Community Behavioral Health Services - San Francisco Department ...

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Specific Requirements for Substance Abuse (CCR, Title 22, sections 51303 & 51341.1)Substance services are supported by various funding sources. As for all CBHS services, the beneficiary mustbe a San Francisco resident. The beneficiary must have a substance abuse diagnosis (or be related to anindividual who has a substance abuse diagnosis). There are specific requirements under Drug Medi-Cal whichdefines Medical Necessity as services which:• Reasonable• Necessary to protect life; to prevent significant illness/disability; or to alleviate severepain through the diagnosis or treatment of disease, illness, or injury• Covered by the Medi-Cal program, and• Subject to utilization controls, to the extent specified.Such utilization controls shall take into account those diseases, illnesses, or injuries which require preventivehealth services or treatment to prevent serious deterioration of health. Authorization may only be grantedwhen fully documented medical justification is provided that the services are medically necessary.For more information on CBHS Medical Necessity requirements, please call Behavioral Heath Access Center at255-3737.93
Compliance (Mental Health and Substance Abuse)The San Francisco Department of Public Health is firmly committed to full compliance with all federal and statelaws, regulations, rules, and guidelines that apply to its operations and services. To emphasize this, DPH hasdeveloped a Compliance Program to assist in the detection, resolution, and prevention of any violations ofregulations. These are the seven key elements of the DPH Compliance Program – as identified by the Office ofthe Inspector General:1. The commitment of leadership2. Written policies and procedures, including standards of conduct3. Education and training of staff on compliance4. Enforcement of compliance standards5. Monitoring and auditing of eligibility, claims, billing, cost reporting, documentation, and record-keepingprocedures6. A process to detect violations and implement corrective action7. A process - such as the use of a Hotline - for reporting known or suspected compliance violations.Coding and billing are areas of particular importance in regulatory compliance. Departmental guidelines foraccurate coding and billing state the following:• DPH shall follow recognized guidelines for accurate coding approved by the Center for Medicare andMedicaid Services (CMS).• All DPH service areas will utilize current billing codes, including those established or approved by CMS,the California Department of Health Services (DHS), and the Department of Mental Health (DMH), andas authorized in the Health Insurance Portability and Accountability Act (HIPAA).• All codes reported for claims and billing must be supported by complete documentation in the patientrecord. Providers or their representatives should not assume a particular code applies to a service, butshould verify the accuracy of all codes used.• DPH Information Systems staff must coordinate with program and/or patient accounting staff tomonitor computer software used in coding and billing.• Staff with job functions that involve coding or billing shall be given ongoing training when codes and/orrules are modified or updated.• Billing units must regularly examine Explanation of Benefits (EOB), payer Remittance Advices (RA), andclaim denials to identify billing accuracy issues and changes in reimbursement policies and procedures.Feedback should be provided to employees, through regularly scheduled meetings, regarding denials,documentation compliance, and results of charging patterns and reimbursement levels.• Policies and procedures on coding, billing, and reimbursement should be outlined in manuals andguidelines within each division. Staff should be trained on the use and scope of the manuals andshould be asked to acknowledge, in writing, that he or she understands the policies outlined therein.• DPH billing departments should maintain adequate references and tools to assist staff in performingtheir job tasks. These references should be kept updated by managers and supervisors and mayinclude printed material as well as Internet/intranet links to policies, rules and regulations.• Staff should have a system available to express any concerns regarding coding and billing practices.Such concerns should be discussed with a supervisor or referred to the Compliance Officer, or to theCompliance Hotline at 642-5790.• In the event that billing inaccuracies are discovered (as a result of routine monitoring, EOB/RAanalysis, review of claims denials, or through staff reporting) they should be reported to theappropriate department manager or supervisor. An action plan to correct and prevent furtheroccurrences will be promptly developed and implemented.• For more information, please call the Performance and Compliance Section at 255-3723.94
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City and County of San Fr ancisco
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CBHS 2010-2011 Provider ManualA wel
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Who is Served by the San Francisco
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Children, Youth, & Family (CYF) - M
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CYF Mental Health and School Partne
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Residential, Sub-acute and Communit
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Adult and Older Adult - Mental Heal
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CBHS Pharmacy ServiceAll clients wh
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Supportive Housing and Shelter-Base
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AOA Outpatient ServicesDesigned to
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Substance Abuse Service ProvidersDr
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Substance Abuse Outpatient Treatmen
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Driving Under the Influence (DUI) p
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AARS - Comprehensive Outreach Proje
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Alternatives Program Damon Eaves, L
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Joe Healy Medical Detox Project off
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This program provides mental health
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Languages: SpanishCATS MAP Mobile A
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Children’s System of Care (CSOC)
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Languages: Amharic, Arabic, Cantone
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Provides specialized neurobehaviora
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Languages: SpanishDSAAM Office Base
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Epiphany Center for Families in Rec
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and to develop a community support
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Languages: Basic translation servic
Page 54 and 55: 1440 Chinook Ct. #A San Francisco C
Page 56 and 57: Evaluation Consultation Unit (DECU)
Page 58 and 59: 2 year transitional house setting f
Page 60 and 61: 1380 Howard Street, 2 nd Floor San
Page 62 and 63: Languages: Spanish, Russiansome res
Page 64 and 65: undergraduate students, and teachin
Page 66 and 67: vocational rehabilitation, housing
Page 68 and 69: Languages: SpanishProgress Foundati
Page 70 and 71: Languages: Amharic, Cantonese, Mand
Page 72 and 73: i-Ability IT Training - Serves SF C
Page 74 and 75: severely and persistently mentally
Page 76 and 77: Seneca Center Community TreatmentFa
Page 78 and 79: Behavioral Health Services to triag
Page 80 and 81: Social Model Detox for men and wome
Page 82 and 83: (SED), neglected, or abused childre
Page 84 and 85: • Opportunities to explore vocati
Page 86 and 87: Child and Adolescent Services (CAS)
Page 88 and 89: Walden House, Inc.Day Rehabilitatio
Page 90 and 91: Westside Ajani (RU#38CP3 )Shona Bau
Page 92 and 93: 888 Turk Street San Francisco CA 94
Page 94 and 95: CBHS Policies, Procedures, andAdmin
Page 96 and 97: • New! Fiscal-Cost Reporto ADP Co
Page 98 and 99: Patients’ RightsMental Health (La
Page 100 and 101: Basic Benefit Eligibility OverviewB
Page 102 and 103: Eligibility-Related Terminology:Ass
Page 106 and 107: CBHS Client Grievance ProcedureCBHS
Page 108 and 109: Adult and Older Adult QOC FormCity
Page 110 and 111: Children QOC FormCITY AND COUNTY OF
Page 112 and 113: Staff ID and Service and Billing Pr
Page 114 and 115: Hjfh;aksjd City and County of San F
Page 116 and 117: Substance Abuse Staff Professional
Page 118 and 119: STATE OF CALIFORNIA - HEALTH AND HU
Page 120 and 121: PH Harm Reduction Policyolicy Numbe
Page 122 and 123: DPH Privacy Policy Matrix forSharin
Page 124 and 125: A Privacy Notice that meets the req
Page 126 and 127: Authorization for disclosure of a p
Page 128 and 129: If a patient has not requested that
Page 130 and 131: • Avatar CANS Treatment Plan Step
Page 132 and 133: OverviewThe Contract Compliance Sec
Page 134 and 135: Alternatives for written materialsL
Page 137 and 138: Counselor Certification Regulations
Page 139 and 140: Behavioral Health Court: A program
Page 141 and 142: COSIGCo-Occurring State Incentive G
Page 143 and 144: psychologists, social workers, and
Page 145 and 146: Intensive Case Management: Intensiv
Page 147 and 148: NOANPINPPESNREPPNTPOBICOBOTNotice o
Page 149 and 150: Recovery:Process by which people ar
Page 151 and 152: TCMTEDSTIPTargeted Case Management
Page 153 and 154: Steven Dempsey Peer Support/ Client
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Toni Rucker Director, Grants & Trai
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