HealthChoices - Program Standards and Requirements

HealthChoices BH Program - Program Standards and Requirements

HealthChoices Behavioral Health Program Standards and Requirements - North/Central State Option


Appendix A - Contractor Integrity Provisions

Appendix B - Standard Contract Terms and Conditions

Appendix C - Contractor Responsibility To Employ Welfare Clients

Appendix D - Lobbying Certification and Disclosure

Appendix E - Pay for Performance

Appendix F - Fraud and Abuse Program Requirements

Appendix F Attachment 1 - MCO Fraud and Abuse Reporting Reqrmnts

Appendix F Attachment 2 - MCO Reporting Form

Appendix F Attachment 3 - Quarterly Program Integrity Report

Appendix F Attachment 4 - DPWs Toll-Free Fraud and Abuse Hotline

Appendix G - HealthChoices Enrollment Program

Appendix H - Complaint, Grievance, and Fair Hearing Processes

Appendix I - Indicators of the Application of CASSP Principles

Appendix I Attachment 1 - CASSP Indicators for County MH Programs

Appendix I Attachment 2 - CSP Indicators for County MH Programs

Appendix J - Principles of Effective Drug and Alcohol Treatment

Appendix K.1 - Performance/Outcome Management System for BH-MCOs

Appendix K.2 - Performance/Outcome Management System for BH MCOs

Appendix K.3 - Performance/Outcome Management System for BH-MCOs

Appendix L - Guidelines for Consumer/Family Satisfaction Teams

Appendix M - HealthChoices Data Reporting Req. - Non Financial

Appendix N - HealthChoices Requirements for County Reinvestment

Appendix N Attachment 1 - Reinvestment Plan Approval Chart

Appendix N Attachment 2 - Sample Letter

Appendix N Attachment 3 - HealthChoices Reinvestment Plan Priority

Appendix N Attachment 4a - Instructions for Reinvestment Bdgt Form

Appendix N Attachment 4b1 - Reinvestment for HealthChoices Recpnts

Appendix N Attachment 4b2 - Reinvestment Form for MA Recipients

Appendix N Attachment 4b3 - Reinvestment Form for Non-MA Recpnts

Appendix N Attachment 4b4 - Reinvestment Form - Total

Appendix N Attachment 5 - Review and Approval Guidelines

Appendix N Attachment 6a - Reinvestment Report

Appendix N Attachment 6b - Reinvestment Report Form

Appendix N Attachment 7 - County Annual Report on HealthChoices

Appendix O - HealthChoices Data Support Provided by the Dept.

Appendix P - Financial Reporting Requirements

Appendix Q - Priority Populations

Appendix R - Reserved

Appendix S.1 - Prescribing Practitioner Data Clarifications

Appendix S.2 - Managed Care Prescribing Practitioner File Layout

Appendix S.3 - Prescribing Practitioner Desk Reference Table

Appendix S.4 - Prescribing Practitioners

Appendix T Part A1 - Adult MH Medical Necessity Criteria

Appendix T Part A2 - Adult MH Service Necessity Criteria

Appendix T Part B1 - Child MH Medical Necessity Criteria

Appendix T Part B2 - Child BH Medical Necessity Criteria - EPSDT

Appendix T Part B3 - Child BH Medical Necessity Criteria - MHSP

Appendix T Part B4 - Child MH Service Necessity Criteria

Appendix T Part C - Adult Client Placement Criteria

Appendix T Part D - Adolescent Placement Criteria

Appendix U - Reserved

Appendix V - HealthChoices Behavioral Health Recipient Coverage

Appendix V Attachment 1 - Children in Substitute Care Refrnce Chrt

Appendix V Attachment 2 - Children Not in Substitute Care Ref Chrt

Appendix V Attachment 3 - Adult Drug/Alcohol Placement Ref Chart

Appendix V Attachment 4 - TFAC Facility Matrix Table Definitions

Appendix W - Behavioral Health Audit Guide

Appendix X - Category/Program Status Coverage Chart

Appendix X Attachment - Managed Care Payment System Table

Appendix X Attachment 1

Appendix Y - Reporting Classification Chart

Appendix AA - Prior Authorization Requirements

Appendix BB - Regulations and Policies Not Applicable

Appendix CC - Indicators of the App of Cultural Comp. Principles

Appendix DD - Master Library Contents

Appendix DD.1 - Library/Internet Desk Reference Chart