GCBH Policies, Plans, Procedures, and Forms

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The Policies & Procedures can be viewed in the following parts.

Name of Document Effective Modified
Administration    
AD100 - GCBH Document Development  [PDF] 01/25/2007 04/05/2007
AD101 - Credentialing of Mental Health Providers  [PDF] 08/02/2005 10/12/2007
AD102.05 - Delegation Policy (Subcontracting)  [PDF] 01/01/1998 01/25/2007
AD103.04 - GCBH Contract Audits  [PDF] 01/01/1998 01/26/2006
AD104.02 - Marketing Education Plan  [PDF] 07/01/1998 08/25/2005
AD105.01 - Addressing Enrollee Needs in the Event of Community Hospital Insolvency  [PDF] 04/28/2005 08/02/2005
AD106 - Employee Orientation  [PDF] 07/27/2006 06/05/2008
AD108 - Customer Service  [PDF] 08/24/2006 06/05/2008
AD109.00 - Provider Network Selection and Retention  [PDF] 08/24/2006 --
AD110 - Nondiscrimination  [PDF] 06/07/2007 --
AD111 - Emergency Response  [PDF] -- 10/12/2007
AD112 - Staff Position Evaluation  [PDF] 11/29/2007 --
AD113 - Benefits  [PDF] 11/29/2007 --
AD114 - Response to Requests for Proposals  [PDF] 02/14/2008 --
Allied System Plans Effective Modified
AS1000 - Tribal Collaboration Plan  [PDF] 11/30/2007 --
AS1001 - Community Integration Assistance Program Coordination Plan  [PDF] 11/30/2007 --
AS1002 - K–12 Education System Coordination Plan  [PDF] 03/01/2007 --
AS1003 - Aging and Disability Services Administration Coordination Plan  [PDF] 03/01/2007 --
AS1004 - Children’s Administration Coordination Plan  [PDF] 03/01/2007 --
AS1005 - Chemical Dependency and Substance Abuse Services Coordination Plan  [PDF] 03/01/2007 --
Clinical Effective Modified
CL301.00 - Level of Care and Authorization Criteria  [PDF] 08/02/2005 --
CL302.04 - Integrated Crisis System Policy  [PDF] 01/01/1998 10/12/2007
CL305 - Mental Health Specialists  [PDF] 01/01/1998 06/05/2008
CL306.01 - Treatment Record  [PDF] 01/01/1999 09/21/2006
CL307.02 - Childrens Psychiatric Consultation Protocol  [PDF] 12/11/2003 10/02/2006
CL308.02 - Childrens Service Delivery Protocol  [PDF] 08/25/2003 09/28/2006
CL309.01 - Older Adult Service Protocol  [PDF] 08/30/2003 01/24/2006
CL310 00 - Local Application Process for Childrens Long-Term Inpatient Treatment  [PDF] 04/25/2004 09/28/2006
CL311 - Advance Directive  [PDF] 06/30/2005 08/02/2007
CL314.01 - Out of RSN Network Referrals  [PDF] 08/02/2005 01/25/2007
CL315 - Second Opinions  [PDF] 08/02/2005 08/02/2007
CL317.01 - Utilization Review Services Policy  [PDF] 08/02/2005 10/12/2007
CL318.00 - Consumer Participation in Service Planning  [PDF] 10/31/2005 10/04/2006
CL319.00 - Best Practices  [PDF] 10/31/2005 10/04/2006
CL321.00 - Medicaid Third Party Liability and Coordination of Benefits  [PDF] 10/31/2005 10/04/2006
CL322.02 - Service Provision Policy  [PDF] 10/31/2005 02/07/2007
CL323.00 - Crisis Services  [PDF] 10/31/2005 10/04/2006
CL324.00 - Evaluation and Treatment  [PDF] 10/31/2005 --
CL325.00 - Rehabilitation Case Management  [PDF] 10/31/2005 --
CL326.00 - Stabilization Services  [PDF] 10/31/2005 --
CL327.00 - Ensuring Care Coordination for High Risk Consumers  [PDF] 11/07/2005 --
CL328.00 - Care Coordination with Primary Care and Emergency Rooms  [PDF] 11/07/2005 --
CL330.00 - Assuring Reliability of Utilization Decision Making  [PDF] 11/07/2005 --
CL331.01 - Early Periodic Screening and Diagnostic Treatment for Children  [PDF] 11/07/2005 09/21/2006
CL332.00 - Ensuring Care Coordination for Complex Care Consumers  [PDF] 11/07/2005 --
CL333.00 - Inpatient and Community Care Coordination  [PDF] 11/07/2005 --
CL334 - Intake Evaluation  [PDF] 11/07/2005 10/12/2007
CL335.00 - Psychiatric Inpatient Service Policy  [PDF] 11/07/2005 09/12/2007
CL336.00 - Special Population Care Coordination  [PDF] 11/07/2005 --
CL338.00 - Clinical Review  [PDF] 09/21/2006 --
CL339.00 - Childrens Care Manager  [PDF] 08/24/2006 --
CL341 - Monitoring of Residential Inpatient Provider System Performance  [PDF] 11/29/2007 --
CL342 - Recovery and Resilency  [PDF] -- 10/12/2007
CL343 - Case Manager Look-Up  [PDF] -- 10/12/2007
CL344 - Involuntary Treatment Service  [PDF] 11/29/2007 --
Compliance Effective Modified
CO201.02 - Fraud and Abuse Compliance Plan  [PDF] 12/11/2003 01/26/2006
CO203.02 - Conflict of Interest  [PDF] 04/01/1999 08/24/2006
CO204 - Professional Code of Conduct  [PDF] 04/01/1999 06/05/2008
CO206.00 - Risk Management  [PDF] 09/21/2006 --
CO207 - Response to Incidents and Media Contacts  [PDF] -- 10/12/2007
Consumer Affairs Effective Modified
CA401 - Consumer Rights  [PDF] 08/02/2005 06/05/2008
CA402 - Fair Hearings  [PDF] 08/02/2005 04/05/2007
CA403 - Consumer Grievances  [PDF] 09/30/2004 06/07/2007
CA405 - Enrollee Service Authorization Notices and Appeals  [PDF] 09/30/2004 02/14/2008
Fiscal Management Effective Modified
FM801 - Fiscal Reporting  [PDF] 09/28/1995 03/13/2008
FM802 - Accounting Records  [PDF] 09/28/1995 04/03/2008
FM803 - Budget  [PDF] 09/28/1995 04/03/2008
FM804.03 - Funding Allocation  [PDF] 12/07/2000 06/25/2007
FM805 - Contracting  [PDF] 09/28/1995 04/03/2008
FM806 - Segregation of Duties  [PDF] 09/28/1995 04/03/2008
FM808 - Travel Reimbursement  [PDF] 09/28/1995 03/13/2008
FM809 - Credit Cards  [PDF] 09/28/1995 03/13/2008
FM812 - Reserve  [PDF] 09/28/1995 04/03/2008
FM814 - Maintenance of Effort  [PDF] 09/28/1995 11/29/2007
FM815 - Accounting Review  [PDF] 09/28/1995 11/29/2007
FM816 - Fiscal Audits  [PDF] 09/28/1995 04/03/2008
FM817 - Expenditures and Revenues  [PDF] 09/28/1995 11/29/2007
FM818.00 - Provision o f Priority State Funded Services  [PDF] 11/07/2005 --
FM819.00 - Delivery of Medicaid Mental Health Rehabilitation Services  [PDF] 11/07/2005 --
FM821.00 - Direct Payment Plan to Community Hospitals for Title XIX Services  [PDF] 11/07/2005 --
FM822 - Professional Services Agreement Initiation  [PDF] 07/27/2006 03/13/2008
FM823 - Honorariums  [PDF] 10/19/2006 03/13/2008
FM824 - Purchases Capitalization Inventory  [PDF] 03/13/2008 --
Management Information System (MIS) Effective Modified
IS702.02 - Network Security Policy  [PDF] 02/24/2001 02/23/2006
IS703 - Establishing or Removing GCBH Data Dictionary Elements  [PDF] 01/27/2000 03/13/2008
IS704 - Information Systems  [PDF] 05/01/1999 03/13/2008
IS705.02 - Business Continuity and Disaster Recovery Plan  [PDF] 04/22/2004 10/19/2006
IS706 - Data Importing Procedure  [PDF] 10/07/2005 03/13/2008
IS707 - Data Integrity Procedures  [PDF] 10/07/2005 03/13/2008
IS708 - Data Integrity and Processing Procedure  [PDF] 10/07/2005 03/13/2008
IS709.01 - Data Exporting  [PDF] 10/07/2005 05/25/2006
IS710.00 - Public Address System  [PDF] 09/21/2006 --
Privacy & Security Effective Modified
PS601.00 - Designated Record Set  [PDF] 08/01/2004 --
PS602.00 - Administrative Requirements for the Adminstration of HIPAA  [PDF] 03/27/2003 --
PS603.00 - Administrative Requirements -Documentation  [PDF] 03/24/2003 --
PS606.00 - Computer and Information Security  [PDF] 03/27/2003 --
PS608.00 - Workstation Use and Portable Computer  [PDF] 08/01/2004 --
PS609.00 - Remote Access  [PDF] 08/01/2004 --
PS610.00 - Password Protection  [PDF] 08/01/2004 --
PS611.00 - Consumer Protected Health Information Rights  [PDF] 03/27/2003 --
PS612.01 - Confidentiality Use and Disclosure of Protected Health Information  [PDF] 03/27/2003 02/23/2007
PS613.00 - E-Mail and Internet Security  [PDF] 03/27/2003 --
PS614.00 - Fax  [PDF] 03/27/2003 --
PS615.00 - HIPAA Complaint  [PDF] 03/27/2003 --
PS616.00 - Information Systems Security Checklist- Onsite Inspection  [PDF] 03/27/2003 --
PS617.00 - Sources of PHI- Inventory and Location  [PDF] 03/27/2003 --
PS618.00 - Privacy Officer Job Responsibilities  [PDF] 03/27/2003 --
PS619.00 - Sanction  [PDF] 03/27/2003 --
PS620.00 - HIPAA Training  [PDF] 08/01/2004 --
PS621.00 - Staff Training Plan for Privacy and Security  [PDF] 03/27/2003 --
PS622.00 - Virus Protection  [PDF] 08/01/2004 --
PS623.00 - HIPAA Administrative Simplification Definitions  [PDF] -- --
PS624.00 - Privacy and Security Plan  [PDF] 03/27/2003 --
PS626.00 - Removal of PHI from Office  [PDF] 01/25/2007 --
Quality Management Effective Modified
QM501 - Quality Management Program Plan  [PDF] 04/27/2000 04/03/2008
QM502 - Network Provider Quality Management Processes  [PDF] 01/01/1998 04/03/2008
QM503.00 - Network Sufficiency and Accessibility  [PDF] 08/02/2005 --
QM504.00 - Ensuring Non-Discrimination for Complex Care Consumers  [PDF] 08/02/2005 --
QM505.01 - Coordination of Mental Health Services with other Systems of Care  [PDF] 04/01/2005 04/28/2005
QM506.00 - Preparedness and Responding to Disasters  [PDF] 11/07/2005 --
QM507.00 - Network Managment Plan  [PDF] 11/07/2005 --
Ombuds/Quality Review Team Effective Modified
QR901.00 - Ombuds Policy  [PDF] 09/01/1998 12/07/2000
QR902.03 - Quality Review Team Policy  [PDF] 06/01/1998 01/25/2006
Forms Effective Modified
Advanced Directive Attestation  [PDF] 11/09/2006 08/02/2007
Application for Services and Consent (adult)  [PDF] -- 04/22/2008
Application for Services and Consent (youth)  [PDF] -- 04/22/2008
Application for Services and Consent - Spanish (adult)  [PDF] -- 04/22/2008
Application for Services and Consent - Spanish (youth)  [PDF] -- 04/22/2008
Business Associate Addendum  [PDF] -- 04/01/2004
CL341 - Provider Performance Review Instrument  [PDF] -- 11/29/2007
Clinical Review Rating Tool (CRRT)  [PDF] 01/02/2007 10/01/2007
Clinician Attestation  [PDF] -- 01/25/2007
CLIP Voluntary Application Form  [PDF] -- 09/01/2006
Computer and Information Security Agreement  [PDF] -- 03/27/2003
Confidentiality & Security Agreement (HIPAA)  [PDF] -- 03/27/2003
Notice of Action   [PDF] 05/01/2006 05/01/2007
Notice of Determination  [PDF] -- 05/01/2007
Privacy Notice Spanish  [PDF] -- 11/06/2007
Privacy Notice  [PDF] -- 11/06/2007