006   Recipient Rights, General Administration, General Rights

SECTION 200 – REPORTING, REVIEWING AND INVESTIGATING

001   Appeals Process
003   Investigation of Complaints
004   Mediation of a Dispute
005   Monitoring Residential Homes and Unusual Incidents
006   Staff Training in Consumer Rights

SECTION 300 – SAFEGUARDING THE RIGHTS OF RECIPIENTS

001   Consent to Treatment
002   Suitable Services, Treatment Environment, Right to Second Opinion
003   Access to Services and Barriers to Treatment
004   Confidentiality and Disclosure
005   Communication, Mail, Telephone, Visits, Access to Media and Entertainment Materials
006   Electroconvulsive Therapy
007   Fingerprinting, Photographing, Audio and/or Video Recording, and Use of One-Way Glass
008   Freedom of Movement
009   Consumer Funds
010   Guardianship
011   Performance of Labor
012   Medical Services and Psychotropics
013   Personal Property
014   Recipient Abuse or Neglect
017   Rights for Minors
018   Restraint, Physical Management and Seclusion
019   Sterilization, Abortion and Contraception
020   Treatment by Spiritual Means

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Recognizing and dealing with my issues and learning how to deal with them in a healthier way. The Schema group is absolutely awesome!
-Mecosta County
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