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Medicare and Medicaid 50th Anniversary Countdown
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Welcome to the Smoky Mountain LME/MCO Provider Network Bulletin. This monthly bulletin features news you need to know as a provider in the Smoky network and information you need to do business with Smoky.
Smoky manages public funds for mental health, substance use and intellectual or developmental disability services in 23 counties in western North Carolina. It is our pleasure to work with you to serve the needs of our local residents. |
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 Recently, Smoky CEO Brian Ingraham offered me a challenge: putting my thoughts and feelings to paper for a monthly column in this bulletin. I immediately went to my head, and my emotions of fear for being judged and lack of self-confidence rose to the surface. When I remembered my daily practice of relaxing, smiling, taking a deep breath and feeling my heart, I quickly found the peace, calm, love and confidence to write to you monthly.
My heart helped me realize I need to share with you not only day-to-day system issues that command our attention, but also how vital it is for me to share the importance of how all of us who touch people must stay true to our hearts, even in a business world. We must manage our emotions to make value-based decisions for all. Therefore, my "little corner" - entitled "The Heart of the Matter" - will hopefully inspire all of us to be heart-centered leaders in this person-centered world. I use the term "leaders" to define each and every one of you, as each of you is a leader within your circle of influence. This column is not just for CEOs, presidents, vice presidents or administrators - it's for every one of us, as we are all leaders in our own right.
I hope to delve not solely into matters of business operations, but also into deeper human attributes and capabilities that allow us to effect positive change in our lives and the lives of others. I'd like this first column to serve as a cornerstone to connect future installments.
Our public service delivery system in North Carolina for mental health, substance use and intellectual and developmental disabilities was built on a noble set of values. These values are represented through person-centered practices that include person-centered thinking and planning, recovery and Wellness Recovery Action Plans® (WRAP®), System of Care (Child and Family Teams), self-direction and self-determination. The values within these practices have impact on how the system, Smoky, I and hopefully each of you not only conduct business, but also how we build and maintain relationships.
The first value that commands our attention is person-centered practices, the foundation of a system committed to ensuring quality care for people. We live and work in a time that promises great opportunity. Person-centered practices offer us the language, concepts and compassion to help us make business decisions and deliver personalized care.
As leaders, we can only implement person-centered practices to the degree that we understand these values. First, individuals must take a personal inventory and decide if these values match who they truly are. In my 30-plus years in the field, I very rarely come across a person working in the system who does not hold these values near to the heart. However, I do see many individuals struggle with how to practice these values in their work life.
We often make things more difficult than they are. For example, many thousands of people have been touched by a simple smile, act of kindness, care or honesty. In these moments, you share your heart and a belief that all of us are equal and connected. This connection emphasizes respect for everyone's dignity and integrity. This connection knows no boundaries and should be relied upon during both good and challenging times.
During challenging times, we must not sway from our values. If we do, two things typically happen. First, emotions become activated, and a negative reaction tends to take over our decision-making abilities. Second, this reaction takes us further away from our heart, creating less tolerance and acceptance of differences. For example, Smoky recently made decisions regarding managing the provider network. Even though we at Smoky know we based these decisions on our values, some individuals have been critical of our decisions. While some people felt challenged, others voiced support for our efforts to ensure long-term sustainability of care for individuals, regardless of future budget cuts and possible new requirements. Decisions like these provide an opportunity to stay engaged and practice many of the aforementioned values.
I invite you to revisit this core set of values, these person-centered practices, upon which everything we do is built. We are all students of these values and principles, and I challenge you to practice along with me. At times, this may be awkward and hard, but we must realize our commitment to people, each other and ourselves.
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Smoky general information
All Smoky departments and staff can be reached at 828-586-5501.
Administrative headquarters
Smoky Mountain LME/MCO
200 Ridgefield Court, Suite 206
Asheville, NC 28806
Provider questions
Call 1-866-990-9712, send an email to
or contact your account specialist
Confidential Compliance Hotline
(To report suspected fraud or abuse): Report online or call 1-866-916-4255, 24 hours a day
AlphaMCS technical support
Call 828-586-5501, ext. 1500, 8:30 a.m. to 5 p.m. Monday through Friday
Incident reporting
More information
Visit the Smoky website for more about:
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UPDATES: PROVIDER
ADVISORY
COUNCIL
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Smoky's Provider Advisory Council is representative of different types of providers practicing throughout our 23-county catchment area. To find out more, view Council meeting minutes and get information about upcoming events, go to the Council's page on the Smoky website.
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UPCOMING TRAININGS & EVENTS
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Preparing for the Future: What you need to know about Certified Community Behavioral Health Clinics (CCBHCs)
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New Program Supports Behavioral Health Treatment Providers
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August 5, 2015 - Asheville
August 26, 2015 - Morganton
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SAVE THE DATE: Smoky Provider Summit
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We are excited to announce a full-day Smoky Mountain LME/MCO Provider Summit on September 21, 2015 in Asheville, NC. Please hold the date and join your colleagues for this dynamic summit. Details including topics and speakers will be provided soon.
Monday, September 21, 2015
Renaissance Asheville Hotel
31 Woodfin Street
Asheville, North Carolina |
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Developmental Screening and Developmental Testing Codes: Joint Communication Bulletin #J139
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Smoky Mountain LME/MCO has made the business decision to follow the requirements for billing codes 96110 (developmental screening) and 96111 (developmental testing) that exist in Clinical Coverage Policy (CCP) 8C. Please see the excerpt below taken from the table on pages 31-32 of the referenced CCP. For more detailed information, please read the entire CCP.
For Psychiatric Diagnostic Evaluation, Psychotherapy, Medication Management, Crisis, and Psychological Testing CPT codes use the following:
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Updating diagnosis in AlphaMCS
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If a service recipient receives an updated evaluation that changes the diagnosis, please submit the diagnosis(es) into AlphaMCS via a client update.
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Update: Harris Regional Project SEARCH
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 The Harris Regional Project SEARCH program celebrated the successful completion of its first year on June 29, 2015 with a graduation for this year's participants.
Project SEARCH is a one year internship program for young adults with intellectual and/or developmental disabilities. It provides a real work experience in an inclusive environment.
In the Spring of 2014, with support from the North Carolina Council on Developmental Disabilities, Smoky partnered with the North Carolina Division of Vocational Rehabilitation Services, Harris Regional Hospital, Southwestern Community College, and Vocational Opportunities of Cherokee to initiate the first Project SEARCH site within Smoky's catchment area. This program offered the six selected participants three different internships of their choosing during the course of a year. The goal of the program is for the participants to gain professional experience, exposure, and references so that they can obtain competitive employment in community-based settings.
The Harris Regional Project SEARCH program is actively recruiting for next year's participants. Eligible participants must have exited high school; have an intellectual and/or developmental disability; live in Jackson, Macon or Swain counties; and be between the ages of 18 and 29. For more information, or to fill out a pre-application form please view the attached document. |
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Updates to SARS for Major Depressive Disorder
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Smoky's Clinical Advisory Committee works with providers to review and endorse clinical guidelines for the treatment of commonly diagnosed illnesses and conditions. For treatment of Major Depressive Disorder, Smoky endorses the clinical guidelines for adults developed by the Department of Veteran Affairs and the clinical guidelines for children and adolescents as outlined by the American Academy of Child and Adolescent Psychiatry.
Effective July 1, 2015, Smoky's Care Management Team now incorporates inquiries into the use of the endorsed clinical guidelines for treatment of Major Depressive Disorder as part of their review of Service Authorization Requests (SARS). Please review the guidelines and be prepared to include the following information in documentation and/or clinical rationale.
For Adult consumers:
- Completion of a standardized assessment (e.g., PHQ-9, Beck Depression Inventory, DLA-20)
- Evidence the consumer has been given psychoeducational information about the nature of depression, its typical course and treatment and available treatment alternatives
- Evidence the consumer has been referred for a medication evaluation if the diagnosis is moderate or severe
For Child consumers:
- Evidence the consumer has been referred for medication evaluation or specialized therapy (i.e., CBT rather than supportive counseling services) if the depression is diagnosed as moderate, severe, chronic or recurrent
- Evidence the consumer has been given age-appropriate psychoeducational information about the nature and treatment of depression
- Evidence the family/guardian has been given psychoeducational information about the nature and treatment of depression
In cases where documentation provided does not yield evidence of the clinical guidelines standards above, a care manager will contact you for more information.
Smoky's review of best practices to ensure compliance with clinical guidelines will focus initially on treatment of Major Depressive Disorder. As review tools are developed for other diagnoses, Smoky will begin to monitor adherence to corresponding guidelines.
We are grateful to you and your efforts to deliver high-quality, effective services. Adherence to clinical guidelines is only one of many ways our providers support consumers. If you have questions, please contact the Smoky Care Management Team at UM@smokymountaincenter.com or at 828-225-2785, ext. 1902.
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Community Activity and Employment Transitions Pilot
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 Smoky will be supporting a new pilot, the Community Activity and Employment Transitions (CAET) model in fiscal year 2015-2016.
CAET provides individual and small group supervision and services during a substantial part of the day in a fully integrated setting with access to the community and community resources. The CAET model promotes individual informed choice and follows the NC Employment First principles.
CAET is designed to support the individual's personal independence and promote social, physical and emotional well-being through activities such as integrated employment supports, community inclusion, social skills development, leisure activities, training in daily living skills, improvement of health status and utilization of community resources.
This service supports people who are currently enrolled or have been in facility-based services, like Adult Developmental Vocational Programs (ADVP). The expected outcome is for individuals to achieve the greatest level of personal independence, which encompasses the promotion of social, physical, financial and emotional well-being. |
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Monthly or Quarterly Notes/Grids Documentation Requirements
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Service providers should refer to the DMH/DD/SAS Records Management and Documentation Manual (RMDM) for the minimum documentation requirements for service notes or grids in the Clinical Coverage Policies. Each claim submitted to Smoky must be supported by the minimum documentation required in the service definition/RMDM. If the note does not comply with the minimum requirements, an overpayment to the provider may be identified. You can find further information on the NC DMH/DD/SAS website. Please see the excerpt below.
DMH/DD/SAS Section 8.1 of APSM 45-2:
Documenting Service Provision in a Service Note or Grid
"In most cases, when an individual receives a service, the person who provided that service shall write and sign the service note. This requirement is applicable for all periodic and twenty-four hour services.
For some services where the frequency requirement for documentation of progress spans a range of time, e.g., monthly or quarterly, and/or where one or more service providers within the same team/agency have carried out the same discrete service for an individual on different days, then the Qualified Professional or other designated staff [one of whom directly provided the service during the time frame in which the service was provided] is responsible for gathering all the relevant information from the other staff on the team and writing and signing a composite service note that outlines the individual's progress during that service period. Such documentation of progress must be based on the individualized goals that were the focus of intervention for the time period being addressed in the service note."
For example, a weekly note or grid that documents progress toward individualized goals secondary to the provision of In-Home Skill Building must have the signature of the QP who supervises the direct care professional providing the service. If that individual is not available, another designated staff member may sign; however, that staff member must verify the information provided on the note/grid, AND must have provided In-Home Skill Building during the same period of time for which the note is written. |
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Contracting and Credentialing Process Change
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To streamline processing, the Western Regional Partnership (WRP) has revised the Request for Nomination and the Provider Change/Add/Delete Request forms.
Revisions to the Request for Nomination form include network changes that must be evaluated by individual LME/MCOs. These forms will continue to be submitted directly to the LME/MCO.
Revisions to the Provider Change/Add/Delete Request form include general changes that can be processed by the Smoky Credentialing Team on behalf of all three organizations.
The purpose, submission instructions and website addresses for each of the documents are listed in the table below. Current versions of the forms are now available on the WRP LME/MCO websites. Please note that prior versions of these forms will not be accepted as of June 15, 2015.
If you have any questions please contact the Smoky Credentialing Team by email at credentialingteam@smokymountaincenter.com, or call 1-855-432-9139 or visit the credentialing section of the Smoky website.
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CNDS numbers
Beginning July 1, 2015, Common Name Database Services (CNDS) numbers are now a required element for submission of NC-TOPPS interviews. By adding the CNDS number, NC-TOPPS will able to link to other state databases and the data will be used for block grant reporting.
For Medicaid consumers, the CNDS number is the individual's Medicaid number. For non-Medicaid consumers receiving a service requiring submission of NC-TOPPS, providers must request a CNDS number through the Smoky NC-TOPPS HelpDesk. Get your request in as soon as possible. For more information, email nctopps@smokymountaincenter.com.
Zixmail
Smoky is committed to ensuring the privacy of the people we serve. On July 1, 2015, Smoky began encrypting all outbound email by default to better meet the privacy needs of providers, consumers, family members and other stakeholders.
Zixmail is the only acceptable form of encryption when emailing protected health information (PHI). If an email comes in to the Smoky NC-TOPPS HelpDesk in another encrypted format, we will send a notice to the sender noting we cannot open this encryption type and to please resubmit via Zixmail.
If you have done so in the past, you may continue to retrieve emails via the Smoky secure email portal. If you are new to our secure email, please read the instructions and view our new training video to learn how to establish a ZixPortal account and open and respond to Zix-encrypted secure email.
If you have questions, please email helpdesk@smokymountaincenter.com or call 828-225-2785, ext. 1500.
Hierarchy of Submission
The Smoky NC-TOPPS HelpDesk has received inquires regarding who is responsible for submission of a NC-TOPPS Interview when a consumer is receiving multiple eligible services. The provider for the service type higher on the hierarchy has the responsibility for submitting and updating NC-TOPPS information. Please review the hierarchy of submission below.
Adult MH/SU
- Residential Services
- Partial Hospitalization
- Assertive Community Treatment Team (ACTT)
- Substance Abuse Comprehensive Outpatient Treatment
- Substance Abuse Intensive Outpatient Treatment
- Community Support Team
- Opioid Treatment
- Supported Employment or Long Term Vocational Supports
- Periodic (State Funded SU only)
Child MH/SU
- Residential PRTF
- Partial Hospitalization
- Multisystemic Therapy Service
- Intensive In-Home
- Substance Abuse Intensive Outpatient
- Child and Adolescent Day Treatment
- Residential Services (except PRTF) & Therapeutic Foster Care
- Supported Employment or Long Term Vocational Supports
- Periodic (State Funded SU only)
Face-to-Face Interviews
Please remember that the expectation from the State and Smoky is that NC-TOPPS interviews be conducted face-to-face with the consumer/family by the second billable visit. If an interview cannot be completed face-to-face, documentation should be in the consumer's record as to why this was not done.
We need your feedback!
Is your agency using NC-TOPPS data? If so, tell us how? Please email nctopps@smokymountaincenter.com and let us know.
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NC Innovations Waiver: Same Staff Different Service
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Under the NC Innovations Waiver, certain services cannot be provided at the same time. Residential Supports is classified as a 24-hour service. Other services and supports, including Community Networking, Day Supports and/or Supported Employment, cannot duplicate services provided under Residential Supports, nor can they be provided at the same time as Residential Supports. As a result, the same Direct Support Professional (DSP) typically cannot provide residential supports and any other periodic services on the same day to the same waiver participant.
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Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual and developmental disabilities in the North Carolina counties of Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey.
For immediate help in a crisis, information about services, screenings and treatment referrals, call 1-800-849-6127, 24 hours a day,
seven days a week (TTY: Call Relay NC 711). Visit us online at www.smokymountaincenter.com.
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