Mid-South Substance Abuse Commission

Policies & Procedures

ADMINISTRATION

●    Communicable Disease

    Communicable Disease Policy 2005    Attachment A-Minimum Knowledge    Attachment B-Communicable Disease Verification Form   

●    Delinquent Reports

    Delinquency Policy 2005    Attachment B - Delinquency Notice    Attachment C - Notice of Withholding Reimbursement

●    Limited English Proficiency

    Limited English Proficient Policy    LEP Contact Log    LEP Training Log    LEP Training Module

●    Procurement Services

   Procurement Policy General    Procurement of Provider Services    Provider Application

●    Provider Inspection & Credentialing

    Provider Inspection & Credentialing Policy    Note: Attachment A is the Provider Application which is found under Procurement Services above    Attachment B-Paid Staff Qualifications Form

●    Appeals to Commission Policy 2004       ●    Cultural Competency Policy 2004    ●    Standards of Practice Policy 2004    ●    LOC Authorization Guidelines 2005-06      ●    Charitable Choice Policy 2006    ●    Charitable Choice Attachment A 2006 

FINANCE & BILLING

●    Insurance Benefits

    Insurance Benefits Policy    Delayed Billing Log   Waiver Of Full Client Fee Authorization Form

●    Sliding Fee Scale Policy & Procedures

       Sliding Fee Scale Policy    Sliding Fee Scale    Attachment B-Determination of Financial Eligibility Worksheet 2005 Attachment C-Instructions for Financial Eligibility Worksheet 2005   Attachment D-Sample Client Fee Agreement Form    Waiver Of Full Client Fee Authorization Form

●      Audit Guidelines

●    Benefit Information 2004   

●    Residential Room & Board Policy 2006   

●    Supplemental Reimbursement Policy 2004

●    Fee Waiver Procedures

●    Determination of Insurance Type 05-06

QUALITY ASSURANCE

●    Administrative Hearing

Administrative Hearing (Fair Hearing) Policy    Administrative Hearing Attachment A    Administrative Hearing Attachment B    Notice of Hearing Rights Attachment C    Notice of Suspension, Reduction or Termination of Services Attachment D    Notice of Denial of Services Attachment E    Request for Administrative Hearing Form Attachment F    Administrative Tribunal Envelope Attachment G    Administrative Tribunal Forms Requisition Attachment H        Hearing Request Withdrawal Form Attachment I

●    Advance Directive

Advance Directive Policy    Attachment A-Advance Directive Policy MI State    Attachment B-Advance Directive Durable Power of Attorney    Attachment C-Advance Directive Patients AD    Attachment D-Advance Directive Acceptance by Patient Advocate    Attachment E-Advance Directive Loss of Decision Making Ability

●    Client Satisfaction

    Satisfaction Survey Policy (surveys provided annually by the CA)   

●    Grievance & Appeals

 Client Grievance & Appeal Policy    Attachment A Notice of Hearing Rights    Attachment B Request for Second Opinion    Attachment C Instructions for Second Opinion    Attachment D Notice of Suspension/Reduction/Termination    Attachment E Notice of Denial    Attachment F Local Dispute Resolution Request    Attachment G Local Dispute Resolution Procedures    Attachment H Request for Administrative Hearing Instructions    Attachment I Request for Administrative Hearing Form

●    LOC & Services Authorization Appeals Procedure

    Flowcharts    Level of Care Appeals Procedure 2004

●    Recipient Rights

    Recipient Rights Complaint & Appeal Policy    Attachment A-Know Your Rights    901 FORM    902 FORM    903 FORM    904 FORM    905 FORM    906 FORM

▪    Site Review

    Annual Site Review Policy    Attachment A-Site Review Rating Code

●    Staff Qualifications

    Staff Qualifications Policy    Attachment A-Verification of Staff Credentials        Attachment C-New Employee Verification Form 2006-2007

●    Wait List Management & Interim Services

Wait List Management Policy 2006    Attachment A-Client Informational Letter    Attachment A.2 Client Informational Letter    Attachment A.3 - Client Informational Letter    Attachment B - Sample Program Wait List    Attachment C - Wait List Interim Services Criteria 2006  

●    Corrective Action & Sanctions Policy 2005

TREATMENT

●    Methadone Services

    Methadone Treatment Policy    Methadone Policy Attachment A      OMT Client Agreement    Attachment B-Urine Drug Screen Summary    Attachment C-MSSAC Methadone Justification Form    Attachment D-Exception Request & Record of Justification        Attachment E-Withdrawal from Methadone Maintenance

●    Primary Care Coordination

    Primary Care Coordination Policy    Attachments A and B Physician Letter

●    Continuum of Care Policy 2005

●    Jail Services 2004

●   Case Management Policy 2006

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2875 Northwind Dr., Ste. 215 * East Lansing, Michigan * 48823 * (517) 337-4406