State of Michigan Medicaid Provider Manual
and
Medicaid Policy Bulletins
CURRENT BEHAVIORAL HEALTH PROVIDER MANUAL- BY SECTION:
1. Introduction
2. Consumer Centered Care: Our Core Values
3. Best Practice Guidelines
4. Access and Care Authorization
5.
Customer Services
6. Appeals and Grievances
7. Rights of Recipients
8. Administrative Requirements for Providers
9. Site Reviews
10. Claims and Reimbursement for Care
Ability to Pay Policies and Procedures
11 Supplement for Residential Care Providers
12 Procedure and Billing Codes
13 Provider Performance Requirements and Standards
View the Archive of out of date manuals.
Current Provider Manual - By Section
1. Introduction
Mission, Vision, Values
1.1 Summary of PIHP Role in Managed Behavioral Healthcare
1.2 Key Functions of the PIHP
1.3 General Information
1.3.1 Frequently Called Phone Numbers
1.3.2 Glossary of Terms
1.3.3 Index of Abbreviations
2. Consumer Centered Care: Our Core Values
2.1 Effective Freedom
2.2 Person-Centered Planning
2.3 Recovery and Relapse Prevention
2.4 Employment
2.5 Code of Ethics
3. Best Practice Guidelines
3.1 Housing Best Practice Guideline
3.2 Inclusion Best Practice Guideline
3.3 Consumerism Best Practice Guideline
3.4 Personal Care Technical Requirement
3.5 Person-Centered Planning Best Practice Guideline
4. The Access and Authorization Function
4.1 The Role of the Access Department
4.2 Access and Authorization System Overview
4.3 Call Triage
4.4 Target Population
4.5 Eligibility, Enrollments and Initial Authorization
4.6 Emergency Services
4.7 Medicaid Health Plans (Formerly "Qualified Health Plans")
4.8 The Authorization Process for Ongoing Services
4.8.1 Authorization Types
4.8.1.1 Pre-Authorized Services
4.8.1.2 Authorized Services
5. The
Customer Services Function
5.1 Overview
5.2
Customer Services Provider-Related Policies
5.2.1 Consumer Orientation
5.2.2 Limited English Proficiency, Accommodations Competencies
and Cultural Competencies
6. Grievance and Appeal Technical Requirements
6.1a Appeal and Grievance Resolution Technical Requirement (Non Medicaid)
6.1b Appeal and Grievance Resolution Technical Requirement (Medicaid)
6.2 Local Dispute Resolution Technical Requirement
6.3 Provider Network Policy and Procedure: Grievance and Appeal
7. Recipient Rights - Behavioral Health Services
7.1 Full Policy and Procedure Set
7.2 Rights Policies (Single Document Covering All Policies)
8. Other Administrative Requirements Applicable to All Providers
8.1 Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement
8.2 Clinical Documentation Policy
8.3 Late Documentation Policy
8.4 National Patient Safety Goals
8.4.1 Prohibited and Dangerous Abbreviations Policy
9. Site Reviews
10. Claims Processing and Reimbursement Procedures
10.1 Overview
10.2 Claims Submission and Reimbursement
10.3 HCFA 1500 Billing Instructions
10.A Ability to Pay Policy and Procedure
Financial Liability for Mental Health Services Policy/Procedure
Determining Ability to Pay (Adult, Non-Residential Recipients)
Determining Ability to Pay (Adult, Residential Recipients)
Determining Ability to Pay (Minors)
Ability Pay Fee Schedule
11. Supplement for Residential Care Providers
Glossary of Terms
Supplement for Residential Care Providers
11.1 Group Home Curriculum Policy and Procedure
11.2 NFPA 101 1985 Life Safety Code
11.3 Appendix F - A Procedure for Determining Evacuation
Capability
11.4 Evacuation Difficulty Score, Destination Training
and Waiver Process
11.5 E-score Clarification of Requirements
11.6 Medications - Storage, Samples, Injectables,
Disposal, Expirations and Recalls Policy and Procedure
11.7 Reporting Retention Guidelines for Fire and Smoke
Related Events in Specialized Residential Group Homes
11.8 Smoke and Fire Incident Report
11.9 Annual Safety and Facility Assessment Form
11.10 Disposal of Sharps Guidelines
11.11 Group Home Safety Emergency Supply Kits
11.12 Lift Sling Training Letter
Ref. 01 Licensing Rules AFC Small Homes
Ref. 02 Certification Requirements for Specialized Programs
Ref. 03a MIOSHA Part 8 Portable Fire Extinguishers
Ref. 03b MIOSHA Part 69 Compressed Gases
Ref. 03c-03d-04a MIOSHA Part 42, 92, 430 and OSHA 29CFR 1910.1200 Hazard
Communications
Ref. 04b OSHA 1910.157 Portable Fire Extinguishers - Training and Education
Ref. 05 Michigan Vehicle Code
Ref. 09 Michigan Fire Prevention Code
12. Billings/Standard Procedure Codes
12.1 Provider Encounter Reporting Codes, Rounding and Other Rules
12.2 HCPCS and Revenue Codes
13. Regional Provider Performance Standards (Site Review Templates)
13.1 Master Protocol (Used by MDCH to review All Providers)
13.2 Primary Care Performance Standards/Site Review Template
13.3 Inpatient Care Performance Standards/Site Review Template
13.4 Vocational Services Standards/Site Review Template
13.5 Supported Independent Placements Standards/Site Review Template
13.6 Residential Services Standards/Site Review Template
Archive Provider Manuals:
FY 2003-2004 Regional Behavioral Health Provider Manual