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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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At our Provider Summit last September, a panel of industry experts and healthcare executives convened for a discussion on Medicaid reform. Among the panelists was Jeff Heck, president and CEO of Mountain Area Health Education Center (MAHEC). During the discussion, Jeff made a statement that has held space in my mind and heart since hearing it:
"Primary care and behavioral health have to work together--not just from a distance, not by telephone, not by letter. I think we have to be in each other's offices."
Although often heralded as innovative, whole-person care is a commonsense approach, ensuring that a person's physical, behavioral, cognitive and social health needs are being met. Studies show that integration of physical and behavioral care and collaboration between these healthcare providers leads to improved access to needed care, reduced cost with earlier intervention and coordination of treatment, improved consumer and provider satisfaction and better health outcomes.
Smoky set a goal for this fiscal year to establish the fundamental components for whole-person care in western North Carolina. As part of our plan, Smoky is collaborating with MAHEC and Northwest AHEC on a region-wide workforce development program designed to build providers' knowledge and skills related to whole-person and collaborative care. Course topics run the spectrum from fundamentals in integrated care concepts to chronic disease care, and are available in multiple locations.
Are you ready to join us on the journey to whole-person care in WNC? Read more about the courses and register for an upcoming class today.
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
Monday through Friday
8:30 a.m. to 5:00 p.m.
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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Brain Injury Association of N.C. Conscious Brews event
March 6, 2016
1:00 to 6:00 p.m.
Highland Brewing, Asheville, NC
The Brain Injury Association of N.C. is kicking off Brain Injury Awareness Month with an afternoon of music and fun. Visit the Facebook page for more information.
Coming Home
April 21, 2016
9:30 a.m. to 1:30 p.m.
Carolina Village, Hendersonville, NC
Land of Sky Regional Council will host an information session on the transition to community living. Attendees will learn about available resources and services, as well as strategies for overcoming housing barriers.
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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 Waiver amendment delay
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Implementation of the Innovations Waiver technical amendment has been delayed. The projected implementation date has been moved from April 1, 2016, to July 1, 2016.
Interested in learning more about the amendment? Attend an upcoming training led by Smoky staff. Find out more below.
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Training opportunity: 2016 Innovations Waiver implementation
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DATE:
Monday, March 7, 2016 TIME:9:30 a.m. to 3:30 p.m. (Lunch on your own) LOCATION:MAHEC119 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 for these sessions by the North Carolina Department of Health and Human Services, 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 Seating is limited, and registration is required. Register online by Thursday, March 3, 2016 to secure your space.
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Medicaid (b)(3) Respite rate change
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Medicaid (b)(3) Respite rates will increase as of April 1, 2016.
| Previous rate | Revised rate | |
Individual
| $3.88 per unit | $4.75 per unit | |
Group
| $3.00 per unit | $3.67 per unit |
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Upcoming program changes and tips to avoid care disruptions
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The N.C. Medicaid Outpatient Pharmacy Program has made changes to three important programs affecting antipsychotic prescribing for Medicaid beneficiaries. These changes take effect June 5, 2016.
Affected programs are:
Antipsychotics - Keeping Documented for Safety (A+KIDS)
Adult Safety with Antipsychotic Prescribing (ASAP)
The antipsychotic portion of the Preferred Drug List (PDL)
Providers must complete an A+KIDS or ASAP prior authorization (PA) for any preferred or non-preferred antipsychotic medication for all Medicaid beneficiaries through the NCTracks Provider Portal or by calling CSC at 1-866-246-8505. There are no fax forms for these programs.
The following points can help avoid care disruptions when prescribing antipsychotic agents for Medicaid beneficiaries, both in primary or behavioral health settings.
- Providers must be proactive on PAs for children/adolescents under 18. Each new antipsychotic prescription in this age group requires an NCTracks PA, so providers should not wait on a PA request from the pharmacy. Once approved for a specific patient and medication, the PA is effective for six months.
- Providers are encouraged to document the PA approval date in their medical records or on a separate sheet. Once authorized, the PA is effective for six months and is at the drug level, meaning it remains in effect if the dose changes. However, another PA is required if the medication switches to a different antipsychotic agent.
- For adults aged 18 and older with "on label" use (FDA approved use) of preferred agents, write "meets PA criteria" on the paper Rx or in the electronic Rx comments section. Most patients seeing a psychiatrist meet PA criteria.
- For "off label" use (non-FDA approved indication), or when prescribing a non-preferred agent, providers should be proactive in having the PA process initiated and approved. We recommend providers document the PA approval date in their medical record. For adults, the PA is effective for one year from approval.
- For all prescriptions requiring a PA, consider writing "PA in process" on the prescription to alert the pharmacy to wait as permissible by the situation (in the pharmacist's professional judgement) before using an override. A 72-hour emergency supply is available for use by the community pharmacy in case the PA has not been initiated or approved.
- Except in acute situations or emergencies, discourage patients from visiting the pharmacy directly to pick up the antipsychotic prescription. This allows time to input the PA request and have it approved.
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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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