Attention - Enhanced Child Services Providers

As announced in previous Provider Communications and in accordance with Session Law 2014-100, Smoky has approved the ratio of staff to clients served on an Intensive In-Home Team from 1:8 to 1:12 with the current rate ($258.20/per diem) effective December 1, 2014. The current rate will remain in effect through 1/31/2015 to allow providers to build their teams. Effective 2/1/ 2015, the rate will decrease to $239.66/per diem, with the increased ratio remaining (1:12) in place.

• Please note: The rate change will be effective for all IIH services as of February 1, 2015 regardless of the team's ratio.
• This is the ONLY change to the service definition.  All other  requirements set forth in DMA Clinical Coverage Policy 8A for Intensive In-Home must be met.
• This ratio does NOT apply when clients with NC Healthchoice are being served on a team - the ratio will need to remain at 1:8.
• If a provider's IIH team serves clients from more than one LME/MCO, then the minimum ratio allowed by any of the affected LME/ MCOs must be followed (e.g. a team is serving 6 CenterPoint clients and 2 Partners clients - Partners requires a 1:8 ratio so the 1:8 must be followed). Failure to adhere to the strictest ratio could result in identification of an overpayment. 

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If you are an IDD provider, please respond by reviewing the information below, choosing a preferred scenario and providing any feedback to Jesse Smathers at Jesse.Smathers@SmokyMountainCenter.com by January 20, 2015. 

Three scenarios to potentially fund the generalization portion of waiver services

• Generalization of skills, previously called maintenance, has always been a component of the implementation of formal and informal habilitative skills.
• The Generalization of skills component of the habilitative service definitions is an effort to increase support available for individuals to use skills they have already learned and streamline the process for providers to be reimbursed for that activity.
• We would appreciate your feedback on the scenarios below as we are trying to determine the correct staff to complete this activity and what training or competency that staff person would need.  

Please indicate which of three scenarios would promote greater opportunities to expand the education of supports and simplify the process for providers.

Thank you for taking the time to provide your thoughts about generalization funding for Innovations Waiver services. If you have any questions, please contact Jesse.Smathers@SmokyMountainCenter.com or 828-225-2785 ext. 5923.

Please join Courtney Cantrell, Director of Division of Mental Health, Developmental Disabilities and Substance Abuse Services; Jessica Keith, Special Advisor on ADA and Sandra Terrell, Director of DMA Clinical Policy at these listening and sharing sessions to voice your input concerning the Home and Community Based Services (HCBS) Plan for North Carolina.

They need you to:

• Talk with them and provide valued feedback about the proposed HCBS Transition Plan to help those receiving these services become a full part of their community.
• Tell them what is working and what needs to change.
• Make a plan that works for everyone.
• Help build on their system's strengths to meet requirements of the HCBS Final Rule (March 17, 2014).
• More information will follow and can be found at http://www.ncdhhs.gov/hcbs/ 

Two sessions conducted in and near the Smoky area are:

To view the dates and locations of all the listening sessions, or for more information, please click here.   

The program is highly recommended by previous participants. Smoky staff have reported, "The Advancing Strong Leadership was a wonderful opportunity to develop effective leadership skills to become a progressive leader in the field of intellectual and developmental disabilities," and "I learned a great deal about myself and my leadership style."

Applications and statements of organizational support must be submitted electronically and are due January 30, 2015. For more information see the N.C. Council on Developmental Disabilities website at www.nc-ddc.org.

Since the trial is about to begin for the suspect in the Boston Marathon bombing, Boston is preparing for victims' traumatic experience to be triggered.  Kate Abell, MHA with NC Department of Health & Human Services, Disaster Preparedness & Response Coordinator asks that if there are providers in our area that are trained in disaster specific interventions such as: CBT for Post Disaster Distress, EMDR, Narrative Therapy, Group Therapy for Disaster Survivors, TF-CBT for Children and Parents, Seeking Safety (for those with substance misuse and behavioral health concerns), to please contact April Naturale, PhD with ICF International, april.naturale@icfi.com. Dr. Naturale is working with the Massachusetts Office for Victim Assistance (MOVA) in the launch of the Boston Marathon Bombing Behavioral Health Program.   They have already accomplished a lot since the early days of the disaster, and are moving to intermediate behavioral health interventions, continuing case management and screening services as well as suicide assessment.

One aspect of the program that MOVA is offering includes paying providers for 12 sessions of short term, symptom focused disaster specific interventions such as those listed above and up to three sessions for survivors to learn Stress Management techniques.  It is similar to other victims' assistance programs.

While marathon bombing survivors were in Boston for the sporting event, many came from across the country.  MOVA would like to know of providers in our area trained in disaster specific interventions who would be able to treat any survivors of the Boston Marathon Bombing that live in this area and are in need of treatment.  Providers would need to register with the MOVA program and if approved, MOVA would contract with and pay them directly for the identified services delivered to Marathon survivors.  Providers would need to be in contact with MOVA before treating Marathon survivors, if they are expecting to be paid by MOVA.  The direct number for MOVA behavioral health supports is: 1-844-STRONG1 (787-6641) or you may contact April Naturale directly via email, april.naturale@icfi.com.

Also, if you have marathon survivors in NC who have been looking for assistance with treatment or paying for treatment, let April Naturale or MOVA know and they can follow up with them. 

The MOVA definition of survivors is noted here:  [1] The definition of Victim being used by MOVA is: "Victim" is being used to connote those persons who were physically injured or killed, their immediate family members, those persons who physically experienced the event or its immediate aftermath, including those in the immediate vicinity of the bombing, those surrounding the scene, those professionals and non-professionals who tended to the wounded, those who were involved in the subsequent apprehension of suspects or any other individual, whom by virtue of their unique experience or prior trauma history, would be triggered or impacted by this event".

REQUIRED ACTIONS BY PROVIDERS

           To keep current with this change to NCTracks, providers need to do the following:

• Review the list of eliminated taxonomies below, and compare to the ones in your Alpha profile and your contract with Smoky Mountain. Provider taxonomies are maintained by Smoky Mountain LME/ MCO as they are required and entered into the AlphaMCS system for both new and renewed contracts. If none of the eliminated taxonomies are ones you contract for, then no further action is needed. REMEMBER: taxonomies are specific for each service location, so make sure to check each location.
• If you find one or more eliminated taxonomies match ones you contract for, you need to do three things: (1) Be sure to inform staff to no longer bill using the eliminated taxonomies, (2) submit a Manage Change Request (MCR) to NCTracks to replace each taxonomy with one from the crosswalk list, (3) notify Smoky Mountain of any taxonomy changes so your Alpha profile/ contract can be updated. 

SUBMITTING A MANAGE CHANGE REQUEST

Only your NCTracks Office Administrator has the required system permissions to put through a Manage Change Request. Click on the link below to view a PDF file on the NCTracks website that explains how to change a taxonomy:

https://www.nctracks.nc.gov/content/public/providers/provider-communications/provider-announcements/Taxonomy-Tutorial.html 

You can also call 1-800-688-6696 or email NCTracksprovider@nctracks.com for help.

NOTIFYING SMOKY MOUNTAIN

Smoky Mountain provider information needs to be consistent with your records. If you update taxonomies or make other changes, make sure to notify your Provider Network Account Specialist so we have current information.  Failure to do so may result in denial of your claims. 

If you have any other questions on provider taxonomy and this instruction, please call the Smoky Provider Line at 1-866-990-9712. 

Smoky Mountain LME/MCO is committed to being a transparent organization and keeping stakeholders informed. To support these efforts, Smoky Mountain has created a brief monthly summary of operations by functional area.

For the summary, please click here.

Smoky will initiate the re-credentialing process by sending a packet and instructions to the provider with the deadline for submitting the re-credentialing application. If a complete re-credentialing application is not received within the specified timeframe, the application process will be considered terminated. If the process is terminated, the provider's credentials will lapse, and the provider will no longer be eligible to bill Smoky for services rendered. Providers are strongly encouraged to carefully read and strictly follow the instructions in the re-credentialing application packet.

If you have any questions please contact us via your preferred method as provided below.

Email: credentialingteam@smokymountaincenter.com 

Phone: 1-855-432-9139

Website: www.smokymountaincenter.com/credentialing 

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 outcomes 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. Providers with questions about contracts please contact your Account Specialist or call 866-990-9712.

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.

Please see link for current 2015 NC SNAP Examiners Certification Schedule.

See link for registration information.