General inquiries: 828-225-2784
Provider questions: Call 1-866-990-9712, contact your account specialist or email
Confidential Compliance Hotline for suspected fraud and abuse: Report online or call 1-866-916-4255
AlphaMCS technical support: 828-225-2784, ext. 1500, 8:30 a.m. to 5 p.m. M-F
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Changes to Medicaid B3 service definitions
A number of Medicaid B3 service definitions are changing as of September 15, 2015. Please review the changes below.
Respite:
A signed service order is no longer a prerequisite to service delivery.
A Person Centered Plan (PCP) is no longer required for a consumer receiving only respite services. An individualized treatment plan, developed in partnership with the consumer/legally responsible person, should be used instead. The plan should be based on an assessment and include the following components: a) expected outcomes and anticipated date of achievement; b) strategies and interventions to be used; c) schedule for review of the plan, at least annually; d) written agreement with the plan by the consumer or legally responsible party; e) dated signature consumer/legally responsible person and the person responsible for creation of the plan.
Authorization may be up to one year, but must align with plan dates.
Note that Mental Health Substance Use B3 respite for children and adolescents is available for individuals with a diagnosis of Autism Spectrum Disorder.
Peer Support:
A signed service order is no longer a prerequisite to service delivery.
Prior authorization is no longer required.
A Comprehensive Clinical Assessment (CCA) is not required for the first six days of billed Peer Support Service.
Providers must continue to assess for medical necessity of the service and provide appropriate services for the population.
Community Guide:
A signed service order is no longer a prerequisite to service delivery.
Authorization may be up to one year, but must align with plan dates.
Intellectual and Developmental Disability Supported Employment/Long Term Vocational Support (LTVS): Prior authorization is not required for first 64 units for initial engagement. A maximum of 70 hours (280 units) per month for the first 90 days of services may be requested for initial job development, training and support.
LTVS is valid for a 12-month authorization period.
Authorization guidelines are available on the Authorization Info page of the Smoky website. For questions, or additional information, please call the Care Management team at 828-225-2785, ext. 1513.
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About provider email alerts
You are receiving this alert because you are a member of the Smoky provider network or have signed up for our Provider Network Bulletin. Smoky issues email alerts to convey critical information as soon as possible. Please note that if you unsubscribe from these alerts, you will also be removed from the Provider Network Bulletin mailing list and may miss out on important information. unencrypt |
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Smoky Mountain LME/MCO | 200 Ridgefield Court, Suite 206 | Asheville, NC 28806
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Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual/developmental disabilities in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey counties in North Carolina. For immediate help or information about services, call 1-800-849-6127, 24 hours a day (TTY: Relay NC 711). Visit us at www.smokymountaincenter.com.
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