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Health and Human Services
LaneCare Provider Manual

This Provider Manual has been prepared by LaneCare Administration and LaneCare Quality Assurance to serve as a basic reference tool for our providers. It provides basic information such as phone numbers and addresses, important policies and procedures, and instructions for obtaining timely authorization and claims processing. The manual also contains copies of forms needed by LaneCare providers.

Table of Contents

Section A - Overview

Overview of LaneCare
LaneCare Executive Committee
Operations Council Description
LaneCare Administrative Design
Lane County/LaneCare Mental Health Delivery System Overview

Section B - Phone Numbers

Important LaneCare Phone and Fax Numbers
LaneCare Participating Provider List
Outpatient Provider Agencies
Consumer and Family Operated Agencies
Residential Housing Provider Agencies
Day Treatment Provider Agencies
Crisis Respite Provider Agencies
Subacute Provider Agencies
Acute Psychiatric Hospital Providers
Important State Phone Numbers & Addresses
Consumer and Family Support

Section C - Providers/Contracting

Becoming a LaneCare Provider
Contracting
Provider Contract Requirements
Provider Services
Quarterly Reports for Special Contracting Form
Quarterly Reports for PEO Projects Form
Provider Complaints Summary Form
Site Review Visit Policy
Quality Assurance Review Protocol
Organizational Review Protocol
Facility Review Protocol
Cultural Competence Guidelines
Adult/Child Protocol
Fraud and Abuse Prevention
Conflict of Interest
Target Guidelines Policy
Reinvestment Policy
Services Coordination
ISA Policy

Section D – Credentialing

LaneCare Credentialing and Recredentialing: QMHA and QMHP
QMHA Application
QMHP Application
QMHA/QMHP Recredentialing Application        
QMHA/QMHP Application Addendum A
QMHA/QMHP Application Addendum B
Family Support & Mental Health/Family Resource Aide Policy
Mental Health/Family Resource Aide Application
Mental Health/Family Resource Aide Recertification Form
Credentialing Orientation Training Policy
Credentialing Continuing Education Requirements Policy
LaneCare CEU Tracking Form or Annual Evidence of Licensure Form
Criminal History Records Check Policy   
Practitioners with Special Skills Policy
Practitioner Special Skills Certification Form

Section E – Member Rights

LaneCare Member Rights and Responsibilities Policy
OHP Member Poster
Your Rights Poster
Member Rights Poster (Spanish)
Your Rights Poster (Spanish)

Section F – Complaint/Grievance

LaneCare Complaint Policy
LaneCare Member Complaint Guide
Notice of Grievance and Appeal Process
Notice of Hearing Rights
LaneCare Member Grievance and Appeal Form
Authorization for Use and Disclosure Form
Authorization for Use and Disclosure Form (Spanish)
LaneCare Provider Quarterly Summary of Complaints Form
Complaint Process – LaneCare Ombudsperson Policy
Ombudsperson Poster
Ombudsperson Poster (Spanish)

Section G – Privacy/Confidentiality

Confidentiality Policy
Authorization for Use and Disclosure
Authorization for Use and Disclosure (Spanish)
Notice of Privacy
Notice of Privacy (Spanish)
Acknowledgement of Receipt
Acknowledgement of Receipt (Spanish)

Section H – Quality Assurance

LaneCare Quality Assurance/Improvement Overview
LaneCare Quality Assurance Committee Description
QAC Subcommittee Structure & Composition
QA Committee and Subcommittee Relationship & Process
LaneCare Quality Assurance Committee Membership Policy

Section I – Clinical Standards

Access Standards
Clinical Standards for the Treatment of Children and Adolescents
Community Standard: Youth Risk Response Protocol
Clinical Standards for the Treatment of Adults
Practice Guidelines for Borderline Personality Disorder

Section J – Eligibility

Eligibility

Section K – Authorization

Authorization of Outpatient Services Policy
Authorization of Inpatient and Subacute Care – Adult Policy
Authorization of Inpatient and Subacute Care – Child/Adolescent Policy
Special Service Needs
Member Information Letter
Authorization for Use and Disclosure Form
Authorization for Use and Disclosure Form (Spanish)
Notice of Action Policy
Notice of Action Sample Letter
Notice of Action Sample (Spanish)
Notice of Action Sample (Large Print)
Member Denial Letter Sample
LaneCare Flexible Funds Procedure
LaneCare Flexible Funds Form
LaneCare Flexible Funds Form (ICTS/ITS)
LaneCare Flexible Funds Form (Transition Team)
Child Agencies Serving Adults/Adult Agencies Serving Children Policy
Utilization Management Policy
Level 2/Collateral Cheat Sheet
Level 2/Collateral Authorization Request Form (Page 1)
Level 2/Collateral Authorization Request Form (Page 2)
Psychiatry Initial Authorization Request Form
Psychiatry Reauthorization Request Form

Section L – Level of Care

Level 2a & 2b Adult
Level 3/Adult
Level 4/Adult
Level 2/Child
Level 3/Child
Level 4/Child

Section M – Claims Payment

PH Tech Claims Processing 
Above and Below the line Diagnosis with Line Matching
LaneCare Fee Schedule
Third Party Resource

Section N – Consumer/Family

Consumer and Family Support
Application to Attend a Conference

Appendices

Definitions
Member Handbook (word)
Member Handbook (Spanish)
Member Handbook (Large Print) (word)
Mental Health Declaration Policy
Declaration for Mental Health Treatment and Advanced Directives Verification Client Form
Declaration for Mental Health Treatment