Trainings

Trainings Opportunities are listed in the bottom left hand column of this bulletin.

In it's 14^th year of fun and celebration Family Fun Day Holiday Fest is coming up on December 13, 2014. Located inside the Expo building of the WNC Ag. Center the 27,000 sq. foot space is transformed into a winter wonderland of holiday characters to meet, llamas to pet, food, face painters, balloonists and much more. A Wide variety of craft, games  and activities are provide by the service provider programs across the area. Through the wonderful efforts of multiple agencies this event is growing . Last year there were 776 people in attendance.

The event is free to all and it offers multiple ways to be involved.

1)   Provide an 'Informational Booth',

2)   Provide an activity for attendees while promoting

       the services you offer,

3)   Be a part of the planning team for the event (meets

       monthly). Deadline for this is end of September.

4)   Off set the costs of the event by offering a financial

       or in-kind contribution

5)   Inform families about it or just come and check it

      out yourself.

Consider how you can be  part of this really fun day, meet families and other providers of services.

For further details please contact Roxann Colwell at 828-230-3555, roxann.colwell@msj.org.     

See link to see how you can be involved..                     

To all Enhanced Services Providers:

Changes to Community Support Team (CST) Authorization Guidelines

In an effort to improve access to appropriate levels of care, effective September 15, 2014, Smoky Mountain Center LME/MCO (Smoky) will begin reviewing requests for Community Support Team (CST) with use of the same Service definition but will allow for more flexibility in authorization guidelines.  This means that the current requirement per Clinical Coverage Policy (CCP) 8A Criteria D of 4 or more of the following conditions be present will no longer be required. Instead, a consumer must clearly meet medical necessity for entrance to this service with evidence that at least 2 of the conditions be met: 

1. High use of acute psychiatric hospitals or crisis or emergency services, including but not limited to mobile crisis management, in-clinic or crisis residential (2 or more admissions in a year), extended hospital stay (30 days within the past year), or psychiatric emergency services;

2. History of difficulty using traditional services (missing office appointments, difficulty maintaining medication schedules, etc.);

3. Intermittently medication refractory (not achieving full response to medication or sustained reduction of symptoms) or difficulty maintaining compliance with taking medication;

4. Co-occurring diagnoses of a substance use disorder (ASAM-any level of care) and mental illness;

5. Legal issues (conditional release for non-violent offense; history of failures to show in court, etc.) related to the beneficiary's mental or substance use disorder diagnosis;

6. Homeless or at high risk of homelessness due to residential instability resulting

from the beneficiary's mental health or substance use disorder diagnosis;

7. Clinical evidence of suicidal gestures, persistent ideation, or both in past 3 months;

8. Ongoing inappropriate public behavior in the community within the last 3 months;

9. Within the past 6 months, physical aggression, intense verbal aggression, or both toward self or others (due to symptoms associated with diagnosis) sufficient to create functional problems in the home, community, school, job, etc; or

10. A less intense level of care has been tried and found to be ineffective for the clinical needs of the beneficiary."

In addition, Smoky CM will be evaluating continued stay requests according to established continued stay criteria; however, may apply more flexibility in authorization guidelines that will permit authorization beyond six (6) months in a calendar year according to a consumer's medical necessity needs.  The hard limit requiring an independent evaluation at six months may, in exceptional circumstances, be waived but will be reviewed per individual consumer and medical necessity review to determine current level of functioning to support continued need for CST beyond 6 months.  If the Smoky Care Manager determines the assessment is required for a medical necessity determination,   Smoky Care Manager will ask for this assessment to be conducted and the evaluation submitted to support the request.  In these cases, Smoky CM will make every effort to allow the provider adequate time from the date of the request to obtain such an evaluation without interruption of care for consumers.

For any questions related to this communication, please contact the Care Management Department at 1- 800-893-6246 ext 1902.                          

ATTENTION PROVIDERS

New 2014-2015- Contracting Process
Smoky Mountain (Smoky) is currently in process of upgrading our contracting processes to improve efficiencies and response time to our providers and stakeholders. During this transition providers will receive their contract in one of the three formats based on the type of contract you currently have with Smoky. At the end of this transition, Smoky will use Docusign for all State and Medicaid contracts. If you have any questions about your contract during this transition time, please contact your assigned Account Specialist or provider.contracts@smokymountaincenter.com.

State Fee-for-Service Contracts (sent via email)
 If you have a state (IPRS) fee for service contract with Smoky it has been sent out electronically via the e-mail address we have on file for your organization. It is important for your organization to print, sign, and return two copies within ten (10) business days of receipt of this contract, as described in the e-mail that went out with the contract. Please return these contracts to Smoky by standard US mail. Do not e-mail these contracts back as it is critical we have an original, signed contract on file. Once returned and signed by Smoky, you will receive a fully executed contract for your files.

If you have not already received your state fee for service contract please contact your Provider Account Specialist immediately or contact us at provider.contracts@smokymountaincenter.com

State Capitation Contracts (to be sent via US mail)

If you have a State (IPRS) Capitation contract and receive a standard one-twelfth payment from Smoky or if your contract is invoice-based, we will send your contract via standard US mail. When you receive your contract, please sign both copies in the designated areas and return both copies to Smoky through standard US mail. Once the contract is received and signed by Smoky, you will receive a fully executed version for your files.

Medicaid Fee-for-Service Contracts - Electronic Signature Process (to be sent via DocuSign)

Smoky Mountain is pleased to announce that we will begin utilizing electronic signatures on Medicaid fee-for-service contracts. The electronic signature process is administratively efficient, legal and free to providers. Smoky Mountain will use Docusign, the same electronic signature vender as the State of North Carolina and Partners Behavioral Health LME/MCO.

The electronic signature process reduces postage & handling costs and increases Smoky Mountain's ability to efficiently manage a large number of provider contracts. The electronic process does not require additional software or training and allows providers to review and legally sign contracts on computers or preferred mobile devices with industry standard security and protection. Providers and Smoky Mountain will be able to track the status of their contracts and store the final version electronically or in print.

Medicaid fee-for-service contracts will be sent to you by secure email with a link to follow to a secure online website. Email confirmations will follow where providers can store, download or print final copies of their contracts with Smoky Mountain.

For information about the Docusign electronic signature process please click and visit the links to the Docusign Guides and How To Videos.

How to Sign Video: https://www.Docusign .com/support/video/signing

How to Sign Steps:

Step 1: Click the link in your notification email from Docusign. With one click on virtually any internet-enabled device, providers can access their contract, review it and start the document signing process.

Step 2: Follow the Docusign tabs. Tabs and simple instructions guide providers through the signing process, even adopting an electronic signature. Electronic signatures are secure and legal.

Step 3: Confirm. Once finished, click "Confirm Signing" and the process is complete.

On January 1st, 2013, pharmacy providers began to receive a message at point-of-sale for prescriptions written by prescribers not enrolled in the Medicaid program. The edit, 00951 states "M/I PRESCR ID - NO ID ON FILE" with EOB 02951 message "PRESCRIBER NPI NOT ON FILE. CONTACT PRESCRIBER AND REFILE WITH CORRECT NPI"- Currently claims pay on this edit, but claims will deny starting on November 1, 2014. This will hold true for originals and refills. If you see this edit, please inform your patients that on November 1, 2014 their prescriptions will no longer be covered by Medicaid because their physician is not a Medicaid provider.

42 CFR 455.410 requires that all ordering, rendering  and referring physicians - as well as other professionals providing services under the N.C. Medicaid, N.C. Health Choice (NCHC) or their respective waiver programs - be enrolled as participating providers. This includes anyone who orders or refers Medicaid and NCHC beneficiaries for items (such as pharmaceuticals) or services and seeks reimbursement. The National Provider Identifier (NPI) of the ordering or referring health care professional must be included in all claims for payment. Enrollment criteria are being developed for providers with taxonomy codes that aren't currently being processed by NCTracks. The information will be posted on the DMA Website and an announcement will be made via NCTracks.

Attention: Smoky Providers

Revised Procedure for Reading Denial and Reconsideration Letters in AlphaMCS

Effective September 1, 2014, Smoky Mountain LME/MCO stopped mailing copies of Notices of Decisions (aka "Denial Letters" and "Reconsideration Letters") to Providers. Providers may view copies of such correspondence in AlphaMCS in the SAR module by going to the "View SAR" tile and looking in Clinical Documents. (We previously directed Providers to look for these letters in the "SAR Justification" tile but have since learned that these documents migrate to the "View SAR" tile.) We are making this change because mailed copies of letters often do not get to the individuals involved in a consumer's treatment, and because of the significant cost of copying and mailing such notices to Providers. If you have questions about this change or about a specific case, please contact the Appeals Department at 1-800-893-6246, ext. 1400. 

Dear Community Partners,

The Division of MH/DD/SAS released a new Comprehensive Crisis Prevention and Intervention Plan (CCP) last fall.  As part of the release, we committed to a continued evaluation of the new tools based on feedback from the field.  Since that time we have had conversations with many of you and reviewed hundreds of survey responses about your experience using the new tools. 

Based on your help, we are now releasing a "new and improved" CCP.  Please forward the attached memo, flyer, and revised forms to all MH/DD/SAS providers for use beginning October 12014.  These instructions and materials will supersede any previously released information. This communication will also be posted at  www.crisissolutionsnc.org.

Crisis Plan Crosswalk

Crisis Plan Flyer

Crisis Plan Memo

Crisis Prevention and Intervention Plan 

Please forward the attached link to all providers within your organizations and networks.  It should take only 3-5 minutes to complete. The survey will be open for one month, closing on September 26.  Thank you in advance for partnering with us in this DHHS Crisis Solutions Initiative survey.

Attention ALL Providers-This is NOT just for the I/DD community!  

Benchmarks/NCCDD/NADSP Initiative: NC Alliance for Direct Support Professionals would like to invite you to a Conference to learn about a National/Statewide movement to empower, educate and work together towards advocating for increased wages for a critical work force, Direct Support Professionals (DSP's). 

The NC Association of Rehabilitation Facilities (NCARF) will be holding its Annual Fall Conference at the Hawthorne Inn in Winston-Salem on Sept 25th and 26th. Come find out what's happening in the Department of Health and Human Services straight from Dave Richard and learn how changes might affect how you provide support services. Gain insight into the Division of Medical Assistance and Medicaid Reform by hearing the latest news and commentary about what the future may hold. Learn to navigate your way through the labyrinth of milestones and BEAM from Vocational Rehabilitation. Understand upcoming changes to the Innovations Waiver and how they impact you and receive the latest news from Raleigh about Provider monitoring. In addition staff will have the chance to share best practices with peers and pick up a few techniques and tools to help you work smarter, not harder. Click on the link to see the agenda and register. The early bird discount ends September 1 so be sure to register soon.

http://events.constantcontact.com/register/event?llr=9lccshrab&oeidk=a07e9mhyo9je7845869

September 7 - 13 is National Direct Support Professionals Recognition Week

Join Smoky LME/MCO in recognizing the dedication and accomplishments of Direct Support Professionals during the week of September 7 - 13.  Direct support professionals (DSPs) are people who work directly with individuals who have Mental Health, Substance Abuse, and Intellectual/Developmental Disabilities with the aim of assisting the individual to become integrated into his /her community or the least restrictive environment.  This year's celebration marks the seventh consecutive year of recognition by the U.S. Senate for this essential workforce. Disability services providers across the country will mark the week by

hosting celebrations to honor their Direct Support Professionals. "Each Direct Support Professional brings us closer as a nation to achieving the promise of the Americans with Disabilities Act of full community participation for individuals with disabilities.

These dedicated professionals work tirelessly every day of the year providing skilled and

compassionate supports to individuals with disabilities," Senator Ben Collins

To learn more about the benefits of working with or as a DSP follow this link:  https://www.nadsp.org/

To register for a free webinar during the week of September 7 - 13 on Direct Support Professionals Make a Difference: A Good Afternoon, or a GREAT Life: Click here

To register for a free webinar hosted by AAIDD and the recipient of ANCOR's National DSP Recognition award that shares DSP success stories:   Click here 

Family Support Network of WNC is gearing up for the

4th Annual Regional Transition into Adulthood Fair,

A Journey toward Independence: Positive Outcomes for Youth with Disabilities, to be held Saturday, October 4^th from 11:00am to 4:00pm at Mission Reuter Children's Center. 

Transition into Adulthold Flyer