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Provider Council Updates | |
The Provider Advisory Council is representative of providers in the entire 23-county Catchment Area of Smoky Mountain LME/MCO.
Click Link for Information on Meetings and Events |
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Trainings | |
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Cultural Diversity Training in Winston-Salem
Pathways to Intergration
Wellness Recovery Action Plan Training
Responding to Domestic Violence and Its Impact on Families
Training for Impact: Creating Successful Presentations
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| NC TOPPS News |  Thank you to all providers submitting NC TOPPS interviews! The number of delinquent interviews has declined significantly since we began sending weekly updates in July. Top TOPPS issues - NC TOPPS interviews are expected to be completed in-person. This allows for more accurate data collection and reporting. Performance data generated by NC TOPPS submissions influences decision-making about services on a local and State level. It is important to have complete, accurate data.
- CNDS numbers become a required field starting January 1, 2015. If your agency has a large number of state-funded consumers, please be sure you are requesting your CNDS numbers early. To obtain a CNDS number for non-Medicaid (or non-NC Health Choice) consumer, email the following information to nctopps@smokymountaincenter.com:
- First name, middle initial, last name
- Date of Birth
- Social
- Language spoken
- Ethnicity
- Gender
- Site address for your agency
For Medicaid and NC Health Choice consumers, the CNDS number is the Participant's Medicaid Identification number. - The Smoky NC TOPPS superusers cannot assist with the following:
- Claims
- SARS
- NC TRACKS
- Contract issues
- Payment issues
These issues need to be addressed by your agency's assigned Account Specialist or Claims Specialist. If you are unsure who to contact, call the provider helpline at 1-866-990-9712. For NC TOPPS related issues and questions, contact the Smoky NC TOPPS helpdesk at nctopps@smokymountaincenter.com. |
| Home Based Therapy | Attention: MH/SA Outpatient Therapy Providers
Smoky has identified a need in the Smoky Benefit Plan(s) for a Mental Health/Substance Abuse (MH/SA) clinical service that can be provided in a consumer's home to maximize effectiveness of care for individuals who face certain barriers to office-based therapy. Effective January 1, 2015, basic benefit 60 minute therapy (90837 + SR) will be available in both the Medicaid and State Benefit Plans at a rate of $112 for all license types. This specialized service will be made available to Medicaid and State funded consumers in all disability groups (MH/SA/IDD) who are unable to benefit from traditional office based treatment and who meet all General, Entrance, Continued Stay and Discharge Criteria as required for Outpatient Behavioral Health Services in DMA Clinical Coverage Policy 8C.
Home Based Therapy (90837 SR) requires face-to-face service delivery and may be used when a consumer's need requires outpatient level-of-care. The service is not intended to address cognitive or intellectual/developmental issues that would not benefit from outpatient therapy services. This 60-minute psychotherapy code requires the focus of the service delivery to be on the individual; however, it can be used with the occasional involvement of family members. In addition, providers of this service must be trained in and follow a rehabilitative best practice or evidence-based treatment model consistent with community practice standards. The selected treatment model must produce positive outcome for the consumer's diagnosis and needs.
State Funded Consumers may access this service through Smoky's regional Comprehensive Care Centers. Smoky will continue to evaluate the need for further expansion of this service; Network Providers who would like to have this code added to their contract are encouraged to contact their Account Specialist for consideration.
In addition to meeting all Entrance, Continued Stay and Discharge Criteria found in Clinical Coverage Policy 8C the following criteria are required:
- A Comprehensive Clinical Assessment must be completed prior to the delivery of Home Based Therapy and must demonstrate necessity for Home Based Therapy to meet the consumer's treatment needs.
- The consumer cannot be safely and effectively treated in a provider's office, and reasonable attempts at office based or community based treatment are documented in the consumer's record. A failure to attempt office based or community based treatment prior to accessing this service will result in denial of authorization or recoupment. Examples of where this criteria are met include the following:
- A consumer who is considered high risk, for example with multiple Emergency Department or after hours crisis visits, who fails to maintain/engage in routine office based treatments.
- A consumer with a phobia or other MH/SA condition that impedes access to traditional office based therapy.
- A consumer who has received a high level enhanced service (i.e. ACTT) for an extended period of time and who has been stabilized but who will not engage in office based treatment.
- A child who is deemed at risk for out of home placement but does not meet other qualifiers for Intensive In Home Services. In addition, all attempts at engagement with parent or guardian have been unsuccessful.
- A consumer with co-occurring IDD/MH diagnosis who presents with physical conditions that impede access to traditional office based treatment.
- A consumer who requires treatment for a MH/SA condition but is unable to access office treatment due to lack of transportation. If the service is required due to a lack of transportation to attend office based treatments, all transportation alternatives, including use of public transportation, Medicaid transportation for Medicaid recipients, and natural supports must be unavailable to the recipient.
- This service can be reasonably expected to be effective in addressing the recipient's diagnosed mental health or substance use disorder.
- Without Home Based Therapy Service, there is an identified, specific, significant health and/or safety risk to the individual OR an identified, specific, significant risk of physical or mental harm to immediate family or community; or the consumer is at risk of out of home placement and/or may require a higher level of care.
Consumers who meet eligibility requirements for this specialized Home Based Therapy may receive up to 8 unmanaged visits. All applicable documentation requirements must be met for all visits, including the 8 unmanaged visits, and must demonstrate the alternatives that were accessed prior to utilizing Home Based Therapy. To request beyond the 8 unmanaged visits providers must submit a Service Authorization Request (SAR) along with the CCA. Authorization guidelines will permit up to 26 sessions for a 90 day period as medically necessary. This is viewed as a time limited service to be titrated as a consumer becomes engaged in traditional community based services.
If this service is added to your contract, any questions about authorization should be directed to the Care Management Department at 1-800-893-6246 ext. 1513. |
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Intensive Alternative Family Treatment |
To: Stakeholder agencies for children in Buncombe, Haywood, Henderson, and McDowell Counties.
Please plan to attend the community stakeholders meeting for the above counties on December 10, 2014 from 2:00 to 4:00pm at the Double Tree Hotel located at 115 Hendersonville Road, Asheville, NC.
This will be a great opportunity to hear about Rapid Resource for Families and the Intensive Alternative Family Treatment service. This premier service functions as an alternative treatment placement for children discharging from a PRTF or who are being considered for placement in a PRTF. The primary goal of this service is to provide a high level of care and treatment in a family setting to help a child transition to his biological home or to a home of permanence. The service is outcome driven and has an effectiveness well supported by data.
Please join us as we work to expand this service in your area to enable more children to benefit from this treatment while keeping children in their home communities.
For more information and to RSVP, please contact:
Phyllis Stephenson CEO (pstephenson@ncrapidresource.org ) 336-263-7491
Danny Nolen Dir. Program Operations (dnolen@ncrapidresource.org ) 704-516-4870
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| 2015 NC SNAP Certification Schedule | |
Please see link for current 2015 NC SNAP Examiners Certification Schedule.
See link for registration information.
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| News You Can Use from the Incident Report Team | | Since our last communication we have seen a great improvement in timely submissions, Thank You!
In addition, we have not seen any incidents with a response of "unknown"; We appreciate your help with this process.
Some friendly reminders to help us reduce the need for resubmissions:
- If there is an allegation against staff member please complete the HCPR form.
- If the police or DSS were called please complete the Authorities Contacted section.
Documents to attach to the incident report when available:
- Death certificates, ME reports, and/or Autopsy - we are unable to close death incidents without this information attached.
- DSS acceptance and/or final investigation letters.
- Internal Investigations documentation for level 3's.
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| Smoky Promotes Medical Recruitment | | Smoky and the N.C. Office of Rural Health and Community Care are working to bring more medical professionals to western North Carolina and support provider agencies interested in adding medical staff.
The two organizations hosted a medical recruitment event October 22 at the Mountain Area Health Education Center (MAHEC) in Asheville that featured presenter Jerry Boylan, a medical placement specialist with the N.C. Office of Rural Health. The session drew an audience of 25 provider organizations and focused on recruitment, placement, retention and medical loan repayment through the N.C. Office of Rural Health.
Smoky recently completed a gap analysis and needs assessment report that confirmed a shortage of medical providers, particularly psychiatrists with specialized practice areas, in many parts of western North Carolina. The report provided extensive data that will be useful in developing a medical recruitment strategy for counties in Smoky's catchment area.
Statewide, about 4.5 million people go without adequate healthcare due to issue including lack of medical insurance, rising healthcare costs and scarcity of services in some areas. The medical placement services program attracts psychiatrists, primary health care physicians, nurse practitioners, physician assistants and dental staff to practices that serve rural and underserved populations across North Carolina. The Office of Rural Health and Community Care, created in 1973, provides student loan repayment and other incentives as recruitment tools.
In 2013, the office identified 58 North Carolina counties as mental health professional shortage areas.
Smoky will begin offering a series of sessions for providers on successful recruitment strategies in a changing healthcare environment. Interested providers should contact Lisa Allen, Training Coordinator, at 828-586-5501, ext. 1163.
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Rutherford County Community Forum | |
Smoky Mountain LME/MCO Presents The Rutherford County Community Forum Thursday, January 15, 2015 1:00-2:30PM Rutherford Community Health Services 187 Main Street-Spindale, NC
Click to learn more |
| Residential Treatment Level III | | Day Treatment services delivered concurrently with Residential Treatment Level III
Smoky Mountain LME/MCO ("Smoky") recently issued a communication about Level III Residential Services for Children and Adolescents. In this communication, clinical expectations regarding Residential Treatment Level III services delivered concurrently with Day Treatment services were articulated.
The following is intended to provide additional information about concurrent Day Treatment and Residential Treatment Level III services. Note that these services can be reviewed together under Early Periodic Screening Diagnosis and Treatment ("EPSDT") guidelines, and will be approved anytime EPSDT criteria apply:
- Consistent with Administrative Code (NCAC 27G .1704(e))* and Clinical Coverage policy 8D-2, Smoky views Level III residential as a comprehensive service.
- Interventions to address behaviors occurring in the school setting that are related to the consumer's diagnosis(es), should be addressed in the PCP
- Smoky is committed to serve consumers in the least restrictive Level of Care, as indicated by accepted best practice standards
- Day Treatment is intended to serve populations for whom school interventions have been attempted and deemed insufficient - addressing consumer's barriers to education is a primary school system responsibility. As with any request for day treatment service, documented evidence that interventions by the school system have not been effective in addressing consumer's behavioral needs are required for evaluation of medical necessity.
- Per Clinical Coverage policy 8A, Day Treatment is intended to be time-limited and titrated
* "Each facility shall be responsible for ensuring supervision of children or adolescents when they are away from the facility in accordance with the child or adolescent's individual strengths and needs as specified in the treatment plan."
Please contact Care Management at 1-800-893-6246 X1910 with any questions or concerns. |
| Psychological Testing Guidelines | | Smoky Mountain LME/MCO Psychological Testing Guidelines Revised Effective Date: September 1, 2014
These Guidelines are applicable to Smoky Mountain-managed Medicaid and State-Funded Services
Click Link to See Guidelines |
| 2014 NC Council of Community Program's Conference and Exhibition | |
Pathways to Integration
December 3-5, 2014
The NC Counsil of Community Programs invites providers and vendors to exhibit at one of the largest mental health, developmental disability and substance abuse service system conferences in NC.
Click to learn more
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| Family Fun Day is scheduled for 12/13/14!! | |
In its 14th 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..
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Smoky Mountain LME/MCO Customer Service Department is available 24 hours a day, 7 days a week to provide information, screening, triage and referrals for mental health, substance abuse and intellectual/developmental disability services. The toll-free phone number is
1-800-849-6127. |
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