providing mental health &
substance abuse  services for
the people of Alameda County ...  
   

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QA Manual

   
   
SECTION  
 
1
 QUALITY MANAGEMENT AND IMPROVEMENT PROGRAM*
 1-1ACBHCS ORGANIZATIONAL CHART
 
  *OTHER CONTENT FOR THIS SECTION IS UNDER REVIEW
 
2
 ETHICAL CONDUCT CODE
 2-1ETHICAL CONDUCT POLICY AND PROCEDURE
 2-2MEDICARE CODE OF CONDUCT
 2-3SUPERVISION AND PROFESSIONAL STANDARDS POLICY *FORTHCOMING UNDER REVIEW
 2-4PROFESSIONAL STANDARDS FOR MFT; MD; LCSW; & PHD PROFESSIONS
 
3
 PROFESSIONAL LICENSING WAIVERS and CREDENTIALING/RE-CREDENTIALING
 3-1CREDENTIALING AND RE-CREDENTIALING POLICY AND PROCEDURE
 3-2RESTRICTION OF PRIVILEGES FOR PRACTITIONERS (INITIAL APPLICANT)
 3-3APROFESSIONAL LICENSING WAIVER - 5/2/2023
 3-3BCREDENTIALING & RE-CREDENTIALING VERIFICATION FOR ACBH MENTAL HEALTH & SUBSTANCE USE SERVICE PROVIDERS - REVISED 10/25/2022
 3-4MENTAL HEALTH PROFESSIONAL LICENSURE WAIVER (BHIN 20-069)
 3-5PROFESSIONAL LICENSING WAIVER FORM
 3-6DHCS PROFESSIONAL LICENSING WAIVER RESOURCES
 
4
 PROVIDER PROBLEM RESOLUTION
 4-1PROVIDER PROBLEM RESOLUTION AND APPEALS
 
5
 NETWORK ADEQUACY/TIMELY ACCESS REPORTING
 5-1DMC-ODS AND SMHS TIMELY ACCESS DATA COLLECTION DEFINITIONS - 5/2/2023
  • DMC-ODS: Also see “Substance Use Disorder (SUD) Timely Access Data Collection” section on the QA Training page
  • SMHS: Also see “Network Adequacy- Client Service Information (CSI) Data Documentation” section on the QA Training page
 
6
 UNUSUAL OCCURRENCES/SENTINEL EVENTS and FORMALIZED TREND REVIEW
Note: You must be logged into the ACBH network with your username/password to use E-Forms
 6-1AUNUSUAL OCCURRENCE NOTIFICATION E-FORM - UPDATED 12/28/2023
 6-1BUNUSUAL OCCURRENCE NOTIFICATION FILLABLE PDF FORM - 12/28/2023
 6-2UNUSUAL OCCURRENCE POLICY AND DEATH REPORTING POLICY - REVISED 04/25/2022
 
7
 CLINICAL RECORD DOCUMENTATION STANDARDS
 7-1CalMHSA Documentation Guides
 7-2CLINICAL RECORD DOCUMENTATION STANDARDS for SMHS
 7-3MHP NETWORK PROVIDER DOCUMENTATION STANDARDS
 7-4STANDARD ABBREVIATIONS
 7-5EPSDT CHART DOCUMENTATION MANUAL
 7-6GUIDELINES AND OPERATIONAL STANDARDS FOR CANS/ANSA TOOLS WITHIN THE MENTAL HEALTH SYSTEM OF CARE
 7-7ACBH MEDICATION CONSENT FORM - REVISED 11/2/2023
 7-8ATelehealth Consent Form: English - Word, PDF
 7-8BTelehealth Consent Form: Arabic - Word, PDF
 7-8CTelehealth Consent Form: Chinese Tradition - Word, PDF
 7-8DTelehealth Consent Form: Chinese Simplified - Word, PDF
 7-8ETelehealth Consent Form: Farsi - Word, PDF
 7-8FTelehealth Consent Form: Korean - Word, PDF
 7-8GTelehealth Consent Form: Spanish - Word, PDF
 7-8HTelehealth Consent Form: Tagalog - Word, PDF
 7-8ITelehealth Consent Form: Vietnamese - Word, PDF
 7-9SUICIDE HOMICIDE RISK ASSESSMENT
 7-10DHCS STANDARD SCREENING AND TRANSITION OF CARE TOOLS
 7-11MEDICATION AND PHARMACY USER GUIDE - NEW 1/23/2024
 7-12ACBH PRACTICE GUIDELINES - NEW 1/23/2024
 7-13ASSESSMENT REQUIREMENTS FOR ACBH DMC-ODS PROVIDERS - NEW 2/28/2024
 
8
 QUALITY ASSURANCE: AUDITS and CQRT REVIEWS
 8-1AUDIT OF MEDICAL CHARTS OF PROVIDERS OF SMHS AND NON-SMHS
 8-2CQRT PROCEDURES-SMHS and DMC-ODS - UPDATED 10/17/2023
 8-2ASMHS CQRT CHECKLIST: PDF | Word - UPDATED 11/16/2023
 8-2BCQRT CHECKLIST GLOSSARY - UPDATED 11/16/2023
 8-2CDMC-ODS CQRT OP AND RESIDENTIAL - UPDATED 11/27/2023
 8-2DCQRT COMMENTS SHEET
 8-2ECQRT TRACKING TOOL
 8-2FCQRT ELECTRONIC HEALTH RECORD ATTESTATION FORM - UPDATED 12/1/2022
 
9
 ULTIZATION MANAGEMENT PROGRAM
 9-1UTILIZATION MANAGEMENT REVIEW POLICY LEVEL I ADULT SERVICES - Forthcoming
 9-2DRUG MEDI-CAL UTILIZATION REVIEW REQUIREMENTS
 9-3UTILIZATION MANAGEMENT PROGRAM
 9-4SB785 POLICY
 
10
 BENEFICIARY RIGHTS INFORMING MATERIALS
 10-1NOTIFICATION OF BENEFICIARY RIGHTS
 10-2ABENEFICIARY HANDBOOK - English
 10-2BBENEFICIARY HANDBOOK - Spanish
 10-2CBENEFICIARY HANDBOOK - Arabic
 10-2DBENEFICIARY HANDBOOK - Chinese (Traditional)
 10-2EBENEFICIARY HANDBOOK - Chinese (Simplified)
 10-2FBENEFICIARY HANDBOOK - Farsi
 10-2GBENEFICIARY HANDBOOK - Vietnamese
 10-2HBENEFICIARY HANDBOOK - Korean
 10-2IBENEFICIARY HANDBOOK - Tagalog
 10-3HOW TO USE INFORMING MATERIALS PACKET
 10-3AINFORMING MATERIALS PACKET - English
 10-3BINFORMING MATERIALS PACKET - Chinese Traditional
 10-3CINFORMING MATERIALS PACKET - Farsi
 10-3DINFORMING MATERIALS PACKET - Spanish
 10-3EINFORMING MATERIALS PACKET - Vietnamese
 10-3FINFORMING MATERIALS PACKET - Chinese Simplified
 10-3GINFORMING MATERIALS PACKET - Korean
 10-3HINFORMING MATERIALS PACKET - Tagalog
 10-3IINFORMING MATERIALS PACKET - Arabic
 10-3JINFORMING MATERIALS PACKET- ANNUAL SIGNATURE PAGE IN ALL LANGUAGES
 10-4CONSUMER GRIEVANCE AND APPEAL PROCESS FOR MEDI-CAL SMHS AND MHSA PROGRAMS
 10-4ACONSUMER AND FAMILY GRIEVANCE FORMS - English - REVISED 12/15/2022
 10-4BCONSUMER AND FAMILY GRIEVANCE FORMS - Farsi
 10-4CCONSUMER AND FAMILY GRIEVANCE FORMS - Spanish
 10-4DCONSUMER AND FAMILY GRIEVANCE FORMS - Chinese Simplified
 10-4ECONSUMER AND FAMILY GRIEVANCE FORMS - Chinese Traditional
 10-4FCONSUMER AND FAMILY GRIEVANCE FORMS - Vietnamese
 10-4GCONSUMER AND FAMILY GRIEVANCE FORMS - Tagalog
 10-4HCONSUMER AND FAMILY GRIEVANCE FORMS - Korean
 10-5CONSUMER AND FAMILY GRIEVANCE POSTER (MULTILANGUAGES)
 10-6ADVANCE DIRECTIVE POLICY
 10-8INFORMING MATERIALS LIST - REVISED 5/31/23
 10-9RESPONSE TO SUBPOENA FOR THE PRODUCTION OF PSYCHIATRIC AND/OR SUBSTANCE ABUSE RECORDS
 10-10CONSUMER RIGHTS GRIEVANCE: FAIR HEARING FOR SUD SERVICES
 10-11PROCEDURE FOR TEST CALLS TO ACCESS PROGRAM
 10-12NOTICE OF ADVERSE BENEFIT DETERMINATION (NOABD) POLICY - New 6/27/19
 
11
 CONFIDENTIALITY POLICIES
 11-1POSITION STATEMENT ON COMMUNICATION OF CLIENT INFORMATION
 11-2MANAGEMENT OF PROTECTED HEALTH INFORMATION
 11-3POLICY ON CLINICAL DATA SECURITY
 11-4PRIVACY, SECURITY AND CONFIDENTIALITY STATEMENT OF CLIENT SERVICES, RECORDS AND INFORMATION
 11-4aE-FORM FOR ACBH EMPLOYEES
 11-4bE-FORM FOR ACBH CONTRACTORS
 11-5HIPAA BREACH REPORTING POLICY
 11-5ASMARTSHEET PRIVACY INCIDENT REPORT FORM - REVISED 5/2023
 11-6RECORD AND DATA RETENTION AND DESTRUCTION OF PROTECTED HEALTH INFORMATION
 11-7SECURE COMMUNICATIONS POLICY - NEW 1/2/14
 11-8RELEASE OF INFORMATION (ROI) TRACKER LOG FORM
 
12
 CONSUMER SATISFACTION SURVEY
 12-1CONSUMER SATISFACTION SURVEY
 
13
 SERVICE AND BILLING RESOURCES
 13-1SERVICE DESCRIPTIONS MH AND SUD - MH, SUD - REVISED 8/15/2023
 13-2ACBH GUIDELINES FOR SCOPE OF PRACTICE CREDENTIALING (MH)
 13-3ACBH GUIDELINES FOR SCOPE OF PRACTICE CREDENTIALING (SUD)
 13-4MH LOCKOUT GRID - REVISED 7/6/2023
 13-5SMARTCARE DIAGNOSIS DOCUMENT INSTRUCTIONS - NEW 11/16/23
 13-6ACBH SMHS OP ICD-10-CM DIAGNOSES FOR CLAIMING - NEW 11/16/23
 13-7ACBH SUD OP ICD-10-CM DIAGNOSES FOR CLAIMING - NEW 11/16/23
 13-8BHIN 20-043 ENCLOSURE 1 - SMHS INPATIENT INCLUDED DIAGNOSIS - NEW 11/16/23
 13-9BHIN 20-074E ENCLOSURE 1 - SUD RESIDENTIAL AND INPATIENT INCLUDED DIAGNOSIS - NEW 11/16/23
 13-10MH SMARTCARE PROCEDURE CODE TABLE EFF. 7-1-2023 - UPDATED 10/4/23
 13-11SUD SMARTCARE PROCEDURE CODES TABLE EFF. 7-1-2023 - UPDATED 8/2/23
 
14
 CALIFORNIA REPORTING LAWS
 14-1POLICY ON REPORTING DEMENTING CONDITIONS
 14-2CHILDREN’S AND ADULT OUTPATIENT CLINIC POLICY REGARDING COURT ORDERED REFERRALS
 14-3ELDER/DEPENDANT ADULT ABUSE REPORTING POLICY - REVISED MAY, 2013
 14-4CHILD ABUSE REPORTING POLICY
 14-5WARNING AND REPORTING REQUIREMENTS IN TARASOFF-LIKE SITUATIONS
 
15
 PROGRAM INTEGRITY
 15-1SERVICE VERIFICATION POLICY - NEW 11/2015
 15-2 OIG and OTHER EXCLUSION LIST MONTIORING OVERSIGHT, AND REPORTING - REVISED 8/2021
 15-3 WHISTLEBLOWER PROGRAM FOR FRAUD, WASTE, AND ABUSE
 15-4 WHISTLEBLOWER REPORTING FORM
 15-5 WHISTLEBLOWER POSTER
 15-6 ACBH COMPLIANCE AND PROGRAM INTEGRITY PLAN
 15-7 CONTRACT COMPLIANCE AND SANCTIONS FOR BHCS-CONTRACTED PROVIDERS
 
16
 MEDI-CAL SITE CERTIFICATION
 16-1MEDI-CAL SITE CERTIFICATION FOR PROVIDERS OF MENTAL HEALTH SERVICES POLICY - REVISED 8/15/22
 16-2MEDI-CAL SITE CERTIFICATION PROTOCOL - REVISED 7/28/23
 16-3MEDI-CAL SITE CERTIFICATION PROTOCOL: DAY TREATMENT - REVISED 7/28/23
 16-4MEDI-CAL SITE CERTIFICATION PROTOCOL: CRISIS STABILIZATION UNIT (CSU) - REVISED 7/28/23
 16-5PROVIDER CHECKLIST for MEDI-CAL CERTIFICATION OF PUBLIC SCHOOL SITES - REVISED 1/23/23
 16-6PROVIDER CHECKLIST for MEDI-CAL CERTIFICATION OF COMMUNITY BASED ORGANIZATIONS - REVISED 1/17/23
 16-7FIRE CLEARANCE REQUIREMENTS - REVISED 5/5/22
 
17
 MISCELLANEOUS POLICIES AND PRACTICES
 17-1TOBACCO POLICIES
 17-2EARLY & PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) NOTIFICATION POLICY
 17-3OBTAINING AUTH FOR PRESCRIBING PSYCH MED TO YOUTH - JV PROTECTION
  JV Forms Link
 17-4CLINICAL PSYCHIATRIC PHARMACIST SCOPE OF PRACTICE FOR MEDICATION THERAPY MANAGEMENT
 17-5GUIDELINES FOR PSYCHOTROPIC MEDICATION PRACTICES
 17-6TIMELY ACCESS TO SERVICE STANDARDS AND TRACKING REQUIREMENTS
 
18
 24/7 LANGUAGE ASSISTANCE
 18-124/7 LANGUAGE ASSISTANCE TO BENEFICIARIES (1/27/20)
 18-2LANGUAGE LINE POSTER
 
19
 FREQUENTLY ASKED QUESTIONS (FAQ)
 19-1SMHS FREQUENTLY ASKED QUESTIONS - POSTED 4/11/22
 19-2CAL-AIM FREQUENTLY ASKED QUESTIONS - REVISED 12/30/22
  19-3DEPARTMENT OF HEALTH CARE SERVICES (DHCS) CALAIM BEHAVIORAL HEALTH INITIATIVE FAQ - Updated regularly by DHCS
  19-4COVID FAQ - POSTED 6/1/2022
  19-5CALAIM PAYMENT REFORM FAQ - POSTED 2/6/2023
 19-6CPT CODES FREQUENTLY ASKED QUESTIONS (FAQ) - REVISED 9/6/23


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