Hot Topics

(11.14.2008)
Attention – Providers Offering Community Support:

Please review Implementation Update #45 regarding the 25% Qualified Professional
requirement.

Your agency will be receiving a letter by the U.S. Postal Service each month from the Wake County LME with the "rolling" average of QP time based on the service and the site. It is very important that your agency is tracking billable units and paid claims for Community Support, also.

We are also posting a spreadsheet with the current "rolling" average data for all providers of Community Support Services in Wake County. An updated spreadsheet will be posted each month.

25% QP rolling average August - October 08

If you have any questions, please feel free to call Dave Peterson at 919-856-6440 or e-mail him at david.peterson@co.wake.nc.us.

(10.24.2008)
Attention CAP Providers

To be eligible to provide Home Supports, existing providers of Residential Supports, OR Home and Community Supports, OR Personal Care services are required to sign this Attestation Letter demonstrating compliance to the Home Supports service definition requirements.

Below is the revised Attestation Letter consistent with this process change. We realize the changes create more confusion, but this change is CRITICAL to ensure current families providing services have available providers for Home Supports. Please use this process and Attestation Letter and process with DMA immediately.

If you have any questions, please feel free to call Jenny Hamm at 919-856-6341 or Dave Peterson at 919-856-6412.

Attestation Letter-DMA Addendum Procedures

Attestation Letter

(9.11.2008)

URGENT: Effective August 1, 2008 - LIMITATION ON IPRS AUTHORIZATIONS

for Community Support Adult and Child/Adolescent

Wake County LME has received an "IPRS user alert" from EDS, indicating that the Division of MH/DD/SA has requested EDS implement the following change to the IPRS claims processing and payment system:

Providers of Community Support for Adults and/or Children/Adolescents will be denied payment for IPRS services in excess of 8 hours per calendar week (Sunday through Saturday) for dates of service occurring on or after August 1, 2008.

This means that IPRS billing will not be reimbursed under the same terms listed for Medicaid-funded CS in Implementation Update #47, in that pre-existing authorizations for services in excess of eight hours of CS per week will not be paid beyond the eight-hour limitation. Nor is the EPSDT option available for children eligible for IPRS-funded services.

Wake County LME urges providers to give careful consideration to these new limitations when delivering and billing for CS services.

Providers serving consumers who have existing authorizations that now exceed the allowable CS service limitations will be notified by letter. Alternative services might be a consideration for some of these consumers.

If you have any questions or concerns, please contact Larry Fuller, Utilization Review Program Manager, at 919-250-3120, or call your Wake LME UR Care Manager.

(09.05.2008)
Attention-CAP Providers

The Wake County LME would like to inform you of recent updates to the CAP waiver, which includes the requirement for CAP Providers to achieve National Accreditation.

We have been informed via e-mail by the State Division of MH/DD/SAS the following:

"Based on the new legislation the National Accreditation will be required within 1 year of waiver implementation or provider enrollment."

It is our understanding that the new waiver is currently being reviewed by the Center for Medicare and Medicaid Services and a final approval to implement the CAP waiver may come in October or November.

When we learn of anything more on the status of National Accreditation for CAP providers, we will keep you updated.

If you have any questions, please feel free to call Jenny Hamm at 919-856-6341 or Dave Peterson at 919-856-6440.

(08.21.2008)
NC-TOPPS Help Desk E-mail

The NC-TOPPS Help Desk has a new e-mail address. Please begin to use
nctopps@ncsu.edu for any questions regarding NC-TOPPS and discontinue using the following e-mails:
kathryn_long@ncsu.edu, jaclyn_johnson@ncsu.edu and alexis_lockett@ncsu.edu.

Please pass along this e-mail address to everyone in your agency.

(07.31.2008)
September is Recovery Month - the theme this year:
"Join the Voices for Recovery - Real People, Real Recovery"

Please click on the above link to find more information.

(07.21.2008)
WakeMed Substance Abuse Services Invitation to participate in
"Celebrate Recovery" Provider Fair

Provider Fair September 12, 2008 Information

(07.09.2008)
ATTENTION: Providers Who Require but have not yet Achieved National
Accreditation

Please read and follow Implementation Update #45 referenced below.

Evidence of "...a formal agreement to engage the accreditation agency of its choice." is to be sent to:

Dave Peterson
Wake County Local Management Entity
2321 Crabtree Blvd., Suite 200
Raleigh, NC 27604

Implementation Update #45 Accreditation Update
"The LMEs are tasked with receiving updates from the providers in their catchment areas according to the schedule identified in Implementation Update #42 (April 7, 2008). Per this schedule, as of May 31, 2008, the providers who were enrolled to provide community intervention services in March of 2006 should have informed the LMEs of the selection of an accreditation agency. The schedule also requires that by July 31, 2008, the provider will have presented evidence to the LME that the provider has entered into a formal agreement to engage the accreditation agency of its choice. That evidence is a letter or other formal communication from the accreditation agency that the transaction is official."

(06.17.2008)
TO Providers of Community Support Service:

Per Implementation Update #42 and #44 Community Support QP calculation is based on DATE OF PAYMENT, not date of service.

The check write Schedule can be found at http://www.dhhs.state.nc.us/dma/2003check.htm

EXAMPLE: For a claim to have been included in May 2008 Medicaid check writes:
Claim Submission:
Electronically submitted claims sent to EDS after 5 p.m. on April 17, 2008, through 5 p.m. on May 22
Paper claims – There is no way of knowing when a paper claim will be processed.

Remittance Advices:
All paid claims on the 5/6, 5/13, 5/20 and 5/29 RAs

Electronic RA (835)
Process Date of 5/2, 5/9, 5/16, and 5/23 Look in Transaction set Header Loop for
DTM*405*Process YYYYMMDD

(06.17.2008)
Community Support QP Monitoring
Medicaid Paid Units in May 2008 Check Writes
CS Sites Located in Wake County

CS 25 Percent QP

(05.14.2008)
Revised Letter of Support Procedures

The revised Letter of Support procedures may be found by clicking on the document at the top right called "Revised Letter of Support Procedures".

(05.09.2008)
TO: Providers of Community Support Service (Adult, and Child/Adolescent)

DATE: Effective May 1, 2008

Providers of Community Support Service (Adult, Child/Adolescent, and Group) should be aware of Implementation Update #42 concerning Community Support Services billing requirements for qualified professionals, which:

“Establishes a minimum 15% Qualified Professional service provision requirement for each individual served and a 25% minimum of Qualified Professional service provision at the aggregate provider level, thus expecting that providers serve consumers of varying acuity levels.”

Implementation Update #42 further states:

“Local Management Entities (LMEs) will begin monitoring the 25% requirement effective with services paid in May 2008. The LME will notify any providers whose CS paid claims during a month do not meet the 25% threshold. If a provider site falls below the 25% requirement for two months in a row, the endorsement to provide CS at that site will be withdrawn. “

Wake LME will be reviewing paid claims on a monthly basis and will be notifying any provider whose paid claims are below the 25% the first month. If this occurs for the next month (or any two months in a row) the Wake LME will:

End the contract for that Community Support service and
Withdraw the endorsement for that service.

It is the responsibility of each provider to self-monitor their claims also.

Implementation Update #42 can be found at:

www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdates/index.htm

If you have any question, please feel free to contact Patsy Coleman at Patricia.Coleman@co.wake.nc.us or Dave Peterson at David.Peterson@co.wake.nc.us.

(05.02.2008)
Attention Child Mental Health and Substance Abuse licensed residential treatment Providers:

Wake County LME is in receipt of a notice and designated time schedule for the completion of DHSR License Renewal for 2009. Please see the attachment at the top of the page titled "Renewal of DHSR License for 2009" for more information.

(04.04.2008)
Attention all Wake Providers:

Please see the flier at top of page titled "inpatient auth instructions to outpatient network" regarding authorizations for publicly funded inpatient mental health and substance abuse services.

(03.19.08)

First Responder Duties

In general, all providers in the Wake LME network are expected to have adequate after-hours coverage for consumers who need crisis assistance. Specifically, "First Responder" coverage is a required component for several of the enhanced Medicaid services.

The Wake LME is beginning to actively check after-hours response by making random calls to our providers.

Providers not responding within 15 minutes of our call, or those that do not give a contact number for emergency calls on their answering machine or answering service, will be notified on the next business day and will be expected to produce a Plan of Correction within 24 hours of notification.

The Plan of Correction will be tested within 14 days. A second failure will result in an immediate recommendation to suspend referrals to the provider for a minimum period of 30 days, and may result in further action, up to and including monitoring for withdrawal of endorsement and/or termination of an IPRS contract, should the provider be unable to demonstrate an ability to sustain a properly functioning after-hours response system within the 30-day suspension period.

Providers will also be assessed on quality measures associated with an after-hours response, including the professionalism and knowledge of the individual answering the calls. Plans of Corrections will be required if these areas are not met.

In addition, Crisis and Assessment Services will begin actively tracking misuse of the service. Clients who are open to services with a provider agency will be asked whether they have received instruction from the agency about how to contact someone after-hours and what their experience with the agency has been like if they tried to call. Providers will be contacted on an individual basis about results of these client surveys.

Thanks for your ongoing efforts to provide quality crisis response to our consumers.

(11.07.2007)

CHILD MH/SA RESIDENTIAL SERVICES / LETTER OF SUPPORT

The Wake LME has received sufficient requests to meet the needs for the provision of residential treatment for children and adolescents in Wake County. There are approximately 50 beds of multiple agencies in the process of requesting licensure in order to become endorsed. The process of requesting a letter of support for CMH/SA residential facilities is now closed.

The State has announced, in the draft contract with LMEs, its intention for a 10 percent reduction in the utilization of Level III facilities across the state.

Additional information will be provided in the coming weeks regarding steps to meet this goal in Wake County.

(09.05.2007)

North Carolina – Treatment Outcomes and Program Performance System Reports

Wake33081MatchedChildMH2006.pdf
Wake33081MatchedAdolesMH2006.pdf
Wake33081MatchedAdolesSA2006.pdf

(05.29.2007)

DEEM Community Forums

Disability & Elderly Emergency Management Initiative Forum Information and Registration

(05.18.2007)

Wake LME Consumer Co-Pay Schedule

Wake County Local Managing Entity (LME) has developed a Consumer Co-Pay Schedule for non-Medicaid services authorized and subsidized by Wake County, to be effective July 1, 2007. Below, you will find links to three documents summarizing the Co-Pay process. We appreciate your help in ensuring that our limited public funding for MH/DD/SA services is targeted to persons who most need assistance.

Letter To Providers May 16, 2007.pdf
Wake LME Consumer Co-Pay Schedule Eff 7107.pdf
Contract Agency Discharge Data Form.pdf

(05.11.2007)

Crisis Funding Available for Children Eligible for Child MH/SA Services

Please click on the links below for more information:

Crisis Funds Guidance Document Crisis Funds Service Benefits Form

(05.01.2007)

Wake LME Non-Medicaid Service Providers

Please click on the link below to read about changes regarding end-of-year timely filing requirements for non-Medicaid services:

IPRS EOY Filing Requirements memo.pdf

(04.10.2007)

Child MH/SA Residential Treatment Providers

As the fiscal year draws to a close it is very important for child mental health residential treatment providers to bill the Wake LME as soon as possible once you've determined that you can bill for room and board for consumers served in your programs. There are two instances permitting the LME to make a room and board payment. They are:

The parent of a consumer in your program has received the second denial for SSI and provided you a copy of the denial letter, or
The consumer has been awarded SSI, but the documented SSI payment is less than the total allowable for room and board per month according to the room and board guidelines.

Send questions about billing for the difference between the maximum allowable room and board rate and the approved SSI payment that your agency has received to Greta Gill at: ggill@co.wake.nc.us or call 919-212-9494.

(03.12.2007)

Wake County Local Managing Entity (LME) has developed a Consumer Co-Pay Schedule for non-Medicaid services authorized and subsidized by Wake County, to be effective July 1, 2007. It has been under development for a number of months, with input from the Consumer and Family Advisory Committee (CFAC) and the Community Provider Advisory Committee (CPAC). See the links below for complete information regarding the Consumer Co-Pay Schedule.

Co-Pay Memo 03.09.2007.doc
Consumer Co-Pay Schedule Effective 07.01.07.doc
Poverty Guidelines 2007.xls