customer services standards training template.pppt 181458 7

8/6/2019 Customer Services Standards Training Template.pppt 181458 7

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Standard #4Telephone calls to the customer servicesTelephone calls to the customer servicesunit shall be answered by a live voiceunit shall be answered by a live voiceduring business hours. Telephone menusduring business hours. Telephone menusare not acceptable. A variety of alternativesare not acceptable. A variety of alternativesmay be employed to triage high volumes of may be employed to triage high volumes of

calls.calls.



Standard #5The hours of customer service unitThe hours of customer service unitoperations and the process for accessingoperations and the process for accessinginformation from customer services outsideinformation from customer services outsidethose hours shall be publicized.those hours shall be publicized.



Standard #6The customer handbook shall contain theThe customer handbook shall contain thestatestate--required topicsrequired topics



Standard #7The Medicaid coverage name and theThe Medicaid coverage name and thestate¶s description of each service shall bestate¶s description of each service shall be

printed in the customer handbook. printed in the customer handbook.



Standard #9Affiliate CMHSP, substance abuseAffiliate CMHSP, substance abusecoordinating agency, or network provider coordinating agency, or network provider names, addresses, phone numbers, TTYs, Enames, addresses, phone numbers, TTYs, E- -mails, and web addresses shall be containedmails, and web addresses shall be containedin the customer handbook.in the customer handbook.



Standard #10Information about how to contact theInformation about how to contact theMedicaid Health Plans or Medicaid feeMedicaid Health Plans or Medicaid fee- -for for--service programs in the PIHP service areaservice programs in the PIHP service areashall be provided in the handbook (actualshall be provided in the handbook (actual

phone numbers and addresses may be phone numbers and addresses may be

omitted and held at the customers servicesomitted and held at the customers servicesoffice due to frequent turnover of plans andoffice due to frequent turnover of plans and providers) providers)



Standard #11Customer services unit shall maintain currentCustomer services unit shall maintain currentlistings of all providers, both organizations andlistings of all providers, both organizations and

practitioners, with whom the PIHP has contracts, practitioners, with whom the PIHP has contracts,the service they provide, languages they speak,the service they provide, languages they speak,and any specialty for which they are known. Thisand any specialty for which they are known. Thislist must include independent personlist must include independent person- -centeredcentered

planning facilitators. B eneficiaries shall be given planning facilitators. B eneficiaries shall be giventhis list initially and be informed annually of itsthis list initially and be informed annually of itsavailability.availability.



Standard #12Customer services unit shall have access toCustomer services unit shall have access toinformation about the PIHP includinginformation about the PIHP includingCMHSP affiliate annual report, currentCMHSP affiliate annual report, currentorganizational chart, CMHSP boardorganizational chart, CMHSP boardmember list, meeting schedule and minutesmember list, meeting schedule and minutes

that are available to be provided in a timelythat are available to be provided in a timelymanner to an individual upon request.manner to an individual upon request.



Standard #13Upon request, the customer services unitUpon request, the customer services unitshall assist beneficiaries with the grievanceshall assist beneficiaries with the grievanceand appeals, and local dispute resolutionand appeals, and local dispute resolution

processes, and coordinate as appropriate processes, and coordinate as appropriatewith Fair Hearing Officers and the localwith Fair Hearing Officers and the local

Office of Recipient Rights.Office of Recipient Rights.



Standard #14Customer services staff shall be trained toCustomer services staff shall be trained towelcome people to the public mental healthwelcome people to the public mental healthsystem and to possess current workingsystem and to possess current workingknowledge in, and know where in theknowledge in, and know where in theorganization detailed information can beorganization detailed information can be

obtained on at least the following«obtained on at least the following«



Standard #14.a.Information regarding the populationsInformation regarding the populationsserved (serious mental illness, seriousserved (serious mental illness, seriousemotional disturbance, developmentalemotional disturbance, developmentaldisability and substance use disorder) anddisability and substance use disorder) andeligibility criteria for various benefits planseligibility criteria for various benefits plans

(e.g., Medicaid, AdultB

enefitW

aiver,(e.g., Medicaid, AdultB

enefitW

aiver,MIChild)MIChild)



Standard #14.b.Service array (including substance abuseService array (including substance abusetreatment services), medical necessitytreatment services), medical necessitycriteria, and eligibility for and referral tocriteria, and eligibility for and referral tospecialty servicesspecialty services



Standard #14.c.PersonPerson--centered planningcentered planning



Standard #14.d.Self Self--determinationdetermination



Standard #14.e.RecoveryRecovery



Standard #14.f.Peer SpecialistsPeer Specialists



Standard #14.g.Grievance and appeals, Fair Hearings, localGrievance and appeals, Fair Hearings, localdispute resolution processes, and Recipientdispute resolution processes, and RecipientRightsRights



Standard #14.h.Limited English Proficiency (LEP) andLimited English Proficiency (LEP) andcultural competencycultural competency



Standard #14.i.Information about Medicaid coveredInformation about Medicaid coveredservices and referral within PIHPs as wellservices and referral within PIHPs as wellas outside to Medicaid Health Plans, Feeas outside to Medicaid Health Plans, Fee- -for for--Service practitioners, and Department of Service practitioners, and Department of Human ServicesHuman Services



Standard #14.j: The PublicMental Health System

Structure

Funding

Services

Protections



General Service Structure

MDCH

Medicaid PrepaidInpatient Heath Plans(18 PIHPs)

Community MentalHealth Services

Programs (46CMHSPs)

ServicesEach local CMHSP provides an array of Mental Health services through a network of providers to adults with SPMI, children with SED, persons with DD and personswith substance use disorders.



FundingState taxes Federal Medicaid

State Appropriations

MDCH Federal BlockGrant funding

Services

County Mental Healthappropriation

CMHSP - GF contractCMHSP - PIHP Affiliate agreement

PIHP Medicaidcontract



The Mental Health and Substance Abuse Treatment Delivery System in Michigan

T he PrivateMental Health and Substance

Abuse T reatment SystemT he Public Mental Health and Substance Abuse T reatment System

PersonalFinancial

Resources

PrivateInsuranceincludingMedicare

Private mental healthand substance usedisorder providers

include :

Addiction counselors,Marriage counselors,Licensed social workers,Licensed psychologists,Various types of therapists,Physicians,PsychiatristsPrivate mental health clinics,Private psychiatric hospitals

Primarily made up of acombination of State andlocal taxes (GF),

recipient sliding scalefees and co-pays

MedicaidFee for Service(FFS)

MedicaidManaged Care

Established under the state¶sMental Health Code, the forty-six (46) Community MentalHealth Services serving thestate¶s eighty-three (83)

counties provide a full array of of mental health services toperson with serious mentalhealth, serious emotionaldisturbances, anddevelopmental disabilitiesbased upon their priority of need.

T hose applicants who are themost involved and findthemselves most urgently inneed of services are a priorityfor services. T hose with lower

levels of needs may be either placed on an agency¶s waitinglist or referred to privateproviders in the community for service.

Other Services include theChildren's Waiver for childrenwith emotional disturbances,the MI Child (limited benefit)program, and the Adult BenefitWaiver (limited benefit)program

T his is a ten (10)session annualbenefit provided byany psychiatristaccepting new

Medicaid FFSpatients.

T here is also anexpanded benefitfrom PIHPs and their affiliate CMHSPswhen the personrequires a ³specialtylevel´ of careintervention

Medicaid Health Plans(16 in the state?)

Provides Medicaidbeneficiaries with up toT

wenty (20) outpatientsessions per year under the basic mental healthbenefit for persons withmild to moderate mentalhealth needs. (nosubstance use disorder treatment)

Health Plan providersare to refer beneficiaries to thePIHP or CMHSPaffiliate if beneficiary¶slevel of care cannot beadequately addressedwith outpatient services

Specialty Mental Health andSubstance Abuse Managed

Care Services made up of PIHPs (18),

CMHSP affiliates (46)

andSubstance Abuse Coordinating Agencies (16 in the state)

T he PIHP and its affiliateproviders are responsible for providing those Medicaidbeneficiaries with moderate tosevere needs with all B and B3Specialty Services that aremedically necessary. T he arrayof potential services isextensive and by design, veryflexible.

T here are also three limitedenrollment waivers:1. T he (DD) Children¶s waiver

which helps children remainin their natural home whootherwise would be admittedto an ICF/MR,

2. T he (Adult) HabilitationWaiver (HAB) for personswith developmentaldisabilities who otherwisewould be admitted to an ICF/MR, and

3. T he SED waiver for childrenwith severe emotionaldisturbances.

Substance UseDisorder

T reatment

Combination of personal,

resources, privateinsurance andFederal BlockGrant funding

Substance AbuseCoordinating

Agencies (16)arrange for

treatment througha network of licensed locally

based treatmentproviders



Mental Health Code Services

W ithin the available state funding « priority for services shall be given to individuals with the most severeforms of serious mental illness , serious emotional disturbances anddevelopmental disability, with priority to be given to those in urgent or emergency situations«

Persons who do not meet this threshold of severity may be put on waitinglists (or referred elsewhere) for services.

The public generally does not understand these financial and legallimitations to service.



Medicaid Mental HealthServices

Medicaid beneficiaries presenting with aspecialty level of care are entitled toreceive all ³medically necessary coveredservices and supports from the CMHSP totreat, ameliorate, diminish or stabilize their mental health, developmental disabilityand substance abuse conditions.



Recipient Protections

The person centered planning process

The individualized plan of serviceDedicated local Customer Service/problem

resolution staff Local recipient rights protection systemLocal dispute resolution processLocal Grievance and Appeal Process

And the Lansing-based Medicaid fair hearing process



Standard #14.k.B alanced B udget Act relative to customer B alanced B udget Act relative to customer services functions and beneficiary rightsservices functions and beneficiary rightsand protectionsand protections



Standard #14.l.Community Resources (e.g., advocacyCommunity Resources (e.g., advocacyorganizations, housing options, schools,organizations, housing options, schools,

public health agencies) public health agencies)



Standard #14.m.Public Health Code (for substance abusePublic Health Code (for substance abusetreatment recipients if not delegated to thetreatment recipients if not delegated to thesubstance abuse coordinating agency)substance abuse coordinating agency)



Customer Services Handbook Each PIHP must provide a beneficiary an upEach PIHP must provide a beneficiary an up- -toto--date handbook when they first come for servicesdate handbook when they first come for servicesand periodically thereafter and periodically thereafter There are BB AThere are BB A--required topics that must be in therequired topics that must be in thehandbook handbook There is MDCHThere is MDCH- -required language for somerequired language for sometopics to ensure consistency across the statetopics to ensure consistency across the statePIHPs may tailor information to reflect their localPIHPs may tailor information to reflect their localoperations and may add information to eachoperations and may add information to eachtemplatetemplate



Customer Services Handbook, IIPIHPs that have quantity of handbooks onPIHPs that have quantity of handbooks onhand may give these out as long as theyhand may give these out as long as they

contain or are supplemented with thecontain or are supplemented with therequired informationrequired informationDrafts of new handbooks must be availableDrafts of new handbooks must be availablefor review in the Spring 2007for review in the Spring 2007

New handbooks must be distributed New handbooks must be distributed beginning October 1, 2007 beginning October 1, 2007



Customer Services Handbook, III

There are 12 topics that require the use of There are 12 topics that require the use of template language.template language.

They are not required to appear in this order They are not required to appear in this order



Template #1

Confidentiality and family access toConfidentiality and family access toinformationinformation



Template #2

Coordination of careCoordination of care



Template #3

Emergency and after Emergency and after- -hours access tohours access toservicesservices



Template #4

GlossaryGlossary



Template #5

Grievance and appealsGrievance and appeals



Template #6

Language accessibility and accommodationLanguage accessibility and accommodation



Template #7

Payment for ServicesPayment for Services



Template #8

PersonPerson--centered planningcentered planning



Template #9

Recipient rightsRecipient rights



Template #10

Recovery & ResiliencyRecovery & Resiliency



Template #11

Service array, eligibility, medical necessity,Service array, eligibility, medical necessity,and choice of providers in network and choice of providers in network



Template #12

Service authorizationService authorization



Other Required Handbook Topics

How to access the PIHP or CMHSPHow to access the PIHP or CMHSPHow to obtain access to outHow to obtain access to out- -of of--network network servicesservices



Other Required Handbook

Topics, IIAffiliate [for DetroitAffiliate [for Detroit- -W ayne, the MCPNs]W ayne, the MCPNs]addresses and phone numbersaddresses and phone numbers

Executive director Executive director Medical director Medical director Recipient Rights officer Recipient Rights officer Customer Services address & phoneCustomer Services address & phonenumber, what it can do for customer number, what it can do for customer



Other Required Handbook

Topics, IIICommunity Resource list (includesCommunity Resource list (includesadvocacy organizations)advocacy organizations)

IndexIndexRight to information about PIHP operationsRight to information about PIHP operations(org chart, annual report, etc)(org chart, annual report, etc)

Services not covered under contractServices not covered under contractW elcome to PIHPW elcome to PIHP



Other Suggested Handbook

Topics, IVCustomer services phone number in theCustomer services phone number in thefooter of each pagefooter of each page

Safety informationSafety information



Final Questions and Answers

customer services standards training template.pppt 181458 7

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