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
258.34 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
458.13 KB
SWMBH 2.3 Credentialing and Re-Credentialing - Organizational Providers
835.51 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
251.89 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 (7 documents)
SWMBH 3.1 QAPIP Plan FY 2023
1.87 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
561.50 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
366.89 KB
SWMBH P4.2.1 Access Management, Triage, and Referral Protocol Procedure
555.04 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
333.45 KB
SWMBH P4.8.1 Processing Retrospective Review Requests Procedure
219.60 KB
SWMBH 4.9 Medication Assisted Treatment - Methadone
905.85 KB
SWMBH P4.9.1 Medication Assisted Treatment - Methadone Procedure
355.46 KB
SWMBH 4.10 Levels of Care
790.03 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
391.87 KB
Public Policy (4 documents)
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
374.79 KB
SWMBH 6.4 Customer Appeal Systems
514.43 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
315.60 KB
SWMBH 6.10 Stipends To Customers and Family Members
751.22 KB
SWMBH P6.4.1 Appeal
391.08 KB
SWMBH P6.4.2 Adverse Benefit Determination
375.39 KB
SWMBH 6.3 Customer Grievance System
397.78 KB
SWMBH P6.3.1 Grievance
375.87 KB
Information Systems Management (1 documents)
Security Audit RFP Questions
36.28 KB
Financial Management (2 documents)
SWMBH 8.2 Cash Management for Grants and Contracts
370.01 KB
SWMBH 8.3 Stipends to Substance Use Disorder Oversight Policy Board (SUDOPB) Members
137.77 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
366.03 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
308.27 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
383.18 KB
SWMBH P10.5.1 Effective Compliance Education and Training Procedures
559.34 KB
SWMBH 10.6 Compliance Reporting Responsibilities
377.14 KB
SWMBH 10.7 Compliance Auditing and Monitoring
574.81 KB
SWMBH 10.8 Compliance Reviews and Investigations for Reporting
807.45 KB
SWMBH P10.8.1 Compliance Reviews and Investigations for Reporting Procedure
1.33 MB
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
1.13 MB
SWMBH 10.13 Ownership, Control and Criminal Conviction Disclosures Requirements
383.03 KB
SWMBH P10.13.01 Ownership & Control Disclosures, Criminal Conviction Disclosures, and Exclusions Monitoring
1.49 MB
SWMBH 10.14 Appeal Process For Compliance Decisions
589.74 KB
SWMBH 10.15 Clinical Documentation Review
727.59 KB
SWMBH 10.16 Breach Team Program Oversight
756.29 KB
SWMBH P10.16.1 Breach Oversight: Risk Assessment Procedure
1.64 MB
SWMBH P10.16.2 Breach Oversight: Breach Notification Procedure
372.86 KB
SWMBH 10.17 Social Security Privacy Policy
606.85 KB
SWMBH 10.18 Breach Notification
1.01 MB
SWMBH 10.20 Compliance Document Retention
586.26 KB
SWMBH 10.21 Use of MDHHS Standard Consent Form
327.27 KB
SWMBH 10.22 60-Day Requirement for Reporting and Returning of Overpayments
466.93 KB
Substance Abuse Treatment and Prevention (24 documents)
SWMBH 11.1 Treatment Planning SUD
324.51 KB
SWMBH 11.2 SA Wait List
711.03 KB
SWMBH 11.3 Women's Specialty Treatment Services
353.02 KB
SWMBH 11.4 Services for Women and Their Children
375.53 KB
SWMBH 11.5 Communicable Disease Testing & Education
258.92 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
374.08 KB
SWMBH 11.10 Substance Abuse Prevention Services (1)
445.21 KB
SWMBH 11.11 Recipient Rights of Substance Abuse Consumers
381.13 KB
SWMBH 11.13 Substance Abuse Service Authorization Guidelines
686.56 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
575.06 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
320.14 KB
Clinical Practices (30 documents)
SWMBH 12.1 Assessment and Services for Co-Occurring Disorders
489.90 KB
SWMBH 12.2 Integrated Healthcare
470.89 KB
SWMBH P12.2.1 Integrated Care Team Procedure
449.08 KB
SWMBH P12.2.2 Community Outreach Procedure
635.99 KB
SWMBH P12.2.3 Physical Health Communication
303.70 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
348.43 KB
SWMBH P12.5.1 Discharge and Follow-Up Procedure
385.01 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)
5.60 MB
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
407.74 KB
SWMBH P12.11.1 Clinical Documentation Procedure
327.15 KB
SWMBH 12.13 Supports Intensity Scale
394.71 KB
SWMBH 12.14 LOCUS - Fidelity & Inter-Rater Reliability
316.43 KB
SWMBH 12.15 COVID-19 Resource Support
317.27 KB
SWMBH 12.16 Person-Family Centered Planning
1.94 MB
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
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 (4 documents)
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 (3 documents)
2023 SWMBH General Overview
3.65 MB
Letter of Welcome 2020
144.14 KB
SWMBH Organizational Chart
69.18 KB
Provider Network (8 documents)
Credentialing Process SWMBH
42.36 KB
Applicant Credentialing Rights
308.98 KB
SWMBH Independent Practitioner Credentialing Application
624.78 KB
SWMBH Organization Credentialing Application
762.75 KB
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
191.52 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 2023 QAPIP Plan
1.87 MB
FY 2022 QAPIP Evaluation Report
4.11 MB
2022 Customer Satisfaction Survey Analysis
1.03 MB
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
366.89 KB
SWMBH P4.2.1 Access Management, Triage, and Referral Protocol Procedure
555.04 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
333.45 KB
SWMBH P4.8.1 Processing Retrospective Review Requests Procedure
219.60 KB
SWMBH 4.9 Medication Assisted Treatment - Methadone
905.85 KB
SWMBH P4.9.1 Medication Assisted Treatment - Methadone Procedure
355.46 KB
SWMBH 4.10 Levels of Care
790.03 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
391.87 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 (4 documents)
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)
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
447.18 KB
SWMBH Code of Conduct 2020
91.72 KB
SWMBH Compliance 2020 training
578.23 KB
SWMBH Customer Service Concepts Training
438.82 KB
SWMBH Grievance, Appeal, and Notice Training
574.75 KB
SWMBH HIPAA Privacy and Security 2016 training
633.20 KB
SWMBH LEP Training
514.94 KB
SWMBH MCIS Adjudication Logic
111.99 KB
SUD Providers
Employee Resources (6 documents)
BH TEDS Smartcare
928.29 KB
BH-TEDS QA 09/08/2016
701.09 KB
FY17 BH-TEDS Coding Instructions
628.32 KB
SWMBH BH TEDS for SUD Overview
312.48 KB
Tx Planning for SUD v5.1
385.99 KB
Community Resources (1 documents)
BHDDA Health Home Press Release
114.82 KB
SUD Treatment Providers General Information (1 documents)
MAT Guidelines for Opiod Use Disorders
1.11 MB
Opioid Health Home
Opioid Health Home Enrollment Paperwork (4 documents)
Opioid Health Home Needs Assessment
1.22 MB
Opioid Health Home Care Plan Template
91.70 KB
Opioid Health Home Consent to Treatment
118.54 KB
MDHHS 5515 Consent Form
135.70 KB
Opioid Health Home Handbook (1 documents)
Opioid Health Home Handbook V2
532.40 KB
Opioid Health Home Processes (5 documents)
Opioid Health Home Overview
116.78 KB
Opioid Health Home Disenrollment Process
138.04 KB
Opioid Health Home Enrollment Process
106.02 KB
Opioid Health Home Encounters
150.96 KB
Opioid Health Home FAQ
205.49 KB
Opioid 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
