Medicaid Child and Adult Non-Innovations I/DD Utilization Review Guidelines

Medicaid Adult MH/SA Utilization Review Guidelines

Supported Employment Definition

NC Mentor has made the decision to voluntarily withdraw from participation in the Smoky Mountain LME/MCO network of providers for all services, including outpatient therapy, medication management, therapeutic foster care, child and adolescent day treatment and intensive in-home services.  Smoky acknowledges that this decision was voluntary and considers NC Mentor to be in good standing for purposes of future enrollment, reenrollment, participation, credentialing or re-credentialing.  Smoky and NC Mentor will work collaboratively over the next 60 days to ensure a safe and orderly transition of any consumers affected by this decision.  Smoky will ensure that consumer choice is respected throughout this process.  Smoky Network providers who have capacity to accept new consumers for the above-listed services will be contacted directly by a Provider Network Account Specialist in the coming days to discuss transition activities.  Any providers wishing to discuss the possibility of hiring current NC Mentor staff should contact Jeannie King, State Director of Periodic Services at 919-790-8580 (Ext 7115).  Network Providers and community stakeholders with questions about this transition should contact Smoky Provider Relations at 1-866-990-9712.  Consumers and family members may contact their Smoky Care Coordinator (if assigned) or Smoky Customer Services at 1-888-757-5726.

When requesting additional units for an existing authorization,  providers should follow the following procedure:

1.   Submit a SAR for the additional units needed that includes a clinical justification statement for the additional units.  Emails and telephone requests will not be honored for this purpose.

2.   The requested start date of the newly submitted SAR should not pre-date the SAR submission date ; the end date of the newly submitted SAR should match the end date of the original authorization.

3.   No Additional documentation is required to be submitted with the SAR.

4.   The Clinical Justification should clearly state the specific date for which the original authorization should be lapsed. The number of units requested on the newly submitted SAR should reflect the number of additional units that is requestied to add to the existing authorization.

Questions regarding this process should be directed to: Judith Collins, Care Management Director, 828-586-5501 x 1260 or Judith.collins@smokymountaincenter.com

The NC TOPPS Improvement Team would like to thank our providers for sending in your questions regarding performance on NC TOPPS. Please continue to send in questions and data inquiries to nctopps@smokymountaincenter.com.

Weekly TOPP Five Issues:

1. Providers continuing to call Smoky for NC TOPPS Inquiries. Please use the email address listed above.
2. Providers submitting initial interviews without completing updates or episode completion interviews.
3. Late submissions. Remember, NC TOPPS can be submitted two weeks before and two weeks after the due date.
4. Providers required to submit NC TOPPS for services provided, but failing to do so.
5. Providers of a service requiring NC TOPPS that are not registered with NC TOPPS.

Reminder: If you provide one of the services identified below, you must participate in NC TOPPS.

• Residential - PRTF
• Partial Hospitalization
• Assertive Community Treatment Team (ACTT)
• Multi-systemic Therapy Services (MST)
• Substance Abuse Comprehensive Outpatient Treatment (SACOT)
• Intensive In-Home Services (IIH)
• Substance Abuse Intensive Outpatient Treatment (SAIOP)
• Community Support Team (CST)
• Child and Adolescent Day Treatment
• Opioid Treatment
• Residential - Level II (Program and Family Type) and Level III
• Outpatient (IPRS SA Only): Individual, Group, Family

The NEW NCTOPPS SFY 2014-2015 Guidelines have been published. You can find the new manual by going to:

http://www.ncdhhs.gov/mhddsas/providers/NCTOPPS/nctoppsguidelines7-2014.pdf

Smoky Mountain LME/MCO is updating the requirements for providers in order to come into compliance with the NC Consumer Data Warehouse (CDW) data submissions. 

Please click link for a list of required data fields and the CDW communication

The monitoring of Unlicensed Alternative Family Living (AFL) homes shall be conducted by the Contract Performance Team of the Smoky Mountain Provider Network Department to ensure a safe environment for the consumer.

See link for the entire Communication  

Smoky Mountain LME/MCO is updating the local modifier that is attached to the Level 4 Behavioral Health Residential Long-Term Treatment procedure code, previously referenced in the Smoky AlphaMCS system as H0019U4.

Click link to learn more                          

Attn.: All Innovation Waiver Providers

This is of concern to all providers who operate under the Innovations Waiver; more specifically, to the staff who complete and submit Innovations Back Up Staffing Incident Reports (Appendix S). 

As of June 20^th, 2014, providers will be able to enter back up staffing reports to Smoky electronically in Alpha. Smoky Mountain LME/MCO (Smoky) has worked with ALPHA MCS to develop and implement a mechanism within the ALPHA MCS system to be compatible with Back Up Staffing reports. Submission through Alpha MCS allows for a more reliable and effective process between providers and Smoky.  Any questions can be addressed by contacting Grievance & Incident Team specialists within Smoky' s QIO Department or by emailing incidentreport@smokymountaincenter.com . 

Effective July 1, 2014, ALPHA MCS will be the only method of submitting Back Up Staffing Incident Reports for Smoky to verify and review.  (Between the dates of June 20, 2014 and June 30, 2014, Smoky will accept both electronic-in Alpha-and faxed or emailed reports.)  In the event that paper (by fax or email) reports are sent to Smoky after July 1^st, they will be returned to the provider with instructions to submit reports via Alpha MCS.

Thank you for making this transition with us to improve processes.  

Documentation Training for Non-Licensed Staff

Cultural Diversity Training

This TBI training is a free training course intended for service providers in North Carolina public service agencies, including: Local Management Entities (LMEs), vocational rehabilitation or independent living offices, educators, case managers, substance abuse or mental health professionals, social security or social services professionals, advocacy or support agencies, or anyone else who serves people with brain injury.

Register Early to save on Current Trainings

The Free Clinic is sponsoring a Smoking Cessation Class

Date: July 31, 2014 (8:30a-5:00p) - McDowell

Presenters: Melissa Ledbetter & Robin Winkler, SMC Community Specialist

 Training and Registration Information

Date: August 7, 2014 (8:30a-5:00p) - Polk

Presenters: Ann Dupre Rogers & Marilyn Kaylor, SMC Community Outreach Team

Training and Registration Information

Steward of Children is a prevention training program that teaches adults how to prevent, recognize, and react responsibly to child sexual abuse.

August 5, 2014-Caldwell

5:00 pm to 8:00 pm

Smoky Mountain Office

825 Wilkesboro Boulevard, Lenior, NC

Training and Registration Information 

October 14, 2014-McDowell

9:00 am to 12:00 pm

Smoky Mountain Office

408B Spaulding Road, Marion, NC

Training and Registration Information