COMMUNITY MENTAL HEALTH

AFFILIATION OF MID MICHIGAN

Home Page

 

POLICIES & PROCEDURES

An Overview of the Affiliation Policy System

January 2003

Purpose: The policies of the Affiliation are intended to guide the work of the Affiliation’s members. They are not intended to take the place of the policies  of each affiliate. Each affiliate, as a member of the CMH Affiliation of Mid-Michigan, agrees to adhere to the policies of the Affiliation. Additionally, each affiliate can develop its own policies and procedures designed to further define its unique approach to fulfilling the Affiliation’s policies.

Development of policies: The policies will be developed by issue-specific workgroups, made up of representatives of all of the Affiliation members, under the direction of the Affiliation Consumer Advisory Council (CAC).

Approval of Policies: The formal approval of the policies is done by the Board of Directors of the PIHP, CMHA of Clinton, Eaton, and Ingham Counties. Given that the policies are jointly developed by representatives of all of the Affiliation members, under the direction of the Affiliation Consumer Advisory Council, these policies will reflect the combined interests of all of these parties.

As with the policies of any payor, they do not require the approval of each Affiliate in order to be implemented. Rather, by agreeing to be a member of the Affiliation, each Affiliate agrees to abide by the policies of the Affiliation.

Policy Content and Structure: The following is the Affiliation’s policy structure. Note that the explanations that are provided for each section of the policy is intended to provide the policy  author with guidance; these explanations will not appear in the final version of the policy.

 

 

Effective February 2006

POLICIES PROCEDURES
1.0  PIHP Administration 1.1  Administration Capacity
  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
  1.8  Affiliation Consumer Advisory Council
   
2.0  Clinical 2.2  Jail Diversion
  2.4  Coordination & Continuity of Care
  2.5  Habilitation Supports Waiver
  2.6 Co-Occurring Disorders
  2.7 Behavior Treatment Review Committee
  2.8 Health and Safety
   
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
  3.7  Second Opinion
  3.8  Advance Directives
   
4.0  Quality Improvement  
  4.2  Sentinel Events
  4.4  Level of Care Review
  4.5  Clinical 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 
  6.2  Data Validation
  6.3  PIHP Software Standardization
   
7.0  Finance 7.3  Risk Management - ISF
  7.4  Habilitation Supports Waiver
  7.5  Capitation Payments
  7.6  Costing