Cenpatico Integrated Care Provider Manual Summary of Changes for May 1, 2018 Edition
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1 Cenpatico Integrated Care Provider Manual Summary of Changes for May 1, 2018 Edition o Acronyms will be spelled out throughout the Provider Manual TABLE OF CONTENTS Updated. SECTION 1 INTRODUCTION TO CENPATICO INTEGRATED CARE SECTION 2 COVERED SERVICES AND RELATED PROGRAM REQUIREMENTS 2.3 Maternity Services for Title XIX/XXI Adults with SMI (content changes) Maternity Care Provider Standards (content changes) General Obstetrical Standards of Care (content changes) High Risk Maternity and Perinatal Care Management (content changes) Outreach, Education and Community Resources for Pregnant Members (content changes) 2.4 Family Planning for Title XIX/XXI Adults with SMI (content changes) Sterilization (content changes) Medically Necessary Pregnancy Termination for Title XIX/XXI Adults with SMI (content additions and changes) Prior Authorization Requirements for Sterilization and Pregnancy Termination (content additions and changes) Annual Preventative Care (new section) Primary Care Provider (PCP) Requirements (phone number change) 2.6 Dental Services for Title XIX/XXI Adults with SMI (content changes) Emergency Dental Coverage for Title XIX/XXI Adults with SMI 21 Years and Over (content changes) SECTION 3 BEHAVIORAL HEALTH NETWORK PROVIDER SERVICE DELIVERY REQUIREMENT Wait times (content changes) 1 P a g e
2 3.12 Arizona State Hospital (content changes) Admissions (content changes) 3.13 Out-of-State Placements for Children and Young Adults (content changes 3.15 Cultural Competence (content changes) Culturally and Linguistically Appropriate Services (CLIA) Standards (content changes) Culturally Competent Care (content changes) Workforce Development and Training (content changes) Documenting Clinical Cultural and Linguistic Need (content changes) Communication and Language Assistance (content changes) Cultural Competency Reporting and Account Ability Measures (content changes) Laws and Policies Addressing Discrimination and Diversity (content changes) Business Continuity/Recovery Plans (content changes and additions) Business Continuity and Emergency Response Plan Provisions (content changes) Individualized Service Plan (content changes) Monthly Treatment Updates (content changes) Coordination with Agencies (content changes) Community-Based Alternatives (content changes) SECTION 4 BEHAVORAL HEALTH PROVIDER COORDINATION OF CARE REQUIREMENTS Transition of Persons Being Discharged from Inpatient Settings (content changes) At Risk Member Transitions (content changes) Referral to Another T/RBHA/Health Plan for Service Provisions (content changes) Department of Child Safety (DCS) (web link update) 2 P a g e
3 SECTION 5 PHYSICAL HEALTH PROVIDER REQUIREMENTS No changes this month SECTION 6 SPECIFIC BEHAVIORAL HEALTH PROGRAM REQUIREMENTS Computer and Wireless Specifications (content changes) 6.7 Birth to Five Provider Program Requirements (content changes) Staff Requirements (content change) Crisis Counseling, Triage, Tracking, Mobile Team Dispatch and Resolution (content changes) Coordination of Care (content change) Peer Outreach and Coordination (content changes) Crisis Mobile Team Provider (content changes) Coordination Calls and Coordination with Outpatient Department (content changes) Telephone and Internet Connectivity (content changes) Billing (content added) Services (content changes) Staffing Requirements (content changes) Authorization and Continued Stay Requirements (content added) 6.14 Program Requirements for Providers of Services to Adolescents Who Act Out Sexually (content change) 6.15 Program Requirements for Providers of Services to Adults Who Act Out Sexually (content change) Pinal County Horizon Health and Wellness Capacity (new content) SECTION 7 CREDENTIALING AND RE-CREDENTIALING REQUIREMENTS 7.2 To Whom This Applies (content changes) 7.4 Initial Credentialing Process and Requirements (content changes) 3 P a g e
4 7.5 Additional Credentialing Requirements for Organizational Providers (content changes) 7.6 Temporary/Provisional Credentialing Process and Requirements (content change) 7.8 Credentialing Approval/Denial Process (content changed) SECTION 8 FINANCE/BILLING 8.5 Claim or Encounter Submission Requirements (content changed and added) 8.6 Claim Submission Time Frames (content changed) Requirement (title and content change) SECTION 9 QUALITY MANAGEMENT REQUIREMENTS 9.1 Advance Directives (content added) Information Regarding Advance Directives (content added) Assistance with Developing and Executing an Advance Directive (content added) Other Requirements Regarding Advance Directives (content change) Advance Care Planning and End of Life Care Concept (new section) 9.2 Medical Records Standards (content change) Comprehensive Clinical Record (content change) Physical Health Information for the Integrated Provider (content added) Behavioral Health Record (content added and changed) 9.3 Member Surveys (content added) 9.6 Peer Review (content change, sections removed) Quality Management Plan (removed) SECTION 10 MEDICAL MANAGEMENT/UTILIZATION MANAGEMENT REQUIREMENTS 10.2 Securing Services that do not Require Prior Authorization (content change) Screening Services with a Non-Contracted Outpatient Provider (content changed/added) 10.3 Purpose of Utilization Review Process (content changed) Prior Authorizing Medications (content changed) 10.4 Technology (content changed) 10.5 Retrospective Review (content added) 10.8 Integrated Care Management and Care Coordinator Services (name change) Definition (content change) 4 P a g e
5 Role and Function of Integrated Care Management and Care Coordination (content change) Provider Responsibilities Related to Integrated Care Management and Care Coordination (content changed) Integrated Care Management (content changed) Disenrollment from Integrated Care Management (content change) Coordination of Care (content change) Integrated Care Management/Care Coordinator Team Responsibilities (content change) Care Planning (content change) Interdisciplinary Care Plan Rounds (content change) Sections , , have been deleted 10.9 Disease Management (content change) Out-of-Home Service Requirements (content changed) Cenpatico Integrated Care s Drug List (content change) Prior Authorization (content changed) SECTION 11 TRAINING AND PEER SUPPORT SUPERVISION REQUIREMENTS 11.2 Peer Support/Recovery Support Training, Certification and Supervisions Requirements (whole section changes) Parent/Family Support Provider Training Curriculum Standards (content changes) SECTION 12 COMPLIANCE 12.5 Duty to Warn (a section removed) Disclosures of Alcohol and Drug Information (content changed) Disclosure to Health, Mental Health and Social Service Providers for Treatment, Payment or Health Care Operations; Reports of Abuse and Neglect (content changes) Disclosures of Alcohol and Drug Information (content changes) Security Breach Notification (change in phone number, address, address) SECTION 13 DATA SYSTEMS/REPORTING REQUIREMENT 13.1 Enrollment, Disenrollment and Other Data Submissions (content change). SECTION 14 CENPATICO INTEGRATED CARE MEMBER HANDBOOK 5 P a g e
6 SECTION 15 GRIEVANCE AND APPEAL SYSTEM SECTION 16 DELIVERABLES Updated Deliverable Requirements: All references to Assurance Health and Wellness have been replaced with the new name of Community Partners Integrated Health EC-308 Business Continuity/Recovery Plan Checklist (Providers required to submit and due date changed) EC-309 Business Continuity/Recovery Plan Summary (Providers required to submit and due date changed) EC-310 Annual Heat Plan Update (providers required to submit changed) New Deliverables: None. Terminated Deliverables: ED-307 Disaster Recovery Certification EC-311 PCP Transition Log SECTION 17 REFERENCES No changes this month SECTION 18 PROVIDER MANUAL FORMS & ATTACHMENTS 18.1 Forms Provider Manual Form Notification of Member in Need of Special Assistance (Revised April 2018) Provider Manual Form Out-of-State Placement, Initial Notice and 30 day Update (name change) 6 P a g e
7 18.2 Attachments Provider Manual Attachment Special Assistance Guidance Document (Revised ) Provider Manual Attachment Minimum Lab Monitoring Psychotropic Medications (Revised ) Provider Manual Attachment Rapid Response Guidance Manual (Revised ) Provider Manual Attachment Cytochrome P450 Mediated Drug Interactions (retired) Provider Manual Attachment Belsomra (retired) Provider Manual Attachment ADHD Medications in Children Under 6 Years Old (Revised ) Provider Manual Attachment Antipsychotic Medications in Children Under 6 Years Old (Revised ) Provider Manual Attachment Seroquel XR (Revised ) Provider Manual Attachment Paliperidone (Invega) (Revised ) Provider Manual Attachment Vortioxetine (Trintellix) (Revised ) Provider Manual Attachment Non-Benzodiazepine Insomnia (Revision Date 4/1/2018) (New) Provider Manual Attachment Crisis Medication List (Revised ) SECTION 19 DEFINTIONS & ACRONYMS 7 P a g e
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