Policies 2009

Mid-South Substance Abuse Commission

Policies 2009

Master Page Page Index Reference Forms

Administration A001 Procurement OMB Circular A-102 & A-110 A103

A002 Conflict of Interest None None

A003 Appeals to Commission Policy None None

A004 Supplemental Reimbursement None None

A005 Communicable Disease Minimum Knowledge Standards for SA Professionals A101, A102

A006 Charitable Choice Model Notice to Individuals Receiving Substance Abuse Services

A007 Recipient Rights Administrative Rules for Substance Abuse Programs in MI 901, 902, 903, 904, 905, 906

A008 Delinquency Reporting Notice of Withholding Reimbursement A100

A009 Customer Service Mid-South Member Handbook

www.michiganrelay.com Michigan Relay Center

ASAM Patient Placement Criteria

Mid-South Standardized Sliding Fee Scale (below)

A010 Cultural Competency Policy LEP Policy T004 (below)

A012 Progressive Corrective Action Policy Problem Identification and Correction Action Process Flow Chart

Formal Appeal to Commission Policy A003 (above) None

A013 Staff Qualifications Policy Staff Qualifications by Service Type/Billing Code A105 A106 107

Communicable Disease Policy A005 (above)

Job Functions, Supervision, & MCBAP Requirements Chart

MCBAP Web Site http://www.mcbap.com

A014 Welcoming Policy ODCP Treatment Technical Advisory #05

A015 Whistle Blowing Policy

A016 Business Continuity Plan

Finance F001 Benefit Information Initial Authorization & Reauthorization Grace Period &

Lapse Date Defined

Residency Policy T005 (below)

Medicaid Provider Manual-Sections 3, 12, & 18

MiChild Provider Manual

F002 Insurance Benefits F102, F110

F003 Audit Guidelines Federal Circular A122 & A133;

MDCH Audit Guidelines

F004 Sliding Fee Scale Policy Standardized Sliding Fee Scale F103

Determination of Financial Eligibility Worksheet

Sample Client Fee Agreement

Insurance Benefit Policy F002 (above)

F005 Room and Board None None

F006 Investment Policy GASB 40 None

F007 ACH Policy PA738 of 2002

F008 Capitalization Policy

F009 Anti-Fraud Policy A002 Conflict of Interest Policy (above)

A015 Whistle-Blowers Policy (above)

Quality Q001 Client Satisfaction Survey Q100

Q002 Site Review Mid-South Site Review Schedule None

Q003 Medicaid Administrative Hearing Flowchart; Change in LOC/Reduction in # of Sessions DCH 0092

Flowchart Termination; Notice of Hearing Rights DCH-0368

Notice of Suspension, Reduction, or Termination of Services DCH 0093

Notice of Action: Denial of Services DCH 0646

Q004 Utilization Management ASAM Patient Placement Criteria, 2nd Edition Revised

Mid-South Best Practice Guidelines (below)

Administrative Rules for Substance Abuse Programs in MI (below)

Mid-South Standards for CareNet Entry

Notification of Service Letter

Q005 Advance Directive Policy http://www.michigan.gov/mdch/0,1607,7-132-2941_4868_41752---,00.html Advance Directive Brochure

http://www.michbar.org/elderlaw/adpamphlet.cfm

http://www.bcbsm.com/member/establishing_advance_directive/advance_directive_faq.shtml

Treatment T001 Primary Care Coordination List of Safe and Unsafe Drug for Recovering Addicts

Sample Letter to Physician

T002 Medication-Assisted Treatment for OPIOID Addiction

MSSAC Best Practice Guidelines

Center for Substance Abuse Treatment references (see bottom of policy)

T003 Confidentiality and Protection of Client Information Acknowledgment of Notice of Privacy Practices

HIPAA Notice of Privacy Practices

Sample Client Notice of Confidentiality

Authorization and Consent for Release of Confidential Information Standard

Authorization and Consent for Release of Confidential Information Criminal Justice

Authorization and Consent for Release of Confidential Information Drug Court

Center for Substance Abuse Treatment (CSAT) (1997): Confidentiality of Alcohol and

Other Drug Treatment Records Training Manual. New York: Legal Action Center

Legal Action Center (LAC) (2003): Confidentiality and Communication, 5th Edition.

City of New York, Inc.

Legal Action Center (March 2004): The HIPAA; A Summary of the Privacy

Standards' Relationship with the Drug and Alcohol Confidentiality Regulations

(42 CFR Part 2)

Legal Action Center (2006): Confidentiality and Communication, 6th Edition.

City of New York, Inc.

T004 Limited English Proficiency LEP Training Material for Trainer T101

LEP Answers to Quiz

LEP Training Log

LEP Person Contact Log

T005 Residency Determination None None

T007 Client Grievance Policy MDCH Alternative Dispute Resolution

Medicaid Administrative Hearing Policy Q003 (above)

Recipient Rights Policy A007 (above)

Limited English Proficiency Policy T004 (above)

2875 Northwind Drive * Suite. 215 * East Lansing, Michigan * 48823