Medical Necessity Criteria:
Mental Health: MCG http://careweb.careguidelines.com
Substance Use Disorders: American Society of Addiction Medicine https://www.asam.org/
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SWMBH Policies
General Management (3 documents)
SWMBH 1.7 Substance Abuse Community/Block Grant Authorized Use for Treatment Services
585.76 KB
SWMBH 1.9 Infection Control
206.04 KB
SWMBH P1.9.1 Infection Control Procedure-COVID-19 Return to Work
340.50 KB
Provider Network Management (23 documents)
SWMBH 02.20 Home and Community Based Services (HCBS) Compliance Monitoring
371.95 KB
SWMBH 2.1 Delegation of Credentialing
203.88 KB
SWMBH 2.2 Credentialing and Re-Credentialing - Behavioral Health Practitioners
469.21 KB
SWMBH 2.3 Credentialing and Re-Credentialing - Organizational Providers
839.16 KB
SWMBH P02.03.01 Credentialing Reciprocity
393.83 KB
SWMBH 2.4 Clean Credentialing and Re-Credentialing Files
209.99 KB
SWMBH 2.5 Credentialing Committee, Confidentiality of Credentialing Records, and Provider Nondiscrimination
215.80 KB
SWMBH 2.6 Organizational Providers Credentialing of Practitioners
207.24 KB
SWMBH 2.7 Provider Communication
203.45 KB
SWMBH 2.8 Network Reporting Obligations and Network Directory
263.02 KB
SWMBH P2.8.1 Network Reporting and Access Remediation
333.77 KB
SWMBH 2.9 Participating Provider Precautionary Suspension
376.62 KB
SWMBH 2.10 Sub Contracting
245.96 KB
SWMBH 2.11 Out of Network Providers
202.53 KB
SWMBH 2.12 Network Adequacy Evaluation
376.06 KB
SWMBH P2.12.1 Provider Network Adequacy Evaluation
257.42 KB
SWMBH 2.13 Provider Network Monitoring
7.27 MB
SWMBH 2.14 Grievance and Appeal - Non-Clinical
228.45 KB
SWMBH 2.15 Provider Training
399.27 KB
SWMBH 2.16 Criminal History Screening
232.64 KB
SWMBH 2.17 Provider Office Site Quality
942.25 KB
SWMBH 2.18 Ongoing Network Provider Monitoring
211.11 KB
SWMBH 2.19 Provisional Provider Approval for Home and Community-Based Services (HCBS)
877.67 KB
Quality Management (10 documents)
SWMBH CSS Results 2023
1.59 MB
CSS Survey Results - 2023
1.59 MB
FY23 QAPIP Evaluation Report
4.74 MB
FY 2024 QAPIP Plan
1.42 MB
SWMBH 3.2 Quality Assurance & Performance Improvement
409.74 KB
SWMBH 3.4 Member Input and Satisfaction of Provider Services
400.99 KB
SWMBH 3.5 Incident Event Reporting and Monitoring
414.04 KB
SWMBH 3.6 Access Standards and Monitoring
664.84 KB
SWMBH 3.7 Cultural and Linguistic Competency
218.37 KB
SWMBH 3.8 Jail Diversion
315.55 KB
Utilization Management (23 documents)
SWMBH Call Center Process Flow Charts
352.31 KB
Call Center Phone Tree
205.08 KB
Psychological-Neuropsychological Evaluation Request Form
151.64 KB
SWMBH Notice of Confidentiality and Privacy Practices Jan 2014
141.12 KB
SWMBH 4.1 Access Management Policy
384.95 KB
SWMBH 4.2 Utilization Management
374.86 KB
SWMBH P4.2.1 Access Management, Triage, and Referral Protocol
637.49 KB
SWMBH 4.3 Service Authorization Outlier Management (URAC)
466.99 KB
SWMBH 4.4 Medical Necessity Criteria Clinical Practice Guidelines
165.35 KB
SWMBH P4.4.1 Private Duty Nursing Procedure
367.83 KB
SWMBH P4.4.2 Habilitation Supports Waiver (HSW)
773.63 KB
SWMBH 4.5 Person Family Centered Planning Policy
1.67 MB
SWMBH 4.6 Self Determination Policy
3.26 MB
SWMBH 4.7 Competitive Employment For Disabled Persons
310.71 KB
SWMBH 4.8 Retrospective Review
324.33 KB
SWMBH P4.8.1 Processing Retrospective Review Requests Procedure
249.79 KB
SWMBH 4.9 Medications for the Treatment of Opioid Use Disorder - Methadone
882.80 KB
SWMBH P4.9.1 Medications for the Treatment of Opioid Use Disorder - Methadone Procedure
575.02 KB
SWMBH 4.10 Levels of Care
287.62 KB
SWMBH 4.11 SMI and SED Specialty Services Eligibility
388.16 KB
SWMBH 4.12 Continued Stay Review Denials
361.85 KB
SWMBH P4.12.1 Processing Continued Stay Review Denials
326.77 KB
SWMBH 4.13 Emergency and Poststabilization on Services
343.42 KB
Public Policy (5 documents)
Save the Date - Regional Healthcare Policy Forum
255.43 KB
State of Emergency Resolution
855.56 KB
SWMBH 5.1 Community Living
561.95 KB
Customer Service (13 documents)
SWMBH 6.1 Customer Services Roles and Delegation
347.95 KB
SWMBH 6.2 Advance Directives
255.06 KB
SWMBH 6.3 Customer Grievance System
278.34 KB
SWMBH 6.4 Customer Appeal Systems
353.19 KB
SWMBH 6.5 Limited English Proficiency
383.30 KB
SWMBH 6.6 Customer Advisory Committee
339.50 KB
SWMBH 6.7 Customer Education & Marketing Orientation
328.26 KB
SWMBH 6.8 Enrollee Rights and Responsibilities
331.48 KB
SWMBH 6.9 Notification of Provider Network Changes
243.86 KB
SWMBH 6.10 Stipends To Customers and Family Members
751.22 KB
SWMBH P6.4.1 Appeal
277.36 KB
SWMBH P6.4.2 Adverse Benefit Determination
252.61 KB
SWMBH P6.3.1 Grievance
252.30 KB
Financial Management (3 documents)
SWMBH 8.2 Cash Management for Grants and Contracts
384.15 KB
SWMBH 8.3 Stipends to Substance Use Disorder Oversight Policy Board (SUDOPB) Members
140.37 KB
SWMBH 8.4 Direct Care Worker Wages
243.25 KB
Claims (10 documents)
SWMBH 9.1 Claims Adjudication
251.98 KB
SWMBH 9.2 Claims Overpayment and Refunds
347.23 KB
SWMBH 9.3 Electronic Claims Submission
469.75 KB
SWMBH 9.4 Provider Communication
303.18 KB
SWMBH 9.5 Provider Claims Grievances and Appeals
306.68 KB
SWMBH 9.6 State and Federal Regulations
253.26 KB
SWMBH 9.7 Paper Claims Control
306.44 KB
SWMBH P9.8.1 Denial Notifications
300.58 KB
SWMBH 9.8 Enrollee Cost Sharing
302.64 KB
SWMBH 9.9 Member Plan Coverage Eligibility Determination
302.03 KB
Compliance (27 documents)
SWMBH 10.1 Corporate Compliance Plan
308.23 KB
SWMBH 10.2 Development of Compliance Plan Policies and Procedures
380.96 KB
SWMBH 10.3 Code of Conduct Distribution and Training
459.60 KB
SWMBH 10.4 Compliance Oversight Committee
378.41 KB
SWMBH 10.5 Compliance Education and Training
258.66 KB
SWMBH P10.5.1 Effective Compliance Education and Training Procedures
255.38 KB
SWMBH 10.6 Compliance Reporting Responsibilities
377.14 KB
SWMBH 10.7 Compliance Auditing and Monitoring
255.69 KB
SWMBH 10.8 Compliance Reviews and Investigations for Reporting
291.11 KB
SWMBH P10.8.1 Compliance Reviews and Investigations for Reporting Procedure
273.23 KB
SWMBH 10.9 Compliance Enforcement and Discipline
325.19 KB
SWMBH 10.10 Conflict of Interest
1.13 MB
SWMBH 10.10a COI Waiver SWMBH Board
1.39 MB
SWMBH 10.11 Fraud and Abuse
661.67 KB
SWMBH 10.12 Freedom of Information Request Policy
309.91 KB
SWMBH 10.13 Ownership, Control and Criminal Conviction Disclosures Requirements
275.54 KB
SWMBH P10.13.01 Ownership & Control Disclosures, Criminal Conviction Disclosures, and Exclusions Monitoring
281.52 KB
SWMBH 10.14 Appeal Process For Compliance Decisions
252.40 KB
SWMBH 10.15 Clinical Documentation Review
727.59 KB
SWMBH 10.16 Breach Team Program Oversight
285.39 KB
SWMBH P10.16.1 Breach Oversight: Risk Assessment Procedure
267.70 KB
SWMBH P10.16.2 Breach Oversight: Breach Notification Procedure
266.05 KB
SWMBH 10.17 Social Security Privacy Policy
258.98 KB
SWMBH 10.18 Breach Notification
1.01 MB
SWMBH 10.20 Compliance Document Retention
254.92 KB
SWMBH 10.21 Use of MDHHS Standard Consent Form
256.68 KB
SWMBH 10.22 60-Day Requirement for Reporting and Returning of Overpayments
308.33 KB
Substance Use Treatment and Prevention (24 documents)
SWMBH 11.1 Treatment Planning SUD
318.80 KB
SWMBH 11.2 SA Wait List
711.03 KB
SWMBH 11.3 Women's Specialty Treatment Services
331.02 KB
SWMBH 11.4 Services for Women and Their Children
358.19 KB
SWMBH 11.5 Communicable Disease Testing & Education
255.00 KB
SWMBH 11.6 Confidentiality and Disclosure of Substance Abuse Information
786.28 KB
SWMBH 11.7 MI Child Admin CA Services
522.45 KB
SWMBH 11.8 Professional Development Plan
194.61 KB
SWMBH 11.9 Fetal Alcohol Spectrum Disorders
196.35 KB
SWMBH 11.10 Substance Use Disorder Prevention Services
347.48 KB
SWMBH 11.11 Recipient Rights of Substance Abuse Consumers
364.03 KB
SWMBH 11.13 Substance Use Service Authorization Guidelines
652.88 KB
SWMBH 11.14 Admission Criteria and Intake Procedures SARF
649.40 KB
SWMBH 11.15 Referrals for SARF
1.13 MB
SWMBH 11.16 Staff Development Program SARF
160.45 KB
SWMBH 11.17 Substance Abuse Services for Minors
151.68 KB
SWMBH 11.19 Substance Abuse Operating Manual SARF
108.57 KB
SWMBH 11.20 Disclosure of Confidential Information, Disposal of Records, and Discontinuation of an SUD Program - SARF
1.29 MB
SWMBH 11.21 Substance Abuse Treatment Documentation SARF
450.19 KB
SWMBH 11.22 Transportation
258.03 KB
SWMBH P11.22.1 Transportation Procedure
780.50 KB
SWMBH P11.22.2 Direct Referral to Detox/Residential Transportation Procedure
814.58 KB
SWMBH 11.23 Criminal Justice Transitional Care Planning
244.00 KB
SWMBH 11.24 Continuity of Care for Medications for Opioid Use Disorder
320.26 KB
Clinical Practices (32 documents)
SWMBH 12.1 Assessment and Services for Co-Occurring Disorders
489.90 KB
SWMBH 12.2 Integrated Healthcare
367.54 KB
SWMBH P12.2.1 Integrated Care Team Procedure
614.67 KB
SWMBH P12.2.2 Community Outreach Procedure
322.86 KB
SWMBH P12.2.3 Physical Health Communication
236.05 KB
SWMBH 12.3 Emergency Mental Health Services
322.88 KB
SWMBH 12.4 Electroconvulsive Therapy
409.49 KB
SWMBH P12.4.1 Electroconvulsive Therapy Procedure
287.10 KB
SWMBH 12.5 Discharge Planning & Follow-Up
274.89 KB
SWMBH P12.5.1 Discharge and Follow-Up Procedure
206.65 KB
SWMBH 12.7 Pre-Admission Screening
258.57 KB
SWMBH 12.8 Autism Services policy
25.70 MB
SWMBH P12.8.1 Applied Behavior Analysis (ABA)
332.83 KB
SWMBH 12.9 Recovery Relapse Effective Freedom
254.99 KB
SWMBH 12.10 Trauma Informed System of Care
367.33 KB
SWMBH 12.11 Clinical Documentation
246.69 KB
SWMBH P12.11.1 Clinical Documentation Procedure
278.80 KB
SWMBH 12.13 Supports Intensity Scale
394.71 KB
SWMBH 12.14 LOCUS - Fidelity & Inter-Rater Reliability
318.07 KB
SWMBH 12.15 COVID-19 Resource Support
317.27 KB
SWMBH 12.16 Person-Family Centered Planning
228.28 KB
SWMBH 12.17 Competitive Integrated Employment for Persons Served
343.65 KB
SWMBH 12.18 Clinical Practice Guidelines
1.56 MB
SWMBH 12.19 Behavior Treatment Review Committee (BTRC)
243.60 KB
SWMBH P12.19.1 Behavior Treatment Review Committee (BTRC) Monitoring
253.13 KB
SWMBH 12.20 Complex Case Management
228.72 KB
SWMBH P12.20.01 Complex Case Management Procedure
256.40 KB
Self Determination Practice & Fiscal Intermediary Guideline
2.43 MB
Inclusion Practice Guideline
158.62 KB
Housing Practice Guideline
122.19 KB
Consumerism Practice Guideline
126.90 KB
Family-Driven and Youth-Guided Policy/Practice Guideline
922.26 KB
Provider Forms and Documents
Downloadable Forms (6 documents)
SWMBH Independent Practitioner Credentialing Application
1.31 MB
SWMBH Organization Credentialing Application
1.37 MB
Release-of-Information
353.68 KB
Consent to Share Behavioral Health Information for Care Coordination Purposes -Spanish
41.35 KB
Consent to Share Behavioral Health Information for Care Coordination Purposes
37.54 KB
Claims Appeal form
29.58 KB
SWMBH Federally Funded Health Care Program Disclosure Forms (2 documents)
SWMBH Federally Funded Health Care Program Disclosure Form - Organization-Group
173.98 KB
SWMBH Federally Funded Health Care Program Disclosure Form - Individual
175.64 KB
Provider Manual
Introduction (2 documents)
Letter of Welcome
144.14 KB
SWMBH Organizational Chart
69.67 KB
Provider Network (9 documents)
Provider Directory Print Out
1.70 MB
Credentialing Process SWMBH
42.36 KB
Applicant Credentialing Rights
308.98 KB
SWMBH Independent Practitioner Credentialing Application
1.31 MB
SWMBH Organization Credentialing Application
1.37 MB
Malpractice Claims Explanation Form
51.59 KB
Provider Disputes Appeals Process SWMBH
34.46 KB
Reporting Material Changes
29.32 KB
Practice Guidelines (13 documents)
Schizophrenia APA Guideline Summary
466.40 KB
Schizophrenia APA Clinical Practice Guideline
2.71 MB
Alcohol Use Disorder APA Guideline Training
730.79 KB
Psychiatric Evaluation APA Guideline Summary
454.21 KB
Psychiatric Evaluation APA Clinical Practice Guideline
3.56 MB
Alcohol Use Disorder APA Clinical Practice Guideline
1.28 MB
Self Determination Practice & Fiscal Intermediary Guideline
96.85 KB
Person-Centered Planning Practice Guideline
225.28 KB
Jail Diversion Practice Guideline
119.51 KB
Inclusion Practice Guideline
86.83 KB
Housing Practice Guideline
85.10 KB
Family-Driven and Youth-Guided Policy & Practice Guideline
38.83 KB
Consumerism Practice Guideline
92.72 KB
Customer Service (2 documents)
BG/GF Customer Services Overview
183.86 KB
MA/HMP Customer Services Overview
187.05 KB
Performance Improvement (3 documents)
FY 2024 QAPIP Plan
1.42 MB
FY 2023 QAPIP Evaluation Report
4.74 MB
2023 Customer Satisfaction Survey Analysis
931.59 KB
Utilization Management (23 documents)
SWMBH Call Center Process Flow Charts
352.31 KB
Call Center Phone Tree
205.08 KB
Psychological-Neuropsychological Evaluation Request Form
151.64 KB
SWMBH Notice of Confidentiality and Privacy Practices Jan 2014
141.12 KB
SWMBH 4.1 Access Management Policy
384.95 KB
SWMBH 4.2 Utilization Management
374.86 KB
SWMBH P4.2.1 Access Management, Triage, and Referral Protocol
637.49 KB
SWMBH 4.3 Service Authorization Outlier Management (URAC)
466.99 KB
SWMBH 4.4 Medical Necessity Criteria Clinical Practice Guidelines
165.35 KB
SWMBH P4.4.1 Private Duty Nursing Procedure
367.83 KB
SWMBH P4.4.2 Habilitation Supports Waiver (HSW)
773.63 KB
SWMBH 4.5 Person Family Centered Planning Policy
1.67 MB
SWMBH 4.6 Self Determination Policy
3.26 MB
SWMBH 4.7 Competitive Employment For Disabled Persons
310.71 KB
SWMBH 4.8 Retrospective Review
324.33 KB
SWMBH P4.8.1 Processing Retrospective Review Requests Procedure
249.79 KB
SWMBH 4.9 Medications for the Treatment of Opioid Use Disorder - Methadone
882.80 KB
SWMBH P4.9.1 Medications for the Treatment of Opioid Use Disorder - Methadone Procedure
575.02 KB
SWMBH 4.10 Levels of Care
287.62 KB
SWMBH 4.11 SMI and SED Specialty Services Eligibility
388.16 KB
SWMBH 4.12 Continued Stay Review Denials
361.85 KB
SWMBH P4.12.1 Processing Continued Stay Review Denials
326.77 KB
SWMBH 4.13 Emergency and Poststabilization on Services
343.42 KB
MDHHS Clinical Policy (5 documents)
SED Technical Requirements
275.50 KB
School to Community Transition Planning Practice Recommendation Guideline
183.96 KB
Recovery Policy & Practice Advisory
1.01 MB
Personal Care in Non-Specialized Residential Setting Technical Requirement
24.49 KB
Employment Works! Policy
59.62 KB
Provider Memos
Provider Memos (5 documents)
97151 Billing Memo February 2024
155.27 KB
ABA Rendering Provider Memo - September 2023
142.88 KB
Rendering Provider Qualifications Memo February 2023
111.38 KB
UPDATED 5.9.23 MDHHS Telehealth Policy Post-PHE
201.00 KB
EVV & Service Documentation Requirements Memo
145.11 KB
Provider Training Materials
Provider Training Materials (13 documents)
SWMBH Corporate Compliance Training
772.43 KB
SWMBH 2024 Corporate Compliance Plan & Code of Conduct
308.23 KB
Self-Determination & Person-Centered Planning Resources
417.84 KB
Third Party Payer Entry Requirements
313.47 KB
ASAM Continuum Interface Primer
258.58 KB
SWMBH 837 Companion Guide
488.50 KB
Behavior Treatment Planning
463.87 KB
SWMBH Care Management User Guide
1.24 MB
SWMBH Advance Directives Training
424.82 KB
SWMBH Customer Service Concepts Training
413.49 KB
SWMBH Grievance, Appeal, and Notice Training
560.66 KB
SWMBH LEP Training
489.43 KB
SWMBH MCIS Adjudication Logic
111.99 KB
SUD Providers
Employee Resources (5 documents)
BH TEDS Update Record SUD
218.54 KB
SWMBH BH TEDS Error Report Instructions
246.08 KB
FY24 BH-TEDS Coding Instructions
1.33 MB
SWMBH BH TEDS for SUD Overview
312.48 KB
Tx Planning for SUD v5.1
385.99 KB
Professional Trainings (1 documents)
Community Resources (1 documents)
BHDDA Health Home Press Release
114.82 KB
SUD Treatment Providers General Information (2 documents)
SWMBH SUD Strategic Plan 2024-2026
926.08 KB
MAT Guidelines for Opiod Use Disorders
1.11 MB
Substance Use Disorder Health Home
Substance Use Disorder Health Home Enrollment Paperwork (4 documents)
Substance Use Disorder Health Home Needs Assessment
168.91 KB
Substance Use Disorder Health Home Care Plan Template
92.74 KB
Substance Use Disorder Health Home Consent to Treatment
121.52 KB
MDHHS 5515 Consent Form
154.02 KB
Substance Use Disorder Health Home Handbook (1 documents)
Substance Use Disorder Health Home Handbook V1
645.27 KB
Substance Use Disorder Health Home Processes (5 documents)
Substance Use Disorder Health Home Overview
134.28 KB
Substance Use Disorder Health Home Disenrollment Process
144.07 KB
Substance Use Disorder Health Home Enrollment Process
110.32 KB
Susbtance Use Disorder Health Home Encounters
154.79 KB
Substance Use Disorder Health Home FAQ
208.18 KB
Substance Use Disorder Health Home Resource Documents (5 documents)
Vision and Dental Resources
66.96 KB
Oral Health Directory
7.94 MB
Mental Health Resources
141.10 KB
Calhoun County Community Resources
226.03 KB
Kalamazoo County Community Resources
272.37 KB
