Table of Contents
- Provider Network Management
- Service and Supports
- Corporate Compliance
- Quality Management and Contract Services
- Customer Service
- Recipient Rights
- Performance Improvement
- Information Technology
What is KCMHSAS?
Kalamazoo Community Mental Health and Substance Abuse Services (KCMHSAS) has been delivering quality services and programs to improve the lives of those we serve for over 30 years. We provide a welcoming and diverse community partnership which collaborates and shares effective resources that support individuals and families to be successful through all phases of life. KCMHSAS works with youth, families, and adults with mental illnesses, intellectual/developmental disabilities, and substance use disorders to help them succeed.
Mission, Vision, & Values:
We promote and provide mental health, intellectual/developmental disability, and substance use resources that empower people to succeed.
We provide a welcoming and diverse community partnership which collaborates and shares effective resources that support individuals and families to be successful through all phases of life.
Respect, trust, responsibility, integrity, competence, effectiveness, teamwork, community, and leadership.
Who We Serve:
Adults with Mental Illness
Persons with Intellectual and Developmental Disabilities
Persons with Co-Occurring Substance Use Disorders
Youth with Serious Emotional Disturbances
What is the Regional Entity?
Southwest Michigan Behavioral Health is the Pre-Paid Inpatient Health Plan for our area and consists of the following eight (8) counties, with the Community Mental Health Services Program (CMHSP) serving as local lead agency for the behavioral healthcare system:
- Barry County
Barry County Community Mental Health Authority
- Berrien County
Berrien Mental Health Authority d/b/a Riverwood Center
- Branch County
Branch County Community Mental Health Authority, d/b/a Pines Behavioral Health Services
- Calhoun County
Calhoun County Community Mental Health Authority, d/b/a Summit Pointe d/b/a Venture Behavioral Health
- Cass County
Cass County Community Mental Health Authority d/b/a Woodlands Behavioral Healthcare Network
- Kalamazoo County
Kalamazoo Community Mental Health and Substance Abuse Services
- St. Joseph County
Community Mental Health and Substance Abuse Services of St. Joseph County
- Van Buren County
Van Buren Community Mental Health Authority
Pursuant to Michigan Mental Health Code, MCL § 330.1204b(3), the above CMHSPs have created a new Regional Entity (RE). The RE will be a public governmental entity separate from the counties, authorities, or organizations that established the entity.
What is a Coordinating Agency (CA)?
Southwest Michigan Behavioral Health (SWMBH) serves as the Coordinating Agency for an eight county region. Counties in the KCMHSAS region include Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joe, and Van Buren. A full continuum of recovery support services is available to both youth and adults ranging from prevention services to treatment. Substance use disorder treatment services are available to individuals who are covered by Medicaid or who are uninsured. SWMBH Access Center staff can help determine whether an individual qualifies for available services and make the appropriate referrals.
KCMHSAS Organizational Charts
- Executive Director
- Administrative Services
- Program Services
- Office of the Medical Director
- Adult Mental Health Services
- Services for Adults with Intellectual / Developmental Disabilities
- Services for Youth and Families
The Provider Network is the entire body of people, clinics, hospitals and agencies that KCMHSAS contracts with to help it achieve its mission. The local healthcare providers that KCMHSAS contracts with provide all services that are not directly provided by KCMHSAS staff. KCMHSAS values its strong and diverse network of providers and is constantly working to increase the networks strength and to fill in any gaps in its service array.
Q. I was denied payment for a service that I provided to a KCMHSAS consumer.
A. You can file an appeal on any denial. Complete this form Provider Appeal and submit it for review.
Q. As part of contract compliance, I was asked to fill out a “Plan of Correction.”
A. Use this Plan of Correction to submit to your response.
Q. Where can I find out about required trainings for my agency and staff?
A. This Training Requirement Chart lays out who needs to take what trainings and when.
Q. What kind of monitoring processes and reviews will I be subject to as a KCMHSAS provider?
A. This Provider Monitoring Matrix explains the kind of reviews and monitoring you can expect.
Q. What qualifications or credentials do I need to have to provide a particular service, like psychotherapy or case management, to a consumer?
A. The Michigan PIHP/CMHSP Provider Qualifications Per Medicaid Services & HCPCS/CPT Codes spells out what is required by the Michigan Mental Health Code.
Provider Network Management Policy
Practice Guidelines KCMHSAS Policies
- Utilization Management and Access
- Clinical Practices
- Intake and Assessment
- Consumer Planning
- Service Coordination
- Transition, Discharge and Follow Up
- Records of Individuals Served
- Record Retention
- Emergency Mental Health
- Children and Adolescents
- Psychiatric Services
- Health Care Education
- Medication/Psychiatric Review
- Psychiatric Evaluation
- Treatment Using Medication for Addictive Illnesses
- Methadone Assisted Treatment and Recovery
- Drug Testing
- Prevention/Jail Diversion
- Diversion Policy
- Housing and Residential Eligibility Policy
- Housing Assistance Policy
The finance department manages everything to do with the flow of money through the agency, including the billing processes. Finance ensures, among other things, that KCMHSAS providers are paid for the services they provide at the correct time, in the correct amount, and from the correct funding sources.
Q. Who do I contact if I have problems getting my claim paid?
A. If you have problems or questions about claims, please contact the financial analyst associated with your population. KCMHSAS has financial analysts who specialize in each population (MIA, I/DD, SED, SUD). Just call 553-8000 and ask to talk to your population analyst.
Q. How do I enter a new claim into Streamline?
A. You can enter a new claim into Streamline by following the step-by-step instructions explained in this document — NEW CLAIM ENTRY
Q. How do I submit billing via 837?
A. You can submit billing via 837 by following the step-by-step instructions explained in this document — 837 COMPANION GUIDE
The Corporate Compliance Office is charged with developing and managing the Compliance Program for KCMHSAS and its provider network.
The primary roles of the office are:
- To ensure KCMHSAS has a functional Compliance Program that meets all federally mandated essential elements and that regulatory and statutory compliance is adhered to across the provider network.
- To ensure KCMHSAS maintains a comprehensive risk management system that monitors key functions across the provider network, identifies potential risk areas, provides recommendations and solutions for remediation, and monitors the system for systemic compliance and risk management concerns.
The office is also available to assist anyone wanting to report alleged Fraud, Waste and Abuse in the Medicare/Medicaid system. Reporting can be made in various ways. Employees have a duty to report concerns, compliance is everyone’s responsibility.
Q. What is the Corporate Compliance Hotline?
A. You may report alleged fraud 24 hours a day, seven days a week by telephone at (866) 939-4823 or during business hours (269) 364-6986. You may also send an email to email@example.com. Click here for a posting for your organization.
Q. Who can file a report?
A. Anyone who believes or has evidence that fraud, waste, or abuse to KCMHSAS may have occurred or is occurring should file a report.
Q. May I remain anonymous?
A. Yes, you may remain anonymous. The Compliance Office strictly honors confidentiality and will not reveal the identity of any informant or source of information without the informant’s authorization or by order of a court of law.
Q. What can be reported?
A. Any kind of fraud or misconduct can be reported related to Medicare/Medicaid funding. You may report any employee, contractor, or vendor who may be committing fraud, or any practice or act you observe that results in the abuse or waste of Medicare/Medicaid resources.
Q. What information should I provide when filing a report?
A. When reporting suspected fraud, please provide as much information and detail as possible, including who, what, when, where, why, and how.
In general, please provide the name of the person(s) involved; explain what is happening and where and when the fraud occurred. Provide as much information as possible. If you are aware of misconduct, any information you have is helpful. If you have documents available, please provide them.
Q. When I call the hotline, am I being recorded?
A. No. We do not record calls made to the hotline.
The Quality Management Department encompasses activities directed at ensuring that standards of staff, program and management performance exist, that compliance with them is assessed and that ongoing improvements are introduced and assessed. The components of Quality Management include:
- Developing and maintaining an effective quality assessment and improvement program that meets MDHHS and other requirements.
- Standard setting, which includes performance expectations for both clinical and management programs and ensuring that there are adequate standards in place for credentialing/re-credentialing, eligibility for services, and practice guidelines.
- Conducting performance assessments, which include the collection and analysis of performance data, stakeholder surveys on their perception of service quality and performance improvement projects.
- Conducting on-site monitoring of services and providers within the provider network.
- Managing outside agency review processes such as MDHHS site reviews, PIHP reviews and accrediting body reviews.
- Providing oversight of the adequacy of staff and provider education and training.
- Analyzing critical incidents and sentinel events.
Q. Why does the KCMHSAS complete reviews of our clinical records, claims and organization every year?
A. The State and Federal Government state that KCMHSAS will be accountable and oversee subcontractors and will monitor the subcontractor’s performance on an ongoing basis (42 CFR & PIHP Contract).
Q. Why do I have to complete Incident Reports?
A. MDHHS requires KCMHSAS to follow-up on all sentinel events and critical incidents that put people at risk of harm and to report specific events directly to MDHHS. The CMHSP also uses this information to make system improvements.
Q. What do I need to do if I someone I am providing services to dies?
A. The Death Report explains what the provider needs to do and contains a copy of the forms to be completed.
Q. Why do Children’s Therapists need to complete 24 hours of Children’s Training?
A. MDHHS requires all mental health professionals who work with children to complete 24 hours of children specific training annually and suggests that no more than 8 hours be completed electronically (Children’s Diagnostic and Treatment Services Program).
Q. Why does KCMHSAS require annual trainings for providers?
A. To promote quality services and desired outcomes for persons served and to meet State and Federal requirements. Training requirements are specified in the contract signed with in Section 2.2 of the contract agreement.
Customer Services for KCMHSAS is available by contacting us at 2030 Portage Street in Kalamazoo. The telephone numbers are (269) 553-7000 or (888) 553-7160. The primary responsibilities of Customer Services for KCMHSAS are to:
Provide an initial welcome and an orientation of the services and benefits available through the community mental health and substance use service system, as well as an overview of the network of providers in our service system.
- Provide information about how to access mental health, substance use, primary health and other community services.
- Provide information about how to access the processes that are in place to protect the rights of the people we serve. This includes providing assistance to file grievances, complaints, or appeals.
- Provide assistance with questions and problems about community benefits.
Q. Where do I find the Handbook?
A. You can print the entire book or any necessary handouts by clicking on Customer Handbook (this link leads you to SWMBH’s website where you can always have access to the most current version of the Customer Handbook as well as the Spanish versions. Once there, click on the blue “Member Documents” drop down menu bar then select the version of the handbook you wish to access.) or contact customer service at (269) 553-7000.
Q. Where do I find Adverse Benefit Determination (Medicaid) and/or Acton Notice (Non-Medicaid) forms?
A. Located on KCMHSAS’s portal, the Adverse Benefit Determination (Medicaid) and Action Notice Non-Medicaid (Non-Medicaid) forms can also be accessed by clicking the links provided or contacting the Customer Services office at (269) 553-7000 to request printed versions. You can access instructions for completion by clicking this link.
Q. What do I do if a customer needs an interpreter for appointments?
A. Click on this link Quick Guide to Interpreter Services.
Q. How do I get training regarding Action Notices and/or Customer Appeals?
A. Training is provided on the 3rd Wednesday of each month at the KCMHSAS Training Center. If you have a question about a how to complete a particular Action Notice for a customer, please contact Customer Services.
Q. How can I help a customer appeal a service decision?
A. If a customer wants you to help them to appeal, first inform your supervisor and secure the customer’s signature on a Consumer Representative Request, intended to grant you that permission.
ORR stands for Office of Recipient Rights. This office is mandated into existence by a law known as the Michigan Mental Health Code (MMHC) for any Community Mental Health Service Program (CMHSP), Licensed Private Hospital/Unit (LPH/U), or state-operated psychiatric facility. Its primary function is to ensure that the rights of recipients of mental health services, guaranteed under the MMHC, are protected. This is done through investigation, monitoring and prevention.
Q. Who is required to abide by the MMHC law?
A. Any CMHSP, LPH/U or state psychiatric hospital employee or their contract providers.
Q. What form do I use to file a complaint?
A. Recipient Rights Complaint Form
Q. What is expected of staff when a rights investigation is initiated?
A. All direct operation or contract provider staff must cooperate fully with a rights investigation as a condition of their employment.
Q. Do employees have any appeal rights under the MMHC with regard to ORR investigative findings?
A. Not at this time.
Q. What if I report a violation and then my employer retaliates against me?
A. It is prohibited for someone to retaliate or harass against the reporter. A person who has been harassed or retaliated against can also pursue their grievance through the Whistleblower Protection Act.
Q. Why do recipients of mental health services get “extra rights”?
A. A recipient does not receive “extra rights” they have protected rights. Protected rights are provided to those who receive public mental health services.
Rights Complaints and Dispute Resolution
- KCMHSAS Strategic Goals (FY 18/20)
- KCMHSAS Strategic Goals – Updates/Progress (FY 16/17)
- Provider Survey Results (2016)
The Information Technology Services (ITS) department:
- Manages and maintains all computer systems owned by KCMHSAS. This includes data center hardware and software, desktop and laptop computers, cell phones and air cards.
- Provides specialized application development services including the creation of reports.
- Provides helpdesk functions to support hardware and software applications and systems.
For our contract providers, ITS supplies and supports the Streamline applications (SmartCare and Provider Access) for clinical and billing functions. These systems include a secure method of communication and should always be used when discussing client information – as opposed to sending protected health information (PHI) using regular email, which is strictly forbidden.
ITS also provides the portal which is heavily used as a document library and collaboration tool. Providers can access the Portal to find policies, forms and reports.
Q. How do I contact the Helpdesk?
A. There are four ways that you can use to contact the ITS Helpdesk:
- Submit a new Helpdesk ticket using the Helpdesk application by clicking here. Please note that in order to do this, you will need a login account to the Portal. This is a great option because your request will be tracked.
- Send an email to firstname.lastname@example.org.
- Call the Helpdesk at (269) 553-8059.
- Contact your provider network manager. They will be able to convey your needs/issues to the ITS Helpdesk and even create a ticket on your behalf.
Q. How do I submit a Portal login request?
A. Requesting a Portal login account is as easy as filling out a “Portal Login Request” form and sending it to the ITS Helpdesk via email. Please note that this form requires that your organization have an NPI number.
Q. How do I get a Streamline login account?
A. In order to obtain a Streamline login ID and password, you need to submit a “Streamline User Request” form to your provider network manager. Once they validate the request, they will forward it on to ITS.