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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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In December, a 21-year-old performer in the Old Moscow Circus dove 90 feet from the tightrope to a safety net below. The move, known as a 'drop', is a regular part of acrobatic acts. But during this performance, the safety net gave way. Amazingly, the woman suffered only minor injuries.
We all have our own safety nets woven of the supports and services we need, from spellcheck to savings accounts to friends and family. When well constructed, these supports provide the help we need to live the lives we choose. But if cords within the net are weak or torn, we struggle to maintain our focus and purpose. As a provider, you are a vital part of the fabric woven together for each individual you serve. And within that fabric is a critical component ensuring the safety and well-being of the individual: a comprehensive crisis plan (CCP). How are the CCPs you have developed for those individuals you serve? Are they strong and secure, or perhaps a bit worn and starting to fray? A recent review of 2014 rapid readmits (individuals readmitted for inpatient stays within 30 days of discharge) found that 42% of individuals with an active provider either did not have a crisis plan or the plan was outdated. As part of the Crisis Solutions Initiative, the North Carolina Department of Health and Human Services (NC DHHS) identified the importance of a CCP in developing an effective crisis intervention strategy and reducing the number of emergency department (ED) visits. NC DHHS requires a CCP as part of every Person-Centered Plan.
For individuals with intellectual or developmental disabilities, avoidable visits to the ED can have an exceptionally detrimental effect. Often isolated from familiar support staff or loved ones with limited access to alternative means of communication, individuals in prolonged ED settings experience worsened or even new symptoms. Among individuals with dual diagnoses, the emergence of mental health or substance use can often be traced back to trauma. Without access to their support systems, each trip to the ED is another potentially traumatic event for these individuals we are committed to serving.
As a vital part of the support system woven together for the individuals we serve, our providers have an opportunity to take the lead in educating other sectors of the healthcare system on the importance of crisis planning for individuals with intellectual and developmental disabilities. Are you ready to get started? - Review the CCPs of those you currently serve. Follow the tips we shared in a December communication bulletin to ensure your plans are strong and tailored specifically to the individual.
- If you are an Innovations Waiver contracted provider, read the update below regarding crisis services and the requirements outlined in Clinical Coverage Policy 8P.
- Attend a training on crisis planning. Benchmarks offers an online course.
Together we can ensure the individuals we serve have the supports they need to live the lives they choose. We at Smoky are grateful to be on this journey with you.
Smiling to your heart,
Christina
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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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UPCOMING TRAININGS & EVENTS
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Tuesdays from 6:00 to 7:00 p.m.
For professionals in Human Services
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Visit these sites for additional training opportunities:
Click here to view the NC Council of Community Programs calendar
Click here to view the MAHEC calendar
Click here to view the Northwest AHEC calendar |
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Innovations providers crisis services
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The North Carolina Innovations Waiver provides support for individuals with intellectual and developmental disabilities, giving individuals and families more control over their lives. The waiver is a resource for funding an array of services, including crisis services.
Crisis Services - Primary Response (H2011HI) or a Memorandum of Agreement with an in-network provider of the same is required of providers of the following waiver services:
- Residential Supports
- In-home Skill Building
- Personal Care
- In-home Intensive Supports
Expectations for Crisis Services - Primary Response are outlined in Clinical Coverage Policy 8P. The service may be accessed by telephone or planned through the Individual Support Plan (ISP) to meet the needs of the member.
Providers must ensure compliance with this mandated requirement by taking one of the following actions:
1. If the provider has the infrastructure to provide Crisis Services - Primary Response, the provider may request the service be added to their contract.
OR
2. If the provider is not contracted for Crisis Services - Primary Response and does not wish to become contracted for the service, the provider must notify Smoky of the provider with whom a Memorandum of Agreement has been established.
Questions? Email providerinfo@smokymountaincenter.com.
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Medicaid (b)(3) Respite update
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We have updated our authorization process to make it easier for members to access Medicaid (b)(3) Respite services.
Medicaid (b)(3) Respite may now be utilized for eligible member populations without prior authorization for a maximum of 1,536 units (384 hours or 24 days) per calendar year. Prior authorization is required for utilization above the annual amount.
Who is eligible?
- Children ages 3-20 with a mental health, substance use, or intellectual or developmental disability diagnosis
- Adults age 21 and older with an intellectual or developmental disability diagnosis
Medicaid (b)(3) Respite may be provided for individuals living in therapeutic foster care (TFC) settings or alternative family living (AFL) placements. The service may also be provided to complement intensive in-home (IIH) services and day treatment services. Providers are encouraged to use Medicaid (b)(3) Respite to support community-based living arrangements and avert crisis situations.
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Open for comment: TBI Waiver amendment
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The public comment period for the North Carolina TBI Waiver amendment is now open. Use the following links for more information:
The 30-day public comment period will end at 12:01 a.m. on February 26, 2016.
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Training opportunity: Innovations Waiver Amendment implementation
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Supporting Individual Success: 2016 Innovations Waiver implementation
 DATE:
Monday, February 29, 2016 OR
Monday, March 7, 2016
TIME:
9:30 a.m. to 3:30 p.m. (Lunch on your own)
LOCATION:
MAHEC
119 Hendersonville Road
Asheville, NC 28803
What does the training cover? Participants will gain the technical knowledge and understanding needed to transition waiver participants as required by the amendment. Led by Smoky staff trained by NC DHHS for these sessions, segment topics will include: - Resource allocation and individual budgeting
- Increased flexibility of services through definition changes
- New Innovations services and implementation expectations
- Community supports and living
- Supported living
- Roles in transition to the new waiver
- Self-direction
Who should attend? Innovations providers and Smoky staff
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2016 START Institute coming to Atlanta in March
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We are proud to be a sponsor of the START National Training Institute, held this year from March 14-16 in Atlanta.
Provided by the University of New Hampshire Institute on Disability's Center for START Services, the institute is geared toward anyone interested in improving services and supports for people with intellectual/ developmental disabilities (I/DD) and behavioral health needs. START teams and their partners, families, self-advocates, social workers, direct support professionals, case managers, service coordinators, educators, physicians, nurses, emergency services personnel and mental health crisis team workers are encouraged to attend. This year's event, "It Takes a Village: The Value of Community Networks," features nationally-recognized keynote speakers and presenters, networking opportunities, interactive sessions and panel discussions on evidence-based practices to improve the lives of individuals with an I/DD and behavioral health needs.
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Provider incident reporting updates
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Friendly reminders to help reduce resubmissions
Information from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services
- Decide on the exact format for your facility name and be consistent in entering it in the "Corporation" field of incident reports.
- If your agency has more than one location, specify the site in the "Local Facility Name" field.
- Always use your agency's email address rather than a personal email (Yahoo, Gmail, etc.).
- It is strongly recommended to include two different contact persons in an incident report. This allows a second person to receive inquiries in case the other person exits the agency.
- List one person in the field "Name and Title of Person completing this form"
- List a different person in the "Name of Supervisor Authorizing Report" field
Reminders about requirements for reporting consumer deaths
- A provider must report a consumer death as soon as the provider is aware of it, even if the death did not occur while the individual was under the provider's care.
- Providers should give verbal notification via phone call, voicemail or email within 24 hours of discovery. An incident report should be submitted within 72 hours.
- When completing an incident report for a consumer's death, the provider must indicate in the comments section if and when a copy of the medical examiner's report/death certificate was requested.
- Any death should initially be reported as a Level 3 with unknown causes until the cause has been officially established by:
- A medical examiner's report
- Death certificate
- Once that documentation is received, it should be uploaded to the IRIS report and the manner of death should be changed accordingly.
- A description detailing how the agency became aware of the consumer's death should be included as well.
Always provide as much information as you can about the consumer's death.
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Useful resources: Screening and assessing for trauma
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Looking to further develop your knowledge of trauma-informed care? Check out the links below for wide-ranging information on screening and assessing for trauma.
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Provider Advisory Council updates
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The Smoky Provider Advisory Council (PAC) provides valuable input, feedback and guidance to Smoky from the service provider's perspective. Representing providers throughout Smoky's 23-county catchment area, the PAC is composed of 32 voting members as well as non-voting participants, including representatives from provider agencies, hospitals, CCNC and Smoky, licensed independent practitioners and members of the Consumer and Family Advisory Committee (CFAC).
The PAC meets the third Wednesday of every month from 10:00 a.m. to 12:30 p.m. February, March and April 2016 meetings will be held at the Western Carolina University campus in Biltmore Park Town Square off I-26 near Asheville.
In addition to the PAC, four Regional Provider Councils (RPCs) meet monthly at localized sites.
| Northern | Central | Western | Highlands | Alleghany
Ashe
Avery
Watauga
Wilkes
| Alexander
Caldwell
McDowell
| Cherokee
Clay
Graham
Haywood
Jackson
Macon
Swain
| Buncombe
Henderson
Madison
Mitchell
Polk
Rutherford, Transylvania
Yancey
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This month, the PAC will begin using MyCommittee.com to share information about meeting times and locations, agendas, meeting minutes, voting members, officers, by-laws and other council-related business. Members will also be able to request agenda items directly through the website.
The PAC and Smoky are currently working to upload names and email addresses of:
- voting members of the PAC;
- individuals who have signed in to PAC and RPC meetings over the course of the past year;
- executive-level individuals from contracted Smoky providers who have contact information loaded into AlphaMCS.
Thank you,
Duncan Sumpter, Chair Jeanne Duncan, Vice Chair Carson Ojamaa, Secretary
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Implementation update: Child and Adolescent Needs Survey
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Full implementation of the Child and Adolescent Needs Survey (CANS) as a prerequisite to requesting or delivering services has been postponed until March 1, 2016.
CANS is an open domain tool for use in service delivery systems that address the mental health of children, adolescents and their families to support care planning and decision making. Staff members who administer the CANS are not required to be licensed clinicians, but must complete the online training and pass the training test.Providers should maintain certificates of training completion for staff responsible for administering the CANS.
Providers should train on the current CANS 0-4 tool, which the developer has verified is appropriate for children through age 5.
Timelines for completion of the CANS are below:
Child receiving enhanced Medicaid services that require authorization
| Initial CANS should be administered within the first authorization period and included in the first concurrent authorization request
| Updated CANS should be completed if enhanced services will be provided for more than six months and with each concurrent request thereafter
| Child receiving enhanced Medicaid services that do not require prior authorization
| Initial CANS should be administered within the first month of service and a copy should be maintained in consumer record
| Updated CANS should be completed when the annual Person Centered Plan is updated
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Questions? Please contact the Care Management Department at 1-800-893-6246, ext. 1513.
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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.
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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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