Policies and Procedures

Chapter 1 – Administration

1.1 Purpose and Authority
1.2 Manual Review and Revision
1.3 Prepaid Inpatient Health Plan
1.4 Administrative Oversight and General Provisions
1.5 Governing Board
1.6 Governance and Community Accountability
1.7 General Information Requirements
1.8 Disclosure of Public Records and Exemption
1.9 Structure and Operations
1.10 Advisory Board
1.11 Provider Selection, Subcontracts, and Delegation of Duties

Chapter 2 – Financial

2.1 Douglas County Financial Policies
2.2 Financial Management
2.3 Fiscal Monitoring
2.4 Reserve Accounts
2.5 Reserve Funds
2.6 Risk Management
2.7 Use of Funds
2.8 Funds Disbursement
2.9 Claim Payments
2.10 Provider Payment Suspension
2.11 Cash Receipts
2.12 Revenues and Expenditures
2.13 Cost Allocation Plan
2.14 Third-Party Liability Requirements
2.15 Audits
2.16 Records Retention
2.17 Payment Related to Medicaid Fraud, Waste, and Abuse
2.18 Civil Money Penalties and Assessments

Chapter 3 – Managed Care

3.0 Consumer Rights
3.1 Available Services and Choice of Provider
3.2 Grievance System
3.3 Notice of Action and Determination
3.4 Nondiscrimination
3.5 Seclusion and Restraint
3.6 Access and Utilization for Mental Health Services
3.7 Access and Utilization for Substance Use Disorder Services
3.8 Medicaid Billing and Self-Pay
3.9 Advance Directives
3.10 Behavioral Health Ombuds
3.11 Cultural Competency and Special Population Consultation and or Evaluation
3.12 Crisis Services and Post-Hospitalization Stabilization
3.13 Inpatient Treatment and Staff Designation
3.14 Discharge from Services
3.15 Coordination and Continuity of Care

Chapter 4 – Quality Management

4.1 Quality Assurance and Improvement (Quality Management Plan)
4.2 Quality Review Team
4.3 Mental Health Practice Guidelines
4.4 Use and Reporting of Evidence/Research Based Practices
4.5 Critical Incidents

Chapter 5 – Information Systems

5.1 Health Information Systems
5.2 System Administrators Responsibilities
5.3 NCWBH PIHP MIS Compliance
5.4 Outpatient Services Authorization Process
5.5 Health Information Systems – Encounter Data Validation and Data Integrity
5.6 Security and Confidentiality
5.7 Acceptable Encryption
5.8 Malicious Software Protection
5.9 Providers and Reporting Unit Identification
5.10 Entry of Demographic and Service Data
5.11 Enrolled Consumer Data Requirements
5.12 Provider Network and Out-Of-Network Provider Data Submission Requirements
5.13 Data Corrections and Editing
5.14 Management Certification of Accuracy of Information Submitted to DBHR-ProviderOne
5.15 Provider Management Certification of Accuracy of Information Submitted to NCWBH
5.16 Exit of Consumers
5.17 Recording Services Activity Time
5.18 CIS and Encounter Submission to NCWBH
5.19 Data Backup and Disaster Recovery
5.20 Electronic Data Submission
5.21 Request for Service to Assessment Time Frame
5.22 MIS Quality Control and Assurance Plans
5.23 Encounter Documentation
5.24 NCWBH MIS Error Report Resolution Process
5.25 NCWBH EDI System Reports
5.26 Native and Encounter File Submission to BHDS and ProviderOne
5.27 Official Health Record
5.28 Provider Enrollment
5.29 Jail Services Enrollment Data Requirements
5.30 Provider Internal Encounter Data Validation Audit
5.31 Report Writing Quality Assurance

Chapter 6 – Privacy

6.1 Adherence to Privacy Rules
6.2 Privacy Definitions
6.3 Administrative Requirements for Implementation of Privacy Rules
6.4 Notice of Privacy Practices (English or Spanish)
6.5 Confidentiality
6.6 Uses and Disclosures – Payment, Treatment, and Health Care Operations
6.7 Uses and Disclosures – Business Associates
6.8 Uses and Disclosures – Research
6.9 Uses and Disclosures – Authorizations
6.10 Right to Request Restrictions
6.11 Right to Access and Amend Personal Health Information
6.12 Opportunity to Agree or Object
6.13 Minimum Necessary
6.14 Accounting of Disclosures and Protected Health Information
6.15 Designated Record Set
6.16 De-Identification and Limited Data Sets
6.17 Marketing
6.18 Right to Confidential Communication
6.19 Private Pay Protected Health Information
6.20 Workforce Training
6.21 Record Retention

Chapter 7 – Security

7.1 Information Systems Security
7.2 Acceptable Use
7.3 Disposal of Protected Health Information
7.4 Protection from Malicious Software
7.5 Server Security
7.6 Router Security
7.7 Remote Access
7.8 Virtual Private Network
7.9 Wireless Access Points
7.10 Copying and Printing Protected Health Information
7.11 Breach Notification
7.12 Facility Access Controls
7.13 Compliance Evaluation

Chapter 8 – Compliance

8.1 Compliance Program
8.2 Code of Ethics and Standards of Conduct
8.3 Conflict of Interest
8.4 Anti-Retaliation Whistleblower Protections
8.5 Medicaid Fraud, Waste, and Abuse
8.6 Utilization Management Compensation
8.7 Excluded Providers
8.8 Credentialing and Re-Credentialing of Contracted or Employed Staff
8.9 Service Verification
8.10 Compliance with 42CFR Part 2