COMMUNITY MENTAL HEALTH

AFFILIATION OF MID MICHIGAN

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CMHAMM Benefit Stabilization Guidelines

 

Effective February 2006

POLICIES PROCEDURES
1.0  PIHP Administration 1.1  Administration Structure
  1.2  Steering Committee & Work Group Meeting Structure
  1.3  Policy & Procedures
  1.4  Compliance Program
  1.5  Deficit Reduction Act Requirements
  1.6  Authorization of Affiliation Requirements
  1.7  PIHP Site Reviews
   
2.0  Clinical 2.1  Self-Determination
  2.2  Jail Diversion
  2.3  Independent Facilitation
  2.4  Coordination and Continuity of Care
  2.5  Habilitation Supports Waiver
   
3.0  Recipient/Enrollee Rights 3.1  Recipient/Enrollee Rights (confidentiality)
  3.2  Appeals & Grievances
  3.3  Customer Service
  3.4  Limited English Proficiency
  3.5  Out of Network Care
  3.6  Cultural Competence
  3.7  Second Opinion
  3.8  Advance Directives
   
4.0  Quality Improvement 4.1  Quality Assessment and Performance Improvement Program
  4.2  Sentinel Events
  4.3  Service Authorization/Practice Guidelines
  4.4  Level of Care Review
  4.5  Record Reviews
  4.6  Satisfaction Surveys
  4.7  Medicaid Claims Verification
   
5.0  Network Management 5.1  Provider Network Management
  5.2  Credentialing
   
6.0  Information Services 6.1  PIHP Requirements for Information Management 
   
7.0  Finance 7.1  Financial Management
  7.2  Claims Monitoring
  7.3  Risk Management - ISF
  7.4  Habilitation Supports Waiver - Finance
 

CMHAMM PIHP Policies/Procedures in process of revision beginning February 2006 

POLICIES

NUMBER ADMINISTRATIVE POLICIES
A0.2 Core Group
  Confidentiality
A0.4 Service Authorization Oversight and Review
   
NUMBER CLINICAL POLICIES
CL.1 Self Determination
CL.3 Independent Facilitation
CL.4 Choice of Case Manager (Therapist)/Supports Coordination
CL.5 Cultural Competency