| LIFEWAYS PROVIDER MANUAL |
| Fiscal Year 2010 (October 1, 2009 through September 30, 2010) |
| TABLE OF CONTENTS |
|
| Last revision: 1/21/2010 | |
| Type | Size | Number of Pgs |
| Section I - Introduction | PDF | 2.50 MB | 33 Pages |
| A. LifeWays Vision and Mission | | | |
| B. LifeWays MCO Administrative Model by Function | | | |
| C. LifeWays Organizational Chart | | | |
| D. LifeWays Overview by Department | | | |
| E. Glossary of Terms | | | |
| F. List of Acronyms | | | |
| | | |
| Section II - Provider Network | PDF | 7.26 MB | 93 Pages |
| A. Credentialing/Re-Credentialing Process | | | |
| 1. Credentialing Flow Chart | | | |
| 2. Organizational Credentialing Application | | | |
| 3. Practitioner Credentialing Application | | | |
| 4. LifeWays Procedure: Procurement | | | |
| 5. LifeWays Procedure: Provider Orientation | | | |
| Credentialing Appendix A: Staff Qualifs. and Definitions by Profession | | |
| Credentialing Appendix B: Ethical Standards | | | |
| B. Provider Training Requirements | | | |
| C. Provider Network Monitoring | | | |
| 1. LifeWays Procedure: Auditing, Certification and Accreditation | | | |
| Attachment 1: Certification Review Content Dictionary | | | |
| | | |
| Section III - Recipient Rights | PDF | 6.57 MB | 103 Pages |
| A. LifeWays Recipient Rights Operating Procedures | | | |
| 1. Abuse and Neglect Reporting | | | |
| 2. Access to Case Records | | | |
| 3. Admission and Discharge | | | |
| 4. Appeals/Appeals Committee | | | |
| 5. Code of Responsibilities | | | |
| a. Recipient Code of Responsibilities Poster | | | |
| 6. Communication, Mail, Telephone, Visits | | | |
| 7. Death Reporting | | | |
| a. Report of Death of LifeWays Recipient Form | | | |
| 8. Duty to Warn | | | |
| 9. Fingerprinting, Photographs, Audiotape, or Use of 1-Way Glass | | | |
| 10. Incident Report Process - Revised 12/14/09 | | | |
| a. Indicator Codes for Incident Reporting - Revised 12/14/09 | | | |
| b. Incident Report Form | | | |
| c. Definitions and Determining a Sentinel Event | | | |
| 11. Intervention Complaints | | | |
| 12. Investigation of Recipient Rights Complaints | | | |
| a. CMHSP Rights System Assessment | | | |
| 13. Personal Property | | | |
| 14. Protection of Recipients of LifeWays Services | | | |
| 15. Recipient Rights Advisors | | | |
| 16. Recipient Rights Advisory Committee (RRAC) | | | |
| 17. Resident Labor | | | |
| 18. Rights Protection/Contract Agreements | | | |
| 19. Seclusion, Restraint, Freedom of Movement | | | |
| 19. Sterilization, Abortion and Contraception | | | |
| 20. Subpoena | | | |
| 21. Suitable Services, Treatment Envirn., PCP | | | |
| B. Recipient Rights Training | | | |
| 1. LifeWays Procedure: RR Training | | | |
| 2. RR Training Schedule 2010 | | | |
| C. Reporting Requirements of Abuse & Neglect: Child Protection Law | | | |
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| Section IV - Accessing and Authorizing Services | PDF | 20.3 MB | 137 Pages |
| A. Eligibility Requirements and Verification | | | |
| B. Medical Necessity | | | |
| C. LifeWays Procedure: Waiting List for CMH Services | | | |
| Attachment A: Adult Eligibility Process Flow Chart | | | |
| Attachment B: Waiting List Maintenance Flow Chart | | | |
| Attachment C: Adult MI Clinical Eligibility Criteria | | | |
| Attachment D: Letter to Consumer Regarding Wait List | | | |
| D. Accessing Services - Revised 1/4/10 | | | |
| 1. Chart 1 - Flow Chart of “First Point of Contact” - Revised 1/4/10 | | | |
| 2. Chart 2 - Brief Screening of Need | | | |
| 3. Chart 3 - Non-urgent/Emergent with Mental Health Need | | | |
| 4. Chart 4 - Allegiance Health Walk-In | | | |
| 5. Chart 5 - Hillsdale Community Health Center Walk-In | | | |
| 6. Crisis Intervention and Provider Responsibility Flow Chart - Revised 1/4/10 | | | |
| 7. 4-Quadrant Model for Referring Consumers with MH/SA | | | |
| E. LifeWays Service Descriptions, Qualifications & Eligibility | | | |
| 1. LifeWays Program Descriptions | | | |
| 2. Services Available by Funding Source | | | |
| a. Medicaid Services Crosswalk of HSW and B-3 Services | | | |
| b.. Medicaid Targeted Case Management, Supports Coordination, and Wraparound Facilitation: Clarifying of their differences and their use. | | | |
| F. LifeWays Procedure: Utilization Management Criteria | | | |
| 1. Service Authorization Process | | | |
| Appendix A: Submission of Electronic Authorization Requests; Authorization Request Forms | | | |
| Appendix B: Service Authorization Grid - Revised 1/21/10 | | | |
| Appendix C: Eligibility Criteria for Infants and Toddlers | | | |
| 2. Level of Care (LOC) Parameters for Assessment of Service Need | | | |
| 3. General Fund Informal Review Process - Revised 1/21/10 | | | |
| G. LifeWays Procedure: Clinical Case Reviews | | | |
| 1. UM Case Review Tool – Interpretive Guidelines: CLS/Skill Bldg | | | |
| | | |
| Section V - Provider Requirements | PDF | 16.6 MB | 162 Pages |
| A. Advanced Directives | | | |
| 1. LifeWays Advanced Directive Form | | | |
| 2. MDCH Advanced Directive for Mental Health Services | | | |
| B. Care Coordination | | | |
| C. Clinical Record Review Policy | | | |
| 1. Clinical Record Review Tools for Provider Use | | | |
| D. Consumer Demographic Reporting Requirements | | | |
| E. Environment of Care (EOC) Standards for Residential Providers | | | |
| F. LifeWays Procedure: Health Insurance Portability and Accountability Act (HIPAA) [PENDING] | | | |
| G. LifeWays Procedure: Michigan Mission-Based Performance Indicator System (MIMBPIS) | | | |
| 1. Timeliness Reporting Requirements | | | |
| H. Model Payment System | | | |
| Attachment 1: MDCH Technical Requirement: Personal Care in Non-Specialized Residential Setting | | | |
| I. Petition for Outpatient Treatment Orders (AOT Order) | | | |
| J. Residential Care Providers: Criminal Background Check Requirement | | | |
| Attachment 1: Long Term Care Workforce – Background Check Process | | | |
| Attachment 2: AFC Facility Licensing Act [Excerpt]; Act 218 of 1979 | | | |
| K. Standards and Best Practice Guidelines | | | |
| 1. Administration and Leadership (LD) | | | |
| 2. Finance and Business (FB) | | | |
| 3. Recipient Rights (RR) | | | |
| 4. Management Information Systems (IS) | | | |
| 5. Professional Competency and Credentialing (CR) | | | |
| 6. Quality Improvement and Performance Monitoring (QI) | | | |
| 7. Corporate Compliance (CC) | | | |
| 8. General Medical Record Requirements (GR) | | | |
| 9. Assessment (AS) | | | |
| 10. Treatment Referrals (RF) | | | |
| 11. Individualized, Person-Centered Treatment (TX) | | | |
| 12. Crisis Interventions (CS) | | | |
| 13. Treatment Monitoring (TM) | | | |
| 14. Discharge Planning (DP) - Revised 1/4/10 | | | |
| 15. Service Delivery (SD) | | | |
| 16. Environment of Care (EC) | | | |
| L. Standardized Clinical Forms Policy | | | |
| 1. Standardized Clinical Forms Link | | | |
| | | |
| Section VI - LifeWays Practice Guidelines and Algorithms | PDF | 4.2 MB | 116 Pages |
| A. LifeWays Procedure: Behavior Risk Management Committee (BRMC) - Revised 11/30/09 | | | |
| 1. Behavior Treatment Plan (BTP) Practice Guideline Algorithm | | | |
| B. Recovery Model | | | |
| C. LifeWays Procedure: Self-Determination Practice Guideline | | | |
| 1. Commonly Asked Questions about Self-Determination | | | |
| D. LifeWays Procedure: Practice Guideline Development | | | |
| 1. LifeWays Procedure: Service Model Fidelity Assessments | | | |
| 2. LifeWays Practice Guideline Algorithms by Diagnosis/Disorder | | | |
| a. Attention Deficit and Hyperactivity Disorder (ADHD) | | | |
| b. Agoraphobia Disorder | | | |
| c. Bipolar Disorder | | | |
| Bipolar Disorder Medication Algorithm | | | |
| d. Borderline Personality Disorder | | | |
| e. Conduct Disorder and Oppositional Defiant Disorder (CD/ODD) Developmental Disabilities | | | |
| f. Generalized Anxiety Disorder (GAD) in Adults | | | |
| g. Major Depressive Disorder | | | |
| Major Depressive Disorder Medication Algorithm | | | |
| Major Depressive Disorder with Psychotic Features Medication Algorithm | | | |
| h. Obsessive Compulsive Disorder (OCD) | | | |
| i. Personality Disorder in Adults | | | |
| j. Phobia Disorder | | | |
| k. Post Traumatic Stress Disorder (PTSD) | | | |
| l. Psychotic Disorder | | | |
| Psychotic (Schizophrenia)Disorder Medication Algorithm | | | |
| Attachment 1: Side Effects Medication Algorithm | | | |
| Attachment 2: Co-Existing Symptoms Algorithm | | | |
| E. MDCH Practice Guidelines | | | |
| 1. Adult Jail Diversion | | | |
| 2. Consumerism | | | |
| 3. Housing | | | |
| 4. Inclusion | | | |
| 5. Person-Centered Planning | | | |
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| Section VII - Claims Payment | PDF | 18.28 MB | 87 Pages |
| A. Claims Payment Procedure: Submission and Payment of Claims | | | |
| 1. Remittance/Payment Schedule | | | |
| 2009 Calendar Year | | | |
| 2010 Calendar Year | | | |
| 2. LifeWays Code Sheet for Claims Submissions | | | |
| 3. “Place of Service” Codes Approved for Claims to LifeWays | | | |
| 4. HCFA-1500 Form and Instructions | | | |
| 5. PIHP/CMHSP Encounter Reporting: HCPCS and Revenue Codes | | | |
| 6. PIHP/CMHSP Encounter Reporting: Costing per Code | | | |
| 7. PIHP/CMHSP Provider Qualifications per Medicaid Service & HCPCS/CPT Codes | | | |
| B. Ability-To-Pay (ATP)/Fee Determination Process | | | |
| ATP Forms: | | | |
| 1. Pharmacy Assistance Program (PAP) Application | | | |
| 2. Ability-to-Pay Package A | | | |
| a. Ability-to-Pay Schedule Method - Revised 1/21/10 | | | |
| b. Income Estimate - Revised 1/21/10 | | | |
| c. Schedule of ATP by Taxable Income Amount | | | |
| d. Willful Failure to Provide Relevant Financial Information | | | |
| e. Work Disclaimer Form | | | |
| 3. Ability-to-Pay Package B | | | |
| a. Total Financial Circumstances Fee Determination | | | |
| C. Denial of Family Subsidy and ATP Appeal | | | |
| Attachment 1: Denial of Family Subsidy Flow Chart | | | |
| Attachment 2: Ability-To-Pay Appeal Flow Chart | | | |
| | | |
| Section VIII - Physicians Unit | PDF | 6.10 MB | 55 Pages |
| A. Medical Guidelines and Best Practices | | | |
| Attachment 1: GF Formulary | | | |
| Attachment 2: GF Non-Formulary Medication Rationale | | | |
| Attachment 3: LifeWays Procedure: Lab Payment Assistance for the Uninsured | | | |
| B. PSU Service Referrals | | | |
| C. PSU Crisis Service Protocols | | | |
| D. Psychiatric Coding and Service Instructions | | | |
| E. Recommended Medication Monitoring Parameters | | | |
| F. Drug Formulary | | | |
| G. Physicians Unit Record Forms | | | |
| 1. PSU Provider Orientation Checklist | | | |
| 2. PSU Chart Index | | | |
| 3. Consent for the Mutual Release of Confidential Information | | | |
| 4. Consent for Participation in Medical Services | | | |
| 5. Referral Form | | | |
| 6. Psychiatric Service Communication Form | | | |
| 7. Health Care Coordination Form | | | |
| 8. HIPAA - Consent for Use of PHI | | | |
| 9. HIPAA - Authorization for Use/Disclosure of Info | | | |
| 10. Case Review Request Memo to Clinical Director | | | |
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| Section IX - Customer Services | PDF | 4.97 MB | 77 Pages |
| A. LifeWays Member Handbook - Revised 1/4/10 | | | |
| B. Customer Services Operating Procedures | | | |
| 1. Advisory Council (MI/DD) Appointment | | | |
| 2. Medical Records Release of Information | | | |
| 3. New and Ongoing Groups (support, education, therapeutic) | | | |
| 4. Planning and Supports for Persons with Limited English Proficiency (LEP) | | | |
| Attachment 1: List of Interpreter Services | | | |
| 5. Provider Access to Closed Records | | | |
| 6. Public Use of LifeWays Meeting Rooms/Meeting Aids Check-out | | | |
| Attachment 1: Meeting Room Capacity | | | |
| Attachment 2: Meeting Room Reservation Form | | | |
| C. Grievance and Appeal Process | | | |
| Attachment A: Grievance and Appeals Resolution Form 720 | | | |
| Attachment B-1: Resolution Letter, Medicaid | | | |
| Attachment B-2: Resolution Letter, Non-Medicaid | | | |
| Attachment B-3: Resolution Letter, General | | | |
| Attachment C-1: Adequate Notice Letter, Medicaid | | | |
| Attachment C-2: Adequate Notice Letter, Non-Medicaid | | | |
| Attachment D-1: Advanced Notice Letter, Medicaid | | | |
| Attachment D-2: Advanced Notice Letter, Non-Medicaid | | | |
| Attachment E-1: Appeal Acknowledgement Letter | | | |
| Attachment E-2: Grievance Acknowledgement Letter | | | |
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