WHO IS ACCREDITED?

Private Organization Accreditation

Southeastern Regional Mental Health, Developmental Disabilities and Substance Abuse Services is a Local Management Entity, covering the geographic areas of Bladen, Columbus, Robeson, and Scotland counties. SER ensures continuity of care to consumers through access to a quality of care system available 24/7/365 days a year through management of our network provider services.
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VOLUNTEER TESTIMONIAL

Rochelle Haimes, ACSW

Volunteer Roles: Commissioner; Peer Reviewer; Standards Panel Member; Team Leader

Rochelle is a Consultant working with a variety of private organizations to become accredited. Her primary area of expertise is in facilitating the development of PQI systems and activities. Her previous experience with both small and large organizations is the cornerstone for her long-standing volunteer activities as a Peer reviewer and as a Team Leader.
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Purpose

Network services are delivered to a defined population through an integrated network of providers with the goal of ensuring optimal access, quality of care, and consumer satisfaction.

Definition

COA’s Network Administration standards apply to network management entities (NME) and address core administrative practices that contribute to the effective management and coordination of an integrated network of service providers.

There are many types of networks and any number of ways that a network can be organized. It could be said that every service-provider network is unique. This is due to many factors that can include: the needs and demographics of the population being served; the availability--both geographically and numerically--of qualified providers and provider organizations; whether the network was formed in response to a legislative or regulatory mandate or was formed voluntarily; its mission and mandates; whether it was formed to realize administrative efficiencies, create a system of care, or compete for managed care contracts; and others.

In all cases, high-functioning service networks provide individuals and families with services that are appropriate to their needs and are provided in a timely manner by qualified providers.

Interpretation: Networks generally are in business to ensure and manage the quality of services provided to covered persons and families.

NA The organization is not a network management entity.

Note: Core administrative practices related to the administration and management of networks are not limited to the Network Administration standards, but are also reflected in each of the 8th Edition’s Administration and Management and Service Delivery Administration standards sections.

Note: Please see Policies and Procedures Manual - Network for additional assistance with this standard.

Note: Please see NET Reference List for a list of resources that informed the development of these standards.

Network Administration Narrative

Self-Study Evidence
    • Provide an overview of the different programs being accredited under this section. The overview should describe:
      1. the program's service philosophy and approach to delivering services;
      2. eligibility criteria;
      3. any unique or special services provided to specific populations; and
      4. major funding streams.
    • How are the network's services funded?
    • Describe how your organization manages communication with providers throughout the network.
    • Describe the scope of the network's utilization management activities (e.g., Does utilization management include authorization that is external to the provider? Is it limited to establishing criteria, reporting utilization data, and retrospective reviews?).
    • How does the network/lead agency monitor the quality of its services network-wide?
    • Provide any additional information that would be useful to the Peer Team.
    • Updated list of contractors with contact information, services provided to the network, accredited or not, and if so by whom.
    • Network Organization chart
    • Completed Network Standards Matrix
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