TABLE OF CONTENTS

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1. WELCOME FROM THE DIRECTOR and MEDICAL DIRECTOR
2. HOW TO USE THIS MANUAL
3. QUICK REFERENCE PHONE NUMBERS
4. SAN FRANCISCO MENTAL HEALTH PLAN MISSION, SYSTEM GOAL, VALUES
5. THE SAN FRANCISCO MENTAL HEALTH PLAN
   • Introduction
   • Eligibility For SFMHP Membership
   • Categories of SFMHP Participating Providers
   • Services Covered By SFMHP
6. HOW TO OBTAIN AUTHORIZATION FOR MENTAL HEALTH SERVICES
   • Planned Services
   • Outpatient Services
   • 24 Hour Mental Health Services
   • Urgent Care
   • Emergency (Unplanned) Services
   • Hospital Admissions
   • Pharmacy and Lab Services
7. MEMBER SERVICES
   • Member Rights
   • Non-Discrimination
   • Determining Eligibility
   • Cultural Competence
   • Member Problem Resolution Process
   • Member Grievance Procedure
8. PROVIDER NETWORK REQUIREMENTS
   • Hospitals and Skilled Nursing Facilities/IMDs
   • Organizational Providers
   • Individual and Group Practitioner Providers (including credentialing)
9. PROVIDER PROBLEM RESOLUTION AND APPEALS
10. CLAIMS PROCESSING AND PAYMENT
11. COORDINATION WITH HEALTH PLAN, PRIMARY CARE PROVIDERS, AND OTHER SOCIAL SERVICES
    • Coordination with Primary Care Provider
    • Consultation/Liaison Services for Primary Care and Other Healthcare Providers
    • Role and Responsibility of Primary Care Provider
    • Coordination with Substance Abuse Treatment Services
    • Coordination with Other Social Services
    • Coordination with Specialized Child and Geriatric Services
12. LEGAL REQUIREMENTS
    • Patient Rights
    • Confidentiality/Release of Information
    • Consent
    • Scope of Practice
    • Reporting of Child or Elder Abuse
    • Duty to Warn/Tarasoff
13. SFMHP QUALITY MANAGEMENT PROGRAM
    • Structure
    • Quality of Care Reporting
    • Documentation/Peer Review
    • Outcomes
    • Consumer Satisfaction
    • Performance Review
    • Provider Performance Profiling
    • Treatment Approach
    • Professional Office Standards
14. APPENDICES
    1.  
    2. Medical Necessity Criteria
    3. Standard Rate Schedule for Participating Providers
    4. San Francisco Mental Health Plan Access Clinics
    5. Reauthorization Process for Organizational Providers
    6. 24 Hour Adult Services Authorization Form
    7. 24 Hour Geriatric Services Authorization Form
    8. List of Pharmaceuticals Carved-Out from Medi-Cal Health Plans
    9. SFMHP Formulary
    10. SFMHP Consumer Complaint and Grievance Resolution Procedure
    11. Provider Network Requirements
    12. HCFA 1500 Form and Directions
    13. Claims Review Request (CRR) Form
    14. SFMHP Policy for Confidentiality and Release of Information
    15. SFMHPPolicy for Consent
    16. SFMHP Policies for Reporting of Child and Elder Abuse
    17. SFMHP Duty to Warn Policy
    18. SFMHP Policy for Quality of Care Reporting
    19. SFMHP Inpatient Psychiatric Utilization Review/Payment Authorization Plan

Last modified: Apr 14, 2000