Billing Manual for Community Care Network Providers

Providers are expected to report all cases of child abuse to the appropriate reportingagency as defined by law. They are also expected to report this to Community Carewhen it involves one of our members. We track this through our SMI reportingmechanisms. The provider may report this either verbally or in writing. ThePennsylvania Childline phone number is 1-800-932-0313.Orientation and ongoing provider education concerning this policy occurs through theprovider manual, provider education and training processes, and on a one-to-one basis,as necessary with providers. SMIs that are considered serious are contained in theprovider benchmarking review for recredentialing purposes. This process is a part of thecomprehensive provider evaluation process (CPEP) and includes monitoring providerstandards of practice as well as their timely response in addressing incidents identified.III.H. Provider Cultural CompetencyAs stated in Section I.B, Community Care has a vision for an effective and accessiblesystem of behavioral health care that requires providers to be culturally competent. Toenhance cultural competency of network providers, Community Care:Assesses providers’ cultural competency.Presents a training session for providers in principles of cultural competence.Has developed outcomes measures related to the care provided in a culturallydiverse system.Assessment of cultural competency includes evaluation of the diversity of providers inthe network and their documentation of all member informational materials (includingaudiovisual materials, training documents, service pamphlets and radio or televisionpublic service announcements).Cultural competency is demonstrated by:Documentation that multi-linguistic populations have access to appropriatetranslators and, when a predetermined percentage of Community Care’smembership speaks a language other than English, to appropriate multi-linguisticwritten member materials.Documentation that member materials address the needs of special-servicepopulations.Documentation that materials are culturally sensitive and appropriate to the memberaudience.Providers’ cultural competency is evaluated using instruments and methods that areconsistent with cultural patterns and norms of the members being served. Theinstruments vary according to the specific cultural groups being surveyed. However, allinstruments evaluate whether the provider understands the culture of the communityCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 83