Hot Topics

(10.22.09)

The following are some important updates for the Provider Network from both the Division of MH/DD/SAS and the Wake LME.

Providers are expected to read the Communication Bulletins, Announcements and Implementation Updates found at: www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdates/index.htm.

Revised IPRS Rates Effective 10-1-09 Dates of Service

Please use the link below to the Rate Table which includes a number of rate changes for IPRS services that are consistent with Medicaid rate changes for the same or similar services. The new rates are effective with dates of service 10-01.

Wake LME Rate Table Effective 10.01.09

The link below with take you to the new version of the Non-Medicaid Service Reporting Form. It is required that Non-Medicaid billing for Direct Enrolled Behavioral Health Outpatient providers be submitted to Wake County Claims Unit on this new form, for service dates 10-01-09 and later. This will ensure that the correct rate is used.

WCHSNonMedicaidSvcandAdjustmentFormsv1012009.xls

New Contact Information for Wake LME Claims Unit

The Wake LME Claims Unit Supervisor is Cynthia Henderson. Her unit now receives and processes claims in addition to processing payments. You no longer need to contact Alice Wilkerson's unit regarding claims. Cynthia's contact information is:

Wake LME Claims Unit
Cynthia Henderson
401 E. Whitaker Mill Road
Raleigh, NC 27608
919-856-7361
NEW FAX FOR SUBMITTING CLAIMS: 919-664-7929 – Effective Immediately!

Required Changes for Authorizing Youth for Residential Treatment

Endorsement Updates

Please open for information from Implementation Update #62 on new time frames and new processes for endorsement.

CAP Re-endorsement Process

If your agency has its corporate office in Wake County and has not submitted the Attestation Letter with supporting documentation, please do so immediately.

Provider Responsibility for Retention of Records

Please open for information from Implementation Update #62 concerning record retention. The LME will be reviewing all providers' record retention plans and procedures to assure that they meet these requirements.

(10.12.09)

This Excel spreadsheet contains CMH/SA provider information regarding the availability to accept new referrals for services. This information is provided to assist Child and Family Teams as they plan for appropriate services for youth involved in the Level III and Level IV residential services transition. Updates will be published in the workbook as providers' update their capacity to accept referrals.

Providers should send updated information to wakecountysystemofcare@wakegov.com only as capacity changes.

(10.12.09)

The IRIS go-live date has been postponed. We have been told that it may go live by the end of October. You will be notified of the official date.

Providers cannot submit real incident reports via the IRIS test site. The test site is temporarily closed to prevent more test site submissions. Please continue to submit incident reports as usual.

(9.21.09)

This e-mail is from the State Division of MH/DD/SAS. If you have any questions, please feel free to contact Dave Peterson at david.peterson@wakegov.com.

Per our conversation at the Area Director's Forum and conversations we have been having in the Community Support Workgroup, please accept this email as authorization to triple the endorsement time frames until further notice. We will announce this change to the field in the October Implementation Update, but we wanted to let you know now so that you can go ahead and plan accordingly. This change is being made for two reasons:

We realize that your LME Systems Management Funds have been reduced and you may be having to try to do the same amount of work with fewer staff, and
As Community Support providers start to transition into other services.

(9.16.09)

Attention Providers Offering Community Support:

Please review Implementation Update #45 and Implementation Update #54 regarding the 25% and 35% 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.

35% QP rolling average June - August 09

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

(9.14.09)

ALL CAP PROVIDERS:

Since the endorsement period is good for three years, most Wake LME CAP Providers are needing to be re-endorsed before 10/15/09. We are requiring CAP providers to submit a Re-Endorsement Attestation Letter (see attached) along with the supporting documents required in the attestation letter. We are also requiring a change form to be completed if there were changes within the agency in the last three years. If you have any questions, please feel free to e-mail Dave Peterson at david.peterson@wakegov.com.

Attestation Letter for Re-Endorsement 09

(8.20.09)

Attention Providers Offering Community Support:

Please review Implementation Update #45 and Implementation Update #54 regarding the 25% and 35% Qualified Professional requirement.

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.

35% QP rolling average May - July 09

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

(8.14.09)

Reminder to providers applying for endorsed services:
Per the state Division of MH/DD/SAS policy on Endorsement, all applications must be submitted via certified mail.

"The Division of Medical Assistance Community Intervention Services Provider Enrollment Package must be submitted with return receipt/certified mail to the Endorsing Agency in which the provider organization’s service is located."

If you have any questions, please feel free to contact Dave Peterson at david.peterson@wakegov.com.

(8.04.09)

Please see the document at the top of the page titled "DMHDDSA Plan of Correction Policy and Procedures". This is the Divisions Policy and Procedure for the Review Approval and Follow-up of Plan(s) of Correction (POC).

Effective Immediately

IPRS or state-funded referrals to community providers for adults with substance use and mental health needs will resume.

In light of the continued increase in demand for services and anticipated budget cuts, we are currently working to refine our benefits plans. Further information regarding these changes will be disseminated once finalized. We appreciate your input and continued support.

(7.10.09)

Attention Providers Offering Community Support:

Please review Implementation Update #45 and Implementation Update #54 regarding the 25% and 35% Qualified Professional requirement.

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.

35% QP rolling average March - May 09

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

(6.22.09)
Attention Providers Offering Community Support:

Please review Implementation Update #45 and Implementation Update #54 regarding the 25% and 35% Qualified Professional requirement.

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.

35% QP rolling average March - May 09

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

(6.11.09)

NOTICE TO THE CMH/SA PROVIDER COMMUNITY & STAKEHOLDERS

One of the most significant changes to be proposed with one of the shortest timeframes from the House Money Report and Special Provisions concerns Children’s Residential Level III. (See language copied from the Money Report and Special Provisions below.)

DHHS has formed a committee consistent with the Special Provision language and put together a Committee for Transition for Residential Level III. The NC Providers Council has members participating on the committee, and through their Regulatory Committee, is forming a task group chaired by Deanna Janus with Pride of NC djanus@pridenc.com and Cliff Parker with Youth Unlimited yui@northstate.net . Input concerning this legislative change should be forwarded to the e-mail address of Deanna Janus or Cliff Parker and copied to Bob Hedrick at bob.hedrick@ncproviderscouncil.org.

From Money Report, page G13, 6-4-09

Item #125 Reduce Group Homes ($31,721,919) R ($45,109,244) R

Reduces funding for High Risk Intervention Level III and IV group homes. Retains 35% of funding for transitions to other services.

From Special Provisions, page 90, 6-4-09

15 (8) MH Residential. – The Department of Health and Human Services shall
16 restructure the Medicaid and State-funded child MH/DD/SA residential
17 services. The Division of Medical Assistance and The Division of
18 MH/DD/SA shall establish a team inclusive of providers, LMEs, prior
19 authorization vendors, and other stakeholders to assure effective transition of
20 recipients to appropriate treatment options. Included in the restructuring21 shall be the following:
22 a. On or before October 1, 2009, the Department shall eliminate High
23 Risk Intervention Residential Level III and Level IV service.
24 b. Submission to CMS of a therapeutic family service definition.
25 c. Within 30 day of this Action, the Department shall Institute a
26 moratorium on admissions High Risk Intervention Residential Level
27 III and Level IV group homes.
28 d. Thirty (30) days after enactment, any concurrent request must be
29 accompanied with a discharge plan. Discharge from the placement
30 must occur within 6 months after the submission of the discharge
31 plan.
32 e. All transition and discharge plans must be developed by the child and
33 family team and with active participation by the LME and/or the
34 Prior Authorization vendor.
35 f. Submission of discharge plan is a required document in order for the
36 request to be considered complete. Failure to submit will be returned
37 as unable to process.
38 g. Any residential provider that ceases to function as a provider shall
39 provide written notification to DMA, the Local Management Entity,
40 recipients and the prior authorization vendor 30 days prior to closing
41 of the business.
42 h. Medical and financial record retention is the responsibility of the
43 provider and shall be in compliance with the record retention
44 requirements of their Medicaid provider agreement or state-funded
45 services contract. Records shall also be available to state, federal and
46 local agencies.
47 i. Failure to comply with notification, recipient transition planning or
48 record maintenance shall result in suspension of further payment
49 until such failure is corrected. In addition, failure to comply shall
1result in denial of enrollment as a provider for any Medicaid or
2 state-funded service.

(5.27.09)

NC-TOPPS Update: Requirement for all Provider Agencies to Have Superuser

Effective July 1, 2009, all provider agencies required to submit outcomes data to the NC Treatment Outcomes and Program Performance System (NC-TOPPS) as referenced in the SFY 2008-2009 NC-TOPPS Implementation Guidelines (http://www.ncdhhs.gov/mhddsas/nctopps/systemusers.htm) must have at least one user in their agency enrolled as a Superuser. Superusers are individuals who have oversight responsibilities for their provider agency and have access to additional administrative tools to assist with such responsibilities.

To become a Superuser, the steps to follow are:

If you are not already enrolled as a user, please sign up at http://www.ncdhhs.gov/mhddsas/nc-topps and click on “User Enrollment.”
Once you have received your user ID and password, e-mail the NC-TOPPS Help Desk (nctopps@ncsu.edu) requesting to be Superuser.
For security reasons, when requesting to be a Superuser please provide the following information to verify authorization from your agency:
1. Supervisor’s name
2. Supervisor’s title
3. Supervisor’s telephone number
4. Supervisor’s e-mail address.

If you have any questions please feel free to e-mail Tammy Bonas at tammy.bonas@wakegov.com.

(5.12.09)
Attention Providers Offering Community Support:

Please review Implementation Update #45 and Implementation Update #54 regarding the 25% and 35% Qualified Professional requirement.

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%/35% QP rolling average February - April 09

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

(5.1.09)
Attention Wake County Providers of Non-Medicaid (IPRS) Funded Services for Adults with Mental Illness or Addiction and Children and Adults with Developmental Disabilities

From: Ramon Rojano, Director, Wake LME

Wake LME has experienced a growing demand for services, which has resulted in approximately 1,000 additional MH/DD/SA consumers being served to date, compared to the same time last fiscal year (an 11% increase), even with budget reductions implemented by the state. Over the past several months, Wake LME has taken a number of proactive steps in an effort to contain expanding demands on the LME’s limited non-Medicaid (IPRS) budget. Benefit plans have been redefined and narrowed, utilization management care managers have increased expectations that consumers be stepped down to fewer service units as quickly as clinically appropriate, and one DD service rate had to be decreased for at least the remainder of this fiscal year.

However, despite these actions, the increased demand for services for adults with mental illness or addiction issues and children and adults with developmental disabilities has depleted our IPRS budgets.

In order to meet our commitment to consumers currently receiving IPRS services and those agencies providing these services, the Wake LME will take the following actions for the remainder of this fiscal year:

No initial IPRS authorizations will be approved for adults with mental illness or addiction or children and adults with developmental disabilities

No IPRS authorization requests for expanded services will be approved for adults with mental illness or addiction or children and adults with developmental disabilities

Please note that there are currently no funding restrictions for IPRS-eligible children with mental health or substance abuse issues.

Beginning May 1, 2009, through June 30, 2009, Wake County Crisis Services, Wake LME’s Access Center (STR), and the DD Access and Entry unit will only refer adult consumers with Medicaid or private insurance to the community provider network. Consumers deemed “urgent” or “emergent” will be triaged to Wake County Human Services’ Behavioral Health Services programs. Consumers deemed “routine” will be offered natural supports and placed on a waiting list.

Similarly, IPRS-eligible consumers (adult MH/SA and child and adult DD) seeking new or expanded services directly from your agency will not be approved for funding effective May 8 through the end of the fiscal year. Agencies may contact the Access Center at 919-250-3133 to have those “routine” consumers placed on the LME’s waiting list. Any “urgent” or “emergent” consumers that present directly to your agency should be referred to Wake County Crisis Services, located at 3000 Falstaff Road (919-250-3133). DD Access and Entry can be contacted at 919-856-5254.

We are taking these actions to ensure current consumers can continue to receive care and that provider agencies can be reimbursed for these services. Questions related to this announcement may be directed to any of the following people:

Carlyle Johnson – 919-250-3123 or cjohnson@wakegov.com

DeDe Severino – 919-250-1534 or dede.severino@wakegov.com

Jeff Hildreth – 919-857-9108 or jhildreth@wakegov.com

Larry Fuller – 919-250-3120 or larryfuller@wakegov.com

We appreciate your willingness to work with us during these difficult economic times.

(4.28.09)
Attention All Providers
Incident Report Changes Level I, II and III

Please be aware of the changes and clarifications made in the incident reporting procedures for Level II and Level III incident reports. These changes became effective April 15, 2009. Please make sure that your agency is aware of these changes. They can be found in the NCDMH/DD/SAS implementation update #55. A link is attached for your convenience.

http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/dmadmh4-3-09update55.pdf

Level I quarterly reports (QM-11) continue to be inaccurate, late or not submitted. Providers who did not submit quarterly reports or submitted the report late for the 3rd quarter will receive a separate e-mail or letter with corrective requirements. Beginning next quarter, the 4th quarter of 08-09, any licensed agency that has a Memorandum of Agreement with the Wake LME and does not submit the QM-11 on time will be referred to the Division of Health Services Regulations. In addition, any agency not submitting the QM-11 may be subject to a focused monitoring.

Please call Robyn Powell at 919-856-6407 or e-mail rpowell@wakegov.com with any questions.

(4.21.09)
Attention All Providers:

The Division of Medical Assistance has posted a new enrollment/endorsement application. If you are adding a new service or starting the endorsement process, please use this new application. If you have any questions, please feel free to contact Dave Peterson at david.peterson@wakegov.com.

http://www.nctracks.nc.gov/provider/enrollment/cisenroll.pdf?formSelect=cisenroll.pdf

(4.15.09)
Attention Providers Offering Community Support:

Please review Implementation Update #45 and Implementation Update #54 regarding the 25% and 35% Qualified Professional requirement.

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%/35% QP rolling average January-March 09

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

(3.17.09)
Attention Providers Offering Community Support:

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

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 December 08-February 09

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

(3.10.09)
Attention Wake County Providers:

The link below is to a "Notice of Change Form" to be used by agencies to notify the Local Management Entity (LME) of significant changes to the agency. This form should be submitted by either fax (919-856-5321) or by mail to 2321 Crabtree Blvd., Suite 200, Raleigh, NC 27604.

LME Notice of Change Form

(3.10.09)
Attention Providers of Medicaid Enhanced Services:

The link below is to the State form "Notice of Change." This form is to be used by agencies when a site or service is changed. It should be submitted to both the Division of Medical Assistance (DMA) and to the Local Management Entity (LME) at 2321 Crabtree Blvd., Suite 200, Raleigh, NC 27604

State Notice of Change Form

(3.3.09)
Attention Wake Providers:

Please note the revised Person Centered Planning Instruction Manual and PCP forms are effective March 1, 2009, and have been posted on the DHHS website. Click on this link below to go directly to the Manual and the Forms.

The new "Notification of Incomplete Checkboxes on PCP Signature Page" form has a direct impact on the QP responsible for the PCP, and for the licensed professional signing the service order section of the PCP. Review the form instructions carefully.

Person Centered Planning Instruction Manual and PCP Forms

(2.27.09)
Attention Providers of Community Support – Adult and Child/Adolescent:

Please review the document titled Calculating the Community Support QP Standard (click on link) related to the change beginning on March 1, 2009, that requires Community Support providers meet a 35% QP service measure.

(2.26.2009)
Attention – Providers Offering Community Support:

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

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 November 08-January 09

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

(2.23.2009)
Attention Providers

Quarterly, the Wake County LME reviews bed occupancy reports from licensed residential facilities in Wake County to assess the need for additional beds.

Based on current occupancy, we are not accepting applications for Letter of Support for the following license types:
.1300
.1700
.5600A

If you have any questions, please feel free to contact Dave Peterson at david.peterson@wakegov.com.

(2.10.2009)
Save The Date – 3rd Annual Wake County System of Care Conference

Theme:	Change Families Can Live By
When:	May 18, 2009
Cost:	$25 Parents of children receiving mental health services may be eligible for a stipend
Purpose:	To promote partnership between families and systems including schools, court, child welfare and the mental health developmental disabilities and substance abuse services to ensure the best future for our children.
Send questions to:	wakecountysystemofcare@wakegov.com

(1.21.2009)
Attention – Providers Offering Community Support:

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

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 October-December 08

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

(12.16.2008)
ALL CAP PROVIDERS

Wake LME wants to remind CAP providers of the state's requirement to become nationally accredited. Below are two Implementation Updates from the Division of MH/DD/SAS. These benchmarks are very important. We will need to see evidence from the accrediting body in each of the benchmarks. Since the CAP waiver began 11/1/08, the 9-month benchmark is 2/1/09, the 6-month benchmark is 5/1/09, and the 3-month benchmark is 8/1/09. The final benchmark requires all CAP providers to be nationally accredited by November 1, 2009.

From the Division of MH/DD/SAS Implementation Update #48 dated 9/2/08

"National Accreditation will be required of providers of waiver services within one year of implementation of the waivers or enrollment with DMA."

From the Division of MH/DD/SAS Implementation Update #47 dated 8/1/2008.

"§ 122C-81. National accreditation benchmarks.
(d) Providers enrolled in the Medicaid program or contracting for State-funded services on or after July 1, 2008, and providing services which require national accreditation shall successfully complete all accreditation requirements and be awarded national accreditation within one year of enrollment in the Medicaid program or within two years following the provider's first contract to deliver a State-funded service requiring national accreditation. Providers providing services that require national accreditation shall be required to discontinue service delivery and shall have their Medicaid enrollment and any service contracts terminated if they do not meet the following benchmarks for demonstrating sufficient progress in achieving national accreditation following the date of enrollment in the Medicaid program or initial contract for State-funded services:

Three months: On-site accreditation review scheduled by accrediting agency as documented by a letter from the agency to the provider and completion of self-study and self-evaluation protocols distributed by the selected accrediting agency.
Six months: On-site accreditation review scheduled by accrediting agency as documented by a letter from the agency to the provider.
Nine months: Completion of on-site accreditation review, receipt of initial feedback from accrediting agency, plan to address any deficiencies identified developed.
If a provider's Medicaid enrollment or service delivery contracts are terminated as a result of failure to meet accreditation benchmarks or failure to continue to be nationally accredited, the provider will work with the LME to transition consumers served by the provider to other service providers in an orderly fashion within 60 days of notification by the LME of such failure.
A provider that has its Medicaid enrollment or service delivery contracts terminated as a result of failure to meet accreditation benchmarks or failure to continue to be nationally accredited may not reapply for enrollment in the Medicaid program or enter into any new service delivery contracts for at least one year following enrollment or contract termination."

If you have any questions please e-mail Dave Peterson at Implementation Update #45 regarding the 25% Qualified Professional requirement.

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 September-November 08

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

(11.11.2008)
Attention – Providers Offering Community Support:

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

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@wakegov.com.

(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

(10.14.2008)
Attention – Providers Offering Community Support:

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

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 July-September 08

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

(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.

(9.10.2008)
Attention – Providers Offering Community Support:

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

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 June-August 08

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

(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 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 questions, please feel free to contact Patsy Coleman at Patricia.Coleman@wakegov.com or Dave Peterson at David.Peterson@wakegov.com.

(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@wakegov.com 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