C11 S05 T01 Cust Services Struct Ops doc by M0Cl9l

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									                            BAY-ARENAC BEHAVIORAL HEALTH
                           POLICIES AND PROCEDURES MANUAL

 Chapter: 11              Access Alliance of Michigan
 Section:   5             Customer Services
 Topic:     1             Customer Services Structure and Operations
 Page: 1 of 10            (BABH) Supersedes:              (BABH) Date:
                          Pol:                            Pol: 12-15-05
                                                                                     ______________________________________
                          Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
 Affiliation CEO                                             5-8-09
 Approval Date:
 01-11-06                                                                                 ______________________________________
                                                                                          Chief Executive Officer Signature
 Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
 10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
 G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                                DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

Policy:

It is the policy of Bay-Arenac Behavioral Health (BABH) the Board to provide customer
services to all persons receiving mental health or substance abuse supports and services.


Purpose:

This policy an d procedure is established to pProvide a centralized customer service operation
                that furnishes the following functions:
 Welcome and orient individuals to services and benefits available, and the provider network.
 Supply information about accessing the mental health, primary health and other community
  services.
 Supply information about how to access the various rights processes.
 Assist individuals with problems and inquiries regarding benefits.
 Assist people with and oversee the complaint and grievance process.
 Track and report patterns of problem areas for the organization.
Provide a centralized customer service operation that will distribute information regarding
available services to persons requesting assistance from the agency.
Applicability:
                                                                                                                                   Field Code Changed
    All BABH Staff                                                                                                                 Formatted: Font: 12 pt
    Selected BABH Staff, as follows:                                                                                               Formatted: Font: 12 pt
    All Contracted Providers:     Policy Only     Policy and Procedure                                                             Formatted: Font: 12 pt
    Selected Contracted Providers, as follows:
                                                                                                                                   Field Code Changed
           Policy Only       Policy and Procedure
                                                                                                                                   Formatted: Font: 12 pt
    BABH’s Affiliates:           Policy Only      Policy and Procedure
                                                                                                                                   Formatted: Font: 12 pt
    Other:
                                                                                                                                   Formatted: Font: 12 pt

Definitions:                                                                                                                       Formatted: Font: 12 pt
                                                                                                                                   Formatted: Font: 12 pt
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                                                                                                                                   Field Code Changed
                            BAY-ARENAC BEHAVIORAL HEALTH
                           POLICIES AND PROCEDURES MANUAL

 Chapter: 11              Access Alliance of Michigan
 Section:   5             Customer Services
 Topic:     1             Customer Services Structure and Operations
 Page: 2 of 10            (BABH) Supersedes:              (BABH) Date:
                          Pol:                            Pol: 12-15-05
                                                                                     ______________________________________
                          Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
 Affiliation CEO                                             5-8-09
 Approval Date:
 01-11-06                                                                                 ______________________________________
                                                                                          Chief Executive Officer Signature
 Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
 10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
 G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                                DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

Grievance: An expression of dissatisfaction not related to an action or Mental Health Code
violation. All grievances can be directed to the Access Alliance of Michigan (AAM) toll free
customer service number.

Procedure:

    1. The PIHP will operate a centralized customer service department consisting of at least
       one (1) full time employee FTE that serves all board, PIHP, and Coordinating Agency
       operations.

    2. The centralized customer service department will have a designated toll-free telephone
       number that is answered by a live voice. The centralized customer service department
       will have access to a TTY number. These phone numbers will be displayed on agency
       brochures and public information materials. The hours of Customer Services Department
       and the process for accessing information after-hours will be publicized in agency
       brochures. Customer Services will respond to all calls and messages within 1 business
       day.

    3. Customer Services will manage all complaints of dissatisfaction about any matter relative
       to treatment for Medicaid and non-Medicaid covered services except for those
       protections and rights described in Chapters 4, 4A, 7 and 7A of the Michigan Mental
       Health Code or the suspicion or actual act of abuse and/or neglect. All suspicion or actual
       act of abuse and/or neglect will be reported to the Department of Human Services as
       required by law. Each CMHSP within the AAM affiliation will maintain an Office of
       Recipient Rights with designated staff. The customer services unit shall refer, as
       appropriate, to the local Offices of Recipient Rights. Furthermore, the local Offices of
       Recipient Rights will refer, as appropriate, to the centralized Customer Services
       department.
       a. Some circumstances may require a dual investigation by both the Customer Service
            department and Recipient Rights Office. Under these circumstances, the Customer
            Service department must only investigate the portion of the complaint pertaining to
            customer dissatisfaction. The actual investigation of a possible Mental Health Code
                           BAY-ARENAC BEHAVIORAL HEALTH
                          POLICIES AND PROCEDURES MANUAL

Chapter: 11              Access Alliance of Michigan
Section:   5             Customer Services
Topic:     1             Customer Services Structure and Operations
Page: 3 of 10            (BABH) Supersedes:              (BABH) Date:
                         Pol:                            Pol: 12-15-05
                                                                                    ______________________________________
                         Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
Affiliation CEO                                             5-8-09
Approval Date:
01-11-06                                                                                 ______________________________________
                                                                                         Chief Executive Officer Signature
Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                               DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

             rights violation must be forwarded within 24 hours to the designated Recipient Rights
             officer for the appropriate actions.

   4. The centralized customer service department will handle all customer related
      correspondence regarding grievances and possibly may handle calls regarding appeals,
      Medicaid Fair Hearings, and MDCH Alternative Dispute Resolution process. Although
      policy 11.5.7 depicts responsible parties in relation to local appeals, Medicaid, and
      MDCH Alternative Dispute Resolution, the PIHP utilizes a “no wrong door” practice.
      Customer Services will link callers to appropriate parties in a welcoming manner if
      needed. The Customer Services allows consumers, guardians, parents of minors, legal
      representatives, or providers to file appeals and grievances on behalf of a consumer;
      however, Customer Services must verify with the consumer or legally responsible party if
      he/she consents to proceed with the appeal/grievance. Confidentiality laws must be
      followed in this process. would also be responsible for handling all customer related
      correspondence regarding appeals. The responsibility for sending an advance or adequate
      notice is detailed in policy and procedure 11.3.2. The responsibility for sending an
      advance or adequate notice would be exercised as detailed in policy and procedure
      11.3.2. The customer service department will receive most grievance/appeal activity
      directly from the AAM Access Center. The Access Center 800 number will also be
      published as the number for customer service.

   5. The customer service department is responsible for the following: The Customer Service
      Department would be responsible for the following:

        a. Recording and investigating details of the grievance.
        b. Working with the affiliate CMHSP’s for prompt resolution of grievances. Ensure that
           the person involved in the grievance resolution process was not involved in the
           previous level of decision-making and ensure that person has the appropriate
           expertise in addressing the grievance issues (clinical if clinical in nature, financial if
           financial in nature, etc.). Routing and tracking all grievances related to local service
           provisions to the CMHSP for prompt resolution.
        c. Sending an Acknowledgement letter within 5 2 business days of receiving the initial
           grievance from the customer. All acknowledgement letters will contain:
                           BAY-ARENAC BEHAVIORAL HEALTH
                          POLICIES AND PROCEDURES MANUAL

Chapter: 11              Access Alliance of Michigan
Section:   5             Customer Services
Topic:     1             Customer Services Structure and Operations
Page: 4 of 10            (BABH) Supersedes:              (BABH) Date:
                         Pol:                            Pol: 12-15-05
                                                                                    ______________________________________
                         Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
Affiliation CEO                                             5-8-09
Approval Date:
01-11-06                                                                                 ______________________________________
                                                                                         Chief Executive Officer Signature
Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                               DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt



                 The date the grievance was received. Date grievance received
                 The expected timeframe for resolution (within 60 calendar days). Expected
                  timeframe in which the grievance must be resolved.
                 Information on the option to file a Medicaid Fair Hearing if grievance is not
                  resolved within the specified timeframe. Option to file an appeal if a grievance
                  resolution is not completed within the specified timeframes.
                 Who may file a Medicaid Fair Hearing grievance on behalf of the customer.
                 How to access accommodations to address language barriers or auditory
                  impairments.
                 Who to contact for assistance or questions during the grievance process.

        d. Sending a Disposition letter to the customer upon the conclusion of the investigation
           and determination of a resolution. Disposition letters will contain:
            The date the grievance was filed. Initial date grievance filed.
            The date the grievance was resolved. Conclusion date of grievance investigation.
            A summary of the grievance and the grievance resolution.
            Resolution of grievance
            How to file a local dispute resolution Medicaid Fair Hearing through MDCH, if
              the specified timeframe for grievance resolution is not met.
            Who may file a local dispute Medicaid Fair Hearing on behalf of the customer.
            Timeframe for filing a local dispute.
            How to access accommodations to address language barriers or auditory
              impairments.

        e. All grievance investigation findings and recommendations are will be reviewed by
           with a designated PIHP Administrator prior to implementation.

   5. Board Affiliates that have a designated Customer Service Representative can receive
      direct customer calls at the designated CMHSP Board Office. Customers will also have
      the opportunity to contact the AAM Regional Customer Service Representative to file a
      grievance if circumstances make it difficult for an individual to file locally. The
                           BAY-ARENAC BEHAVIORAL HEALTH
                          POLICIES AND PROCEDURES MANUAL

Chapter: 11              Access Alliance of Michigan
Section:   5             Customer Services
Topic:     1             Customer Services Structure and Operations
Page: 5 of 10            (BABH) Supersedes:              (BABH) Date:
                         Pol:                            Pol: 12-15-05
                                                                                    ______________________________________
                         Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
Affiliation CEO                                             5-8-09
Approval Date:
01-11-06                                                                                 ______________________________________
                                                                                         Chief Executive Officer Signature
Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                               DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

        designated Board Affiliate Customer Service Representative would be responsible for the
        following:

        a. Work independently of the staff or program involved in the initial decision that led up
           to the grievance.
        b. Handle any grievance related to local service provision.
        c. Document details of the grievance.
        d. Send an Acknowledgement letter within 2 business days of receiving a grievance
           request.
        e. Timely investigation and resolution of the complaint.
        f. Track grievance resolution if a particular staff or department is responsible for
           implementation of the resolution.
        g. Complete data entry of requested information into a shared database.

        Boards that do not have a designated customer service representative would direct all
        customer related issues to the Regional Customer Service Manager at AAM.

   6. All Access staff and the Customer Service staff, with the assistance of the access center
      staff, will be required to maintain:

        a. Up-to-date benefit information
        b. Knowledge of all acceptable insurances and the authorization process per county
           board and contract providers.
        c. Alternative community resources information

   7. All Access staff and the Customer Service staff are will be responsible for the following:

        a. Providing Provide an overview to customers regarding their appeal and grievance
           options.
        b. Providing customers with information on available community resources. Make all
           customers aware of all available community resources.
        c. Mailing benefit applications and/or resource materials as requested by customers.
           Mail out benefit applications or resource materials as requested by customers.
                           BAY-ARENAC BEHAVIORAL HEALTH
                          POLICIES AND PROCEDURES MANUAL

Chapter: 11              Access Alliance of Michigan
Section:   5             Customer Services
Topic:     1             Customer Services Structure and Operations
Page: 6 of 10            (BABH) Supersedes:              (BABH) Date:
                         Pol:                            Pol: 12-15-05
                                                                                    ______________________________________
                         Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
Affiliation CEO                                             5-8-09
Approval Date:
01-11-06                                                                                 ______________________________________
                                                                                         Chief Executive Officer Signature
Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                               DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

        d. Directing customers to appropriate Customer Service staff for the resolution of issues,
           filing of appeals or grievances. Direct all customers to the Customer Services
           Manager to resolve issues, file appeals or grievances as requested by customers.
        e. Receive ongoing customer service and skills curriculum training as established and
           implemented.

   8. The customer service department will establish performance standards for effectiveness
      and efficiency related to:

        a. Intake/phone response
        b. Customer satisfaction with access process
        c. Management of notice/grievance/appeal process

        Monitoring of these measures will occur on a regular basis as a part of the performance
        improvement system. These measures will be monitored on a regular basis and
        incorporated into the boards’ performance improvement system. This will include
        tracking and reporting of problem areas (see attachment for measures).

   9. Any CMHSP local customer service staff will also comply with the established regional
      standards for this department.

   10. CMHSP staff will provide the following information to consumers at their first
       appointment and any subsequent request:

        a. Grievance and Appeals options, including Medicaid Fair Hearing and MDCH
           Alternative Dispute Resolutions.
        b. Regional Consumer Handbook
        c. Regional Provider Directory, including independent facilitator listing
        d. Recipient Rights
        e. Advanced Directives in Michigan
        f. Provider information (detailing hours of operation, services provided and how to
           access the services).
                           BAY-ARENAC BEHAVIORAL HEALTH
                          POLICIES AND PROCEDURES MANUAL

Chapter: 11              Access Alliance of Michigan
Section:   5             Customer Services
Topic:     1             Customer Services Structure and Operations
Page: 7 of 10            (BABH) Supersedes:              (BABH) Date:
                         Pol:                            Pol: 12-15-05
                                                                                    ______________________________________
                         Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
Affiliation CEO                                             5-8-09
Approval Date:
01-11-06                                                                                 ______________________________________
                                                                                         Chief Executive Officer Signature
Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                               DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

        11. Customer Service staff is trained to welcome people to the mental health system and
        to possess current working knowledge, or the ability to find the organization’s
        information, about the following:
        a.      The populations served (serious mental illness, serious emotional disturbance,
        developmental disability and substance use disorder) and eligibility criteria for various
        benefit plans, including Medicaid, Adult Benefit Waiver and MiChild.
        b.      Service array (including substance use disorder treatment services), medical
        necessity requirements and eligibility for and referral to specialty services.
        c.      Person-centered planning
        d.      Self-determination
        e.      Recovery and Resiliency
        f.      Peer Specialists
        g.      Grievance and appeals, Fair Hearings, local dispute resolutions processes and
                Recipient Rights.
        h.      Limited English Proficiency and cultural competency
        i.      Information and referral about Medicaid-covered services within the PIHP as well
                as outside to Medicaid Health Plans, Fee-for-Service practitioners and the
                Department of Human Services
        j.      The organization of the Public Mental Health System
        k.      Balanced Budget Act relative to the customer services functions and beneficiary
                rights and protections.
        l.      Community resources
        m.      Public Health Code
        n.      Information on PIHP structure, CMHSP annual reports, PIHP/CMHSP
                organizational chart, CMHSP board member listing & meeting schedule/minutes.


Attachments:

N/A

Related Forms:
                            BAY-ARENAC BEHAVIORAL HEALTH
                           POLICIES AND PROCEDURES MANUAL

 Chapter: 11              Access Alliance of Michigan
 Section:   5             Customer Services
 Topic:     1             Customer Services Structure and Operations
 Page: 8 of 10            (BABH) Supersedes:              (BABH) Date:
                          Pol:                            Pol: 12-15-05
                                                                                     ______________________________________
                          Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
 Affiliation CEO                                             5-8-09
 Approval Date:
 01-11-06                                                                                 ______________________________________
                                                                                          Chief Executive Officer Signature
 Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
 10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
 G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                                DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

N/A

Related Materials:

    1. Grievance and Appeal Grid
    2. Customer Services Performance standards
    3. Customer Services and Office of Recipient Rights grievance management flow chart
                            BAY-ARENAC BEHAVIORAL HEALTH
                           POLICIES AND PROCEDURES MANUAL

 Chapter: 11              Access Alliance of Michigan
 Section:   5             Customer Services
 Topic:     1             Customer Services Structure and Operations
 Page: 9 of 10            (BABH) Supersedes:              (BABH) Date:
                          Pol:                            Pol: 12-15-05
                                                                                     ______________________________________
                          Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
 Affiliation CEO                                             5-8-09
 Approval Date:
 01-11-06                                                                                 ______________________________________
                                                                                          Chief Executive Officer Signature
 Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
 10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
 G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                                DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt

References/Legal Authority:

    1. Federal Register, Volume 3, No 10, Part 438-Medicaid Managed Care Rules, Subpart A-
       General Provisions.

    2. Michigan Department of Community Health-Medicaid managed Specialty Supports and
       Services Concurrent 1915(b)/(c) Waiver Program FY 03-04.


    3. Michigan Mental Health Code (Act 258 of the Public Acts of 1964 as amended) 2001.

    4. Michigan Department of Community Health Specialty Pre-Paid Health Plan, Application
       for Participation, Customer Services 6.3, 2002.
                            BAY-ARENAC BEHAVIORAL HEALTH
                           POLICIES AND PROCEDURES MANUAL

 Chapter: 11              Access Alliance of Michigan
 Section:  5              Customer Services
 Topic:    1              Customer Services Structure and Operations
 Page: 10 of 10           (BABH) Supersedes:              (BABH) Date:
                          Pol:                            Pol: 12-15-05
                                                                                     ______________________________________
                          Proc: 2-1-06                    Proc: 2-1-06               Board Chairperson Signature
 Affiliation CEO                                             5-8-09
 Approval Date:
 01-11-06                                                                                 ______________________________________
                                                                                          Chief Executive Officer Signature
 Note: Unless this document has an original signature, this copy is uncontrolled and valid on this date only:
 10/2/20129/1/20095/13/2009. For Controlled copy, view shared directory
 G:\\Isimage01\BACMH_users\bacmh_group\Agency\Agency_Manual.
                                DO NOT WRITE IN THE SHADED AREAS ABOVE                                                             Formatted: Font: 10 pt



                                                  Submission Form

Approving Body/Committee/Supervisor:                       Author:                                Approval/Review Date:




Result:
Deletion            New             No Changes                 Replacement                Revision

List reason for deletion/replacement/revision here. If replacement, list policy to be replaced.

								
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