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					                    TOPICAL INDEX AND ABSTRACTS OF DMH/DD/SAS AND DMA IMPLEMENTATION UPDATES



 Implementation   Implementation
                                        Title (s)         Subject(s)                                Summary
   Update #:        Update Date


                                                                      Medicaid recipients will be mandatorily enrolled into each LME-
                                                                      MCO's benefit plan based upon county of Medicaid eligibility. As a
                                                                      reminder, providers are required to enroll in the LME-MCO
                                                                      provider network to ensure that Medicaid services are authorized
                                                                      and that corresponding Medicaid claims are processed by the
                                                                      LME-MCO. CMS requires that each LME-MCO (as they are
                                                                      separate at-risk entities) credential and enroll their own provider
                                                                      network. Providers only need to enroll in certain LME-MCO
                                                                      networks depending on where their practice is and what Medicaid
      #096                                              1915 (b)/(c)
                                   *UPDATE* Provider                  recipients they treat. All providers are required to complete and
    SPECIAL                                           Medicaid Waiver
                    4/25/2012      Enrollment In LME-                 return their enrollment applications (see below) to the LME-MCO
IMPLEMENTATION                                          Expansion
                                     MCO Medicaid                     ninety (90) days before the LME-MCO's "go live" date to ensure
    UPDATE                                                Update
                                       Networks                       that the completed application will be processed by the "go live"
                                                                      date of the LME-MCO. LME-MCOs will post open enrollment
                                                                      dates on their website. Enrollment contracts will be offered during
                                                                      this open enrollment period to all current Medicaid behavioral
                                                                      health providers who are in "good standing" AND have billed for
                                                                      services within sixty (60) days prior to enrollment. Any application
                                                                      received after the LME-MCO open enrollment period, will be
                                                                      evaluated for inclusion in the LME-MCO provider network based
                                                                      upon capacity and need.




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   Update #:        Update Date


                                                                  Three standardized enrollment applications will be used for LME-
                                                                  MCO enrollment: Agency, Hospital and Licensed Independent
                                                                  Professional (LIP). Providers applying to multiple networks can
                                                                  photocopy their application and send to multiple LME-MCOs as
                                                                  appropriate. But, providers are responsible for ensuring that each
                                                                  application has the most up-to-date information included.
                                                                  Enrollment applications for PBH, Western Highlands Network,
      #096                                          1915 (b)/(c) ECBH, Sandhills, and Smoky Mountain Center can be found at:
                                   Standardized
    SPECIAL                                       Medicaid Waiver PBH
                    4/25/2012       Enrollment
IMPLEMENTATION                                      Expansion     http://www.pbhsolutions.org/providers/newproviders/
                                   Applications
    UPDATE                                            Update      Western Highlands Network
                                                                  http://www.westernhighlands.org/provider-enrollment.html
                                                                  East Carolina Behavioral Health (ECBH)
                                                                  http://www.ecbhlme.org/Page_Provider.php?id=118
                                                                  Sandhills
                                                                  http://www.sandhillscenter.org/ProviderCredentialing.htm
                                                                  Smoky Mountain Center
                                                                  http://www.smokymountaincenter.com/providers.asp




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                    TOPICAL INDEX AND ABSTRACTS OF DMH/DD/SAS AND DMA IMPLEMENTATION UPDATES



 Implementation   Implementation
                                       Title (s)         Subject(s)                                Summary
   Update #:        Update Date


                                                                       As noted in the last March Special Medicaid Bulletin and
                                                                       Implementation Update #95, LME-MCOs have been working with
                                                                       stakeholder groups on streamlining the enrollment process. As of
                                                                       this date, the following LME-MCOs will be using the Council for
                                                                       Affordable Quality Healthcare (CAQH) to gather credentialing
                                                                       Independent Professionals (LIP):
                                                                       • CenterPoint Human Services; • CoastalCare (Southeastern
                                                                       Center and Onslow Carteret); • Alliance Behavioral Healthcare
                                                                       (The Durham Center/Cumberland/Johnston/Wake); • East
      #096                                               1915 (b)/(c)
                                                                       Carolina Behavioral Health (ECBH); • Partners Behavioral Health
    SPECIAL                                            Medicaid Waiver
                    4/25/2012      LIP Credentialing                   Management (Pathways, Crossroads and Mental Health
IMPLEMENTATION                                           Expansion
                                                                       Partners); • PBH; • Sandhills; • Smoky Mountain Center
    UPDATE                                                 Update
                                                                       • Western Highlands Network
                                                                       The Division of Medical Assistance (DMA) will publish updated
                                                                       CAQH information as other LME-MCO make decisions about
                                                                       working with enrollment and credentialing vendors. The contracts
                                                                       between CAQH and the LME-MCOs listed above are being
                                                                       currently developed. Future Medicaid Bulletins will
                                                                       notify providers when they can begin using the CAQH on-line
                                                                       enrollment process. Additional information may be found at
                                                                       http://www.caqh.org/ucd.php.




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                                       Title (s)         Subject(s)                                  Summary
   Update #:        Update Date


                                                                       The unmanaged outpatient visits for adults and children will start
                                                                       over for each LME-MCO. In the current Medicaid State Plan,
                                                                       adults may have eight (8) unmanaged outpatient visits and
                                                                       children may have sixteen (16) unmanaged outpatient visits each
                                                                       calendar year. LME-MCOs can increase the number of
                                                                       unmanaged visits per calendar year before prior authorization is
      #096                            Outpatient         1915 (b)/(c) required, but may not decrease the number of unmanaged visits.
    SPECIAL                        Behavioral Health   Medicaid Waiver LME-MCOs are required to publish their Medicaid benefit
                    4/25/2012
IMPLEMENTATION                     Services in LME-      Expansion     packages on their websites. REMINDER: Physicians, Physician
    UPDATE                           MCO Areas             Update      Assistants, and Nurse Practitioners will not need to seek prior
                                                                       approval for providing services to Medicaid recipients in the LME-
                                                                       MCOs unless they are billing behavioral health
                                                                       CPT codes. Further information regarding behavioral health
                                                                       codes, the fee schedules and Medicaid policies
                                                                       can be found at:
                                                                       http://www.ncdhhs.gov/dma/services/behavhealth.htm.


                                                                       As a reminder, all Medicaid-enrolled providers billing for services
                                                                       are expected to adhere to all Medicaid and
      #096                                               1915 (b)/(c) Health Choice policies and guidelines and are expected to stay
    SPECIAL                            Medicaid        Medicaid Waiver informed about any changes. Medicaid
                    4/25/2012
IMPLEMENTATION                         Bulletins         Expansion     Bulletins are published monthly and may include articles not
    UPDATE                                                 Update      found in the Implementation Updates.
                                                                       Medicaid Bulletins can be found at:
                                                                       http://www.ncdhhs.gov/dma/bulletin/index.htm.




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   Update #:        Update Date



                                                                     Tthe following new or updated details have been provided about
                                                                     the 1915(b)/(c) Medicaid waiver expansion and the changes it will
                                                                     mean to Medicaid providers. During a transition process over the
                                                                     next year, Medicaid-funded mental health, substance abuse, and
                                                                     intellectual/developmental disability services (MH/SA/IDD) will be
                                                                     administered by one of eleven Local Management Entities
                                                                     (LMEs) operating Medicaid Managed Care Organizations (MCOs)
      #095                                             1915 (b)/(c)
                                     1915 (b)/(c)                    as Division of Medical Assistance (DMA) vendors. Providers
    SPECIAL                                          Medicaid Waiver
                    3/15/2012      Medicaid Waiver                   should verify recipient county of eligibility using the Recipient
IMPLEMENTATION                                         Expansion
                                     Expansion                       Eligibility Verification tools outlined on the DMA website at:
    UPDATE                                               Update
                                                                     http://www.ncdhhs.gov/dma/provider/RecipEligVerify.htm.
                                                                     Beginning in April 2012, the Medicaid card for new recipients and
                                                                     the updated annual card for current recipients
                                                                     will include the name of each recipient’s LME-MCO based upon
                                                                     Medicaid county of eligibility. In addition, the Automated Voice
                                                                     Response System (AVRS) has been updated to include the
                                                                     recipient's LME-MCO.




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                                        Title (s)           Subject(s)                                   Summary
   Update #:        Update Date




                                                                       The proposed timeline for this transition is listed below. Please continue
                                                                       to read the Medicaid Bulletin for updates on transition dates. The
                                                                       current LME-MCO, PBH, will be expanding on the following schedule: ·
                                                                       PBH was originally comprised of Union, Stanly, Cabarrus, Rowan, and
                                                                       Davidson Counties · Alamance and Caswell Counties were added
                                                                       October, 1, 2011. · Five County LME, consisting of Franklin, Vance,
                                                                       Granville, Warren and Halifax Counties were added January 1, 2012 - ·
                                                                       OPC LME, consisting of Orange, Person, and Chatham Counties will be
                                                                       added April 1, 2012. -The following LMEs will be expanding to become
                                                                       LME-MCOs on the following schedule: · January 3, 2012 - Western
                                                                       Highlands Network, consisting of Buncombe, Henderson, Madison,
                                                                       Mitchell, Polk,Rutherford, Transylvania, and Yancey Counties · April 1,
                                                                       2012 - East Carolina Behavioral Health LME, consisting of Beaufort,
      #095                                               1915 (b)/(c)  Bertie, Camden, Chowan,Craven, Currituck, Dare, Gates, Hertford,
    SPECIAL                           *UPDATE* -       Medicaid Waiver Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans,
                    3/15/2012
IMPLEMENTATION                     Transition Timeline   Expansion     Pitt, Tyrell, and Washington Counties · July 1, 2012 Sandhills LME,
    UPDATE                                                 Update      consisting of Anson, Harnett, Hoke, Lee, Montgomery, Moore,
                                                                       Randolph, and Richmond, Counties. Guilford County may be included in
                                                                       this LME in January 2013. o Smoky Mountain Center, consisting of
                                                                       Alexander, Alleghany, Ashe, Avery, Caldwell, Cherokee,Clay, Graham,
                                                                       Haywood, Jackson, Macon, McDowell, Swain, Watauga, and Wilkes
                                                                       Counties · January 1, 2013 Pathways, consisting of Burke, Catawba,
                                                                       Cleveland, Gaston, Iredell, Lincoln, Surry, and Yadkin Counties;
                                                                       Eastpointe, consisting of Bladen, Columbus, Duplin, Edgecombe,
                                                                       Greene, Lenoir, Nash,Robeson, Sampson, Scotland, Wayne, and
                                                                       Wilson Counties; Mecklenburg LME ; The Durham Center, consisting of
                                                                       Durham, Wake, Cumberland, and Johnston Counties; CenterPoint,
                                                                       consisting of Davie, Forsyth, Rockingham, and Stokes Counties o
                                                                       Southeastern Center and Onslow-Carteret LME, consisting of
                                                                       Brunswick, New Hanover, Pender,Onslow, and Carteret Counties




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   Update #:        Update Date



                                                                     Each LME-MCO will be responsible for enrolling providers into
                                                                     the LME-MCO network, providing prior authorization, and
                                                                     processing claims for the following services found at
                                                                     http://www.ncdhhs.gov/dma/mp/index.htm: · Enhanced
                                                                     Behavioral Health Services (DMA Clinical Coverage Policy 8A)·
                                                                     Inpatient Behavioral Health Services (DMA Clinical Coverage
                                                                     Policy 8B)· Inpatient services for the treatment of mental health
                                                                     and substance abuse disorders and developmental disabilities ·
                                                                     Outpatient Behavioral Health Services (DMA Clinical Coverage
                                                                     Policy 8C) · All services (all CPT codes) provided by psychiatrists
      #095                                             1915 (b)/(c)
                                   *CORRECTED*                       · Psychiatric Residential Treatment Facilities (PRTFs) (DMA
    SPECIAL                                          Medicaid Waiver
                    3/15/2012      Covered Benefit                   Clinical Coverage Policy 8D1)· Therapeutic Foster Care (TFC)
IMPLEMENTATION                                         Expansion
                                      Package                        (DMA Clinical Coverage Policy 8D2)· Residential Child Care
    UPDATE                                               Update
                                                                     Levels II group, III, IV (DMA Clinical Coverage Policy 8D2) ·
                                                                     Intermediate Care Facilities for Individuals with Mental
                                                                     Retardation (DMA Clinical Coverage Policy 8E) · I/DD Services
                                                                     under the NC Innovations (c) waiver · Hospital Emergency
                                                                     Department (ED) services: Each LME-MCO will be responsible
                                                                     for all facility,professional, and ancillary charges for services
                                                                     delivered in the emergency department to individuals with a
                                                                     discharge diagnosis ranging from 290 to 319 · Outpatient
                                                                     Hospital Clinical Services for individuals with a primary diagnosis
                                                                     ranging from 290-319.




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                                        Title (s)         Subject(s)                                Summary
   Update #:        Update Date



                                                                      Medicaid recipients will be mandatorily enrolled into each LME-
                                                                      MCO's benefit plan based upon county of Medicaid eligibility.
                                                                      Providers are required to enroll in the LME-MCO provider network
                                                                      to ensure that Medicaid services are authorized and that
                                                                      corresponding Medicaid claims are processed by the LME-MCO.
                                                                      After the transitional dates , providers will no longer be able to
                                                                      seek prior authorization from a utilization review (UR) vendor or
                                                                      bill Medicaid/HP directly for behavioral health services. CMS
                                                                      requires that each LME-MCO (as they are separate at-risk
                                                                      entities) credential and enroll their own provider network.
                                                                      Providers only need to enroll in certain LME-MCO networks
                                                                      depending on where their practice is and what Medicaid
      #095                         *UPDATE* Provider    1915 (b)/(c)  recipients they treat. Providers are encouraged to apply early to
    SPECIAL                        Enrollment In LME- Medicaid Waiver allow for necessary processing time. Providers should contact the
                    3/15/2012
IMPLEMENTATION                       MCO Medicaid       Expansion     LME-MCO for their catchment area for enrollment information. In
    UPDATE                             Networks           Update      some cases, a provider may see a recipient whose Medicaid
                                                                      eligibility is with a different LME-MCO. The provider will need to
                                                                      contact the LME-MCO from which the recipient’s eligibility
                                                                      originates to contract with that LME-MCO to receive authorization
                                                                      and payment. LME-MCOs will post open enrollment dates on
                                                                      their website. Enrollment contracts will be offered during this open
                                                                      enrollment period to all current Medicaid behavioral health
                                                                      providers who are in "good standing" AND have billed for services
                                                                      within sixty (60) days prior to enrollment. After the LME-MCO
                                                                      becomes operational, it will no longer be required to offer
                                                                      contracts to every willing provider, but will enroll providers based
                                                                      on the needs of the local recipients and on provider network
                                                                      performance.




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                                         Title (s)         Subject(s)                                Summary
   Update #:        Update Date


                                                                       Since many providers practice in several counties, we have
                                                                       required all LME-MCOs to use the same enrollment application.
                                                                       We understand that some LME-MCOs have added addendums
      #095                         *UPDATE* Provider     1915 (b)/(c)  or additional questions to the enrollment application in order to
    SPECIAL                         Enrollment In LME- Medicaid Waiver capture network-specific data or meet URAC credentialing
                    3/15/2012
IMPLEMENTATION                        MCO Medicaid       Expansion     standards. LMEs and other stakeholder groups are being
    UPDATE                         Networks (CONTD)        Update      worked with on ways to standardize the enrollment process and
                                                                       make enrollment easier for providers. Please read future
                                                                       Medicaid Bulletins for updated information on streamlined
                                                                       enrollment procedures.


                                                                      Physicians will need to enroll with the MCO in order to bill the
                                                                      behavioral health CPT codes listed in DMA Clinical Coverage
                                                                      Policy 8C. These codes are for individual, family, and group
                                                                      therapy and psychological testing (i.e. 90806, 90801). These
                                                                      Physicians will NOT need to enroll with an MCO if they treat
                                                                      recipients for mental health issues (i.e. depression, ADHD) in
                                                                      primary care offices and bill E&M codes (i.e. 99213). The only
      #095                                              1915 (b)/(c)  exception to this is psychiatrist billing. All CPT codes for services
                                   *UPDATE* Physician
    SPECIAL                                           Medicaid Waiver provided by psychiatrists must be billed to the LME-MCO. Other
                    3/15/2012        Enrollment and
IMPLEMENTATION                                          Expansion     physicians do NOT need to enroll with the LME-MCO to bill E&M
                                         Billing
    UPDATE                                                Update      codes in their offices. For example, MDs could, and should,
                                                                      continue to bill a 99213 for seeing a child with ADHD. If the
                                                                      physician employs a therapist (LCSW, etc), who does brief
                                                                      behavioral health interventions (i.e. therapy sessions--90806) that
                                                                      LCSW needs to enroll with the LME-MCO. LME-MCOs are
                                                                      responsible for psychiatric care provided in a hospital
                                                                      setting—that includes the Emergency Department, Inpatient, and
                                                                      Outpatient clinics.




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   Update #:        Update Date



                                                                      When claims for mental health, substance abuse, and
                                                                      developmental disabilities are the primary discharge diagnosis
                                                                      (inpatient) or primary diagnosis on the claim (Outpatient Clinic,
                                                                      Emergency Department), the claim must be billed to the LME-
                                                                      MCO—as these would be considered behavioral health services.
                                                                      So, physician groups who provide billable consultation in those
      #095                         *UPDATE* Physician   1915 (b)/(c)
                                                                      settings (regardless of billed codes) need to enroll with the LME-
    SPECIAL                          Enrollment and   Medicaid Waiver
                    3/15/2012                                         MCO. NOTE: DMA has identified an issue in the claims
IMPLEMENTATION                           Billing        Expansion
                                                                      adjudication of a small number of hospital-owned group physician
    UPDATE                             (CONTD)            Update
                                                                      practices that are “split billing” claims to Medicaid/HP as
                                                                      "Outpatient Hospitals." DMA is aware of the potential impact for
                                                                      these providers, and is working with the LME-MCOs, HP, and the
                                                                      affected provider groups to resolve this issue as soon as
                                                                      possible. We will publish updated billing guidance in future
                                                                      Medicaid Bulletins once we reach the best solution to this issue.




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                                        Title (s)        Subject(s)                             Summary
   Update #:        Update Date



                                                                     In order to successfully bill WHN for MH/SA/DD services for
                                                                     recipients with Medicaid eligibility
                                                                     originating in Buncombe, Henderson, Madison, Mitchell, Polk,
                                                                     Rutherford, Transylvania, and Yancey
                                                                     Counties, providers must follow the four steps outlined below:
                                                                     1. Enroll with WHN by having a fully executed provider contract
                                                                     and proof of required
                                                                     insurance on file with WHN (See WHN Operations Manual).
                                                                     Providers should direct questions
                                                                     about enrollment in the Western Highland Medicaid provider
      #095                                             1915 (b)/(c)
                                   Western Highlands                 network to the WHN Enrollment Line
    SPECIAL                                          Medicaid Waiver
                    3/15/2012       Network Billing                  at 1-800-671-6560 x2469 or 828-225-2785 or send email to:
IMPLEMENTATION                                         Expansion
                                        Guide                        WHMedicaidWaiverEnrollmentQuestions@westernhighlands.org.
    UPDATE                                               Update
                                                                     2. Apply for access to the WHN Care Coordination Information
                                                                     System (CCIS). Access is
                                                                     restricted for each individual user with a valid log-in ID and
                                                                     password. Logins and passwords must
                                                                     not be shared with other individuals. Information about CCIS is
                                                                     available on WHN’s IS Help Desk
                                                                     web page: http://www.westernhighlands.org/is-help-desk.html and
                                                                     includes:
                                                                     · User Assignment Request to apply for CCIS Login
                                                                     · CCIS User Guide




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   Update #:        Update Date



                                                                     3. Execute a Trading Partner Agreement with WHN. WHN
                                                                     accepts 837 transactions directly from providers with EDI
                                                                     capability. Providers submitting claims through outside billing
                                                                     services or a claims clearinghouse are responsible to initiate
                                                                     appropriate connections between WHN and the service vendor
                                                                     they have engaged. Providers are also responsible for all charges
      #095                         Western Highlands   1915 (b)/(c)  related to claims processing by other parties. At this time WHN
    SPECIAL                         Network Billing  Medicaid Waiver has established clearinghouse connections with Health Fusions
                    3/15/2012
IMPLEMENTATION                          Guide          Expansion     and Gateway EDI. For more information on setting up 837 billing
    UPDATE                            (CONTD)            Update      with WHN please email WHEDItesting@westernhighlands.org.
                                                                     4. Bill claims electronically to WHN through either the CCIS Direct
                                                                     Data Entry (DDE) secure online billing portal, or by Electronic
                                                                     Data Interchange (EDI) 837 file submission in standard 5010
                                                                     format. Instructions for submitting claims through the WHN CCIS
                                                                     system is available in the CCIS User
                                                                     Guide.




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   Update #:        Update Date


                                                                     Training materials including an overview of enrollment,
                                                                     authorizations, and billing through WHN is
                                                                     available on the WHN website:
                                                                     http://www.westernhighlands.org/images/stories/mandatory_traini
                                                                     ng_1-18-12_update.pdf.
                                                                     Western Highlands offers a Claims and Reimbursement Training
      #095                         Western Highlands   1915 (b)/(c)  at 356 Biltmore Avenue, Asheville, NC.
    SPECIAL                         Network Billing  Medicaid Waiver Seating is limited and registration for specific dates is required.
                    3/15/2012
IMPLEMENTATION                          Guide          Expansion     See available dates and register through the
    UPDATE                            (CONTD)            Update      Provider Training Calendar available online at:
                                                                     http://www.westernhighlands.org/training-and-
                                                                     technicalassistance.html.
                                                                     Personal help for billing issues is available by calling WHN billing
                                                                     assistance line at 1-800-671-6560 or 828-
                                                                     225-2785 ext. 2153, or by email to
                                                                     billingquestions@westernhighlands.org.




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                                      Title (s)        Subject(s)                                Summary
   Update #:        Update Date



                                                                     The following are details about the 1915(b)/(c) Medicaid waiver
                                                                     expansion and the changes it will mean to Medicaid providers.
                                                                     During a transition process over the next year, Medicaid-funded
                                                                     mental health, substance abuse, and intellectual/developmental
                                                                     disability services (MH/SA/IDD) will be administered by one of
                                                                     eleven Local Management Entities (LMEs) operating Medicaid
      #094
                                     1915 (b)/(c)      1915 (b)/(c)  Managed Care Organizations (MCOs) as DMA vendors. Medicaid
    SPECIAL
                    2/16/2012      Medicaid Waiver   Medicaid Waiver recipients will be mandatorily enrolled into each LME-MCO's
IMPLEMENTATION
                                     Expansion         Expansion     benefit plan based upon county of Medicaid eligibility. Providers
    UPDATE
                                                                     should verify recipient county of eligibility using the Recipient
                                                                     Eligibility Verification Web Tool outlined on the DMA website at:
                                                                     http://www.ncdhhs.gov/dma/provider/RecipEligVerify.htm. In the
                                                                     future, the Medicaid card and the other methods of verifying
                                                                     recipient eligibility (listed on the website) will be
                                                                     updated to include information about each recipient’s LME-MCO.




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   Update #:        Update Date



                                                                     Each LME-MCO will be responsible for enrolling providers into
                                                                     the LME-MCO network, providing prior
                                                                     authorization, and processing claims for the following services
                                                                     found at
                                                                     http://www.ncdhhs.gov/dma/mp/index.htm
                                                                     · Enhanced Behavioral Health Services (DMA Clinical Coverage
                                                                     Policy 8A) · Inpatient Behavioral Health Services (DMA Clinical
                                                                     Coverage Policy 8B) · Inpatient services for the treatment of
                                                                     mental health and substance abuse disorders and developmental
      #094
                                                       1915 (b)/(c)  disabilities · Outpatient Behavioral Health Services including all
    SPECIAL                        Covered Benefit
                    2/16/2012                        Medicaid Waiver services provided by psychiatrists for recipients with a diagnosis
IMPLEMENTATION                        Package
                                                       Expansion     in the 290-319 range (DMA Clinical Coverage Policy 8C) ·
    UPDATE
                                                                     Psychiatric Residential Treatment Facilities (PRTFs) (DMA
                                                                     Clinical Coverage Policy 8D1) · Therapeutic Foster Care (TFC)
                                                                     (DMA Clinical Coverage Policy 8D2) · Residential Child Care
                                                                     Levels II group, III, IV (DMA Clinical Coverage Policy 8D2) · I/DD
                                                                     Services under the NC Innovations (c) waiver · Hospital
                                                                     Emergency Department (ED) services: Each LME-MCO will be
                                                                     responsible for all facility, professional, and ancillary charges for
                                                                     services delivered in the emergency department to individuals
                                                                     with a discharge diagnosis ranging from 290 to 319.




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                                      Title (s)         Subject(s)                                Summary
   Update #:        Update Date


                                                                      Any Medicaid recipient currently receiving mental health (MH) and
                                                                      substance abuse (SA) services and CAP
                                                                      I/DD waiver services will continue to be able to do so. CAP- I/DD
                                                                      waiver recipients’ services will crosswalk
                                                                      to NC Innovations waiver services. Each LME will hold
                                                                      information sessions for recipients and providers on
                                                                      the transition to the NC Innovations waivers. The crosswalk of
                                                                      CAP I/DD to NC Innovations services can be
                                                                      found at:
                                                                      http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/compa
      #094
                                                        1915 (b)/(c)  risiongrid12-11.pdf
    SPECIAL                        Authorization of
                    2/16/2012                         Medicaid Waiver Each LME-MCO will assume responsibility for all current MH, SA,
IMPLEMENTATION                        Services
                                                        Expansion     and CAP I/DD authorizations from current DMA Utilization Review
    UPDATE
                                                                      (UR) vendors (Value Options, Durham, Eastpointe, Crossroads,
                                                                      and Pathways LMEs) for their county catchment areas and on the
                                                                      schedule noted below. Providers will not need to take any action
                                                                      to transfer active authorizations; all current authorizations will
                                                                      remain in effect. The one
                                                                      exception to this is Targeted Case Management for adults.
                                                                      Providers will need to send all new and concurrent authorization
                                                                      requests to their LME-MCO once the LMEMCO
                                                                      begins Medicaid operations and once the current authorization
                                                                      ends.




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                                        Title (s)        Subject(s)                              Summary
   Update #:        Update Date



                                                                    Targeted Case Management (MH/SA TCM and I/DD TCM) is not
                                                                    a service available under the 1915(b)/(c)
                                                                    waivers. All authorizations for MH/SA TCM and I/DD TCM for
                                                                    recipients under the age of 21 will be
                                                                    continued to the end of the current authorization period. Any new
                                                                    or concurrent requests for TCM for children under age 21 must
                                                                    follow the established Early and Periodic Screening, Diagnosis,
                                                                    and Treatment (EPSDT) procedures and requirements, which are
                                                                    available at http://www.dhhs.state.nc.us/dma/epsdt. All EPSDT
                                                                    requests for TCM should be sent to the appropriate LME-MCO for
                                                                    processing. The LME-MCO will be working with recipients and
      #094                           Targeted Case                  providers to develop transition plans for any recipients
                                                      1915 (b)/(c)
    SPECIAL                        Management (TCM)                 who are receiving these services at the time of transition. Some
                    2/16/2012                       Medicaid Waiver
IMPLEMENTATION                         and Care                     recipients currently receiving TCM may receive care coordination
                                                      Expansion
    UPDATE                            Coordination                  from the LME-MCO. Under a 1915(b)/(c) waiver, a number of
                                                                    activities that are associated with TCM become the responsibility
                                                                    of the LME-MCO. The LME-MCO refers to these functions as
                                                                    “care coordination.” This is consistent with the way case
                                                                    management is provided in other healthcare settings all across
                                                                    the country and is similar to the model used by Community Care
                                                                    of North Carolina (CCNC) for the management of care for high
                                                                    risk
                                                                    consumers served by Medicaid in primary care practices. LME-
                                                                    MCO care coordination specifically focuses
                                                                    on the unique needs of individuals with mental health, substance
                                                                    abuse, and intellectual and developmental
                                                                    disabilities.




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 Implementation   Implementation
                                        Title (s)         Subject(s)                               Summary
   Update #:        Update Date


                                                                     Care Coordination in an LME-MCO provides the following
                                                                    supports to consumers: · Education about all available
                                                                    MH/SA/DD services and supports, as well as education about all
                                     Targeted Case
      #094                                                          types of Medicaid and state-funded services. · Linkage to needed
                                   Management (TCM)   1915 (b)/(c)
    SPECIAL                                                         psychological, behavioral, educational, and physical evaluations. ·
                    2/16/2012          and Care     Medicaid Waiver
IMPLEMENTATION                                                      Development of the Individual Support Plan (ISP) or Person
                                      Coordination    Expansion
    UPDATE                                                          Centered Plan (PCP) in conjunction
                                       (CONTD)
                                                                    with the recipient, family, and other all-service and support
                                                                    providers. · Monitoring of the ISP, PCP, and health and safety of
                                                                    the consumer. · Coordination of Medicaid eligibility and benefits.




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                                        Title (s)         Subject(s)                                Summary
   Update #:        Update Date



                                                                      Enrollment contracts will be offered to all current Medicaid
                                                                      behavioral health providers in good standing during the LME-
                                                                      MCO's initial provider enrollment period. After the LME-MCO
                                                                      becomes operational, it will no longer be required to offer
                                                                      contracts to every willing provider, but will enroll providers based
                                                                      on the needs of the local recipients and on provider network
                                                                      performance. Providers are required to enroll in the LME-MCO
                                                                      provider network to ensure that Medicaid services are authorized
                                                                      and that corresponding Medicaid claims are processed by the
                                                                      LME-MCO. After the transitional
      #094                                                            dates listed below, providers will no longer be able to seek prior
                                   Enrollment in LME-   1915 (b)/(c)
    SPECIAL                                                           authorization from a UR vendor or bill Medicaid directly for
                    2/16/2012        MCO Medicaid     Medicaid Waiver
IMPLEMENTATION                                                        behavioral health services. Provider enrollments should occur
                                   Provider Networks    Expansion
    UPDATE                                                            within 60 days prior to the effective date of each start-date listed
                                                                      below. However, providers are encouraged to apply early to allow
                                                                      for necessary processing time. Provider should
                                                                      contact the LME-MCO for their catchment area for enrollment
                                                                      information. In some cases, a provider may see a recipient whose
                                                                      Medicaid eligibility is with a different LME-MCO. The provider will
                                                                      need to contact the LME-MCO from which the recipient’s eligibility
                                                                      originates to contract with that LME-MCO to receive authorization
                                                                      and payment. LME-MCOs will offer specific educational sessions
                                                                      for all providers, including hospitals, on obtaining prior approval
                                                                      and submitting claims for payment.




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                                        Title (s)         Subject(s)                                Summary
   Update #:        Update Date



                                                                      LME-MCOs are responsible for reimbursing hospitals for all
                                                                      services (professional, ancillary, and facility) provided in the ED
                                                                      during an emergency admission when the recipient has a primary
                                                                      discharge diagnosis of 290 through 319. In accordance with
                                                                      Section 1932(b)(2) of the Social Security Act, as amended by the
                                                                      Balanced Budget Act (BBA) of 1997, LME-MCOs shall reimburse
                                                                      claims for Emergency Behavioral Health Services consistent with
                                                                      the "prudent layperson standard" as defined in 42CFR 438.114.
                                                                      These services will
                                                                      be reimbursed without regard to the ED’s contractual relationship
                                                                      with the LME-MCO. Emergency Behavioral Health Services
      #094                         Hospital Emergency
                                                        1915 (b)/(c)  provided in the ED do not require prior authorization. LME-MCOs
    SPECIAL                         Department (ED)
                    2/16/2012                         Medicaid Waiver are required to pay for ED Emergency Behavioral Health Services
IMPLEMENTATION                        and Inpatient
                                                        Expansion     for recipients with Medicaid eligibility in their catchment areas
    UPDATE                              Services
                                                                      even if the recipient is seen in an ED in another LME-MCO
                                                                      catchment area. The "out of-network" EDs will need to contact
                                                                      the LME-MCO based on the recipients’ county of eligibility to
                                                                      obtain payment for these ED services. A stakeholder group is
                                                                      currently working on a streamlined approach to ED
                                                                      credentialing/enrollment and payment. Further details will be
                                                                      published as they become available. Psychiatric inpatient
                                                                      services do require prior approval from the LME-MCO. Hospitals
                                                                      must request prior authorization from the LME-MCO managing
                                                                      services for the recipient based upon Medicaid county of
                                                                      eligibility.




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                                        Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                       When a recipient is admitted to a medical floor and then
                                                                      transferred to a separate psychiatric unit within the same hospital,
                                                                      the recipient should be discharged from the medical unit and
                                                                      readmitted to the psychiatric unit in order for all aspects of the
                                                                      claim to adjudicate correctly. The medical claim should be billed
                                   Hospital Emergency                 to Medicaid/HP and the psychiatric claim should be billed to the
      #094
                                    Department (ED)     1915 (b)/(c)  appropriate LME-MCO.
    SPECIAL
                    2/16/2012         and Inpatient   Medicaid Waiver If a claim for inpatient treatment of MH, SA, or I/DD spans the
IMPLEMENTATION
                                        Services        Expansion     date of initial operation of the LME-MCO,then the entire facility
    UPDATE
                                       (CONTD)                        claim should be billed to Medicaid/HP and the LME-MCO is not
                                                                      responsible for any portion of it. Physician-based claims would
                                                                      need to be split, with the portion of the claim prior to the initial
                                                                      date of LME-MCO operations being billed through HP and the
                                                                      portion of the claim after the initial date of
                                                                      operation going to the LME-MCO.


                                                                        Providers should continue to bill Medicaid (HP) for all dates of
                                                                        service prior to the effective start date of the
                                                                        LME-MCO operations. After the start-date of LME-MCO
      #094                                                              operations (listed below), all behavioral health claims for services
                                                          1915 (b)/(c)
    SPECIAL                           Payment for                       listed above should be billed to the appropriate LME-MCO. In
                    2/16/2012                           Medicaid Waiver
IMPLEMENTATION                         Services                         order to bill claims to the LME-MCO for the services listed above,
                                                          Expansion
    UPDATE                                                              providers must be enrolled in the LME-MCO network (the only
                                                                        exception is for emergency services provided in EDs as noted
                                                                        above). The LME-MCOs will accept electronic HIPAA 5010
                                                                        transactions and they will respond with 5010 transactions.




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 Implementation   Implementation
                                        Title (s)        Subject(s)                               Summary
   Update #:        Update Date

                                                                       The current LME-MCO, PBH, will be expanding on the following
                                                                       schedule: · PBH was originally comprised of Union, Stanly,
                                                                       Cabarrus, Rowan, and Davidson Counties
                                                                       · Alamance and Caswell Counties were added October, 1, 2011 ·
                                                                       Five County LME, consisting of Franklin, Vance, Granville,
                                                                       Warren & Halifax Counties were added January 1, 2012 · OPC
                                                                       LME, consisting of Orange, Person, and Chatham Counties will
                                                                       be added April 1, 2012
                                                                       The following LMEs will be expanding to become LME-MCOs on
                                                                       the following schedule: · January 3, 2012
      #094                                                             o Western Highlands Network, consisting of Buncombe,
                                                         1915 (b)/(c)
    SPECIAL                                                            Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania,
                    2/16/2012      Transition Timeline Medicaid Waiver
IMPLEMENTATION                                                         and Yancey Counties · April 1, 2012 o East Carolina Behavioral
                                                         Expansion
    UPDATE                                                             Health LME, consisting of Beaufort, Bertie, Camden, Chowan,
                                                                       Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin,
                                                                       Northampton, Pamlico,
                                                                       Pasquotank, Perquimans, Pitt, Tyrell, and Washington Counties ·
                                                                       July 1, 2012 o Sandhills LME, consisting of Anson, Harnett,
                                                                       Hoke, Lee, Montgomery, Moore, Randolph, and Richmond,
                                                                       Counties o Smoky Mountain Center, consisting of Alexander,
                                                                       Alleghany, Ashe, Avery, Caldwell, Cherokee, Clay, Graham,
                                                                       Haywood, Jackson, Macon, McDowell, Swain, Watauga, and
                                                                       Wilkes Counties




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                                        Title (s)          Subject(s)                                Summary
   Update #:        Update Date

                                                                       · January 1, 2013 o Pathways, consisting of Burke, Catawba,
                                                                       Cleveland, Gaston, Iredell, Lincoln, Surry, and Yadkin Counties o
                                                                       Eastpointe, consisting of Bladen, Columbus, Duplin, Edgecombe,
                                                                       Greene, Lenoir, Nash,
      #094
                                                         1915 (b)/(c)  Robeson, Sampson, Scotland, Wayne, and Wilson Counties
    SPECIAL                        Transition Timeline
                    2/16/2012                          Medicaid Waiver o Mecklenburg LME o The Durham Center, consisting of
IMPLEMENTATION                         (CONTD)
                                                         Expansion     Durham, Wake, Cumberland, and Johnston Counties
    UPDATE
                                                                       o CenterPoint, consisting of Davie, Forsyth, Rockingham, and
                                                                       Stokes Counties o Southeastern Center (ECCS), consisting of
                                                                       Brunswick, New Hanover, Pender, Onslow, and
                                                                       Carteret Counties

                                                                         In 2009, Secretary Lanier Cansler launched N.C. Department of
                                                                         Health and Human Services (DHHS) to a new day and required
                                                                         all DHHS employees to work toward making DHHS the best
                                                                         managed agency in state government by becoming more
                                                                         customer focused, anticipatory, collaborative, transparent, and
                                                                         results-oriented. The Program Integrity Section of the Division of
                                                                         Medical Assistance (DMA) is broadening the lines of
                                                                         communication with stakeholders on efforts to ensure
      #093
                                   Program Integrity -    NC Division of compliance, efficiency and accountability and prevent improper
    SPECIAL
                    11/21/2011     Mission; Initiatives     Medical      payments of Medicaid dollars. Program Integrity believes that an
IMPLEMENTATION
                                     and Strategies        Assistance    analytically-driven approach plus effective, efficient processes
    UPDATE
                                                                         with enhanced governance and reporting is the formula for
                                                                         achieving Medicaid quality assurance and compliance. The
                                                                         DHHS values of being customer focused, anticipating challenges,
                                                                         practicing transparency in decision making, collaborating on
                                                                         issues and holding ourselves accountable for outcomes are the
                                                                         foundation for our strategic
                                                                         approach. Program Integrity is committed to this plan and our
                                                                         stakeholders.




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                                       Title (s)        Subject(s)                                  Summary
   Update #:        Update Date


                                                                      The Medicaid program is funded with state and federal tax
                                                                      dollars. It is designed to pay for health care and certain support
                                                                      services for low-income and vulnerable North Carolinians
                                                                      (children, pregnant women, disabled adults and seniors). Tax
                                                                      dollars are wasted and services are taken away from people who
                                                                      need them when people obtain benefits they are not entitled to or
                                                                      when services are delivered that don’t meet the policy and
                                                                      requirements. What Is Medicaid Fraud, Waste and Abuse?
                                                                      Fraud: Deception or misrepresentation made by a health care
                                                                      provider with the knowledge that the deception could result in
                                                                      some unauthorized benefit to him or herself or some other
                                                                      person. It includes any act that constitutes fraud under federal
                                                                      requirements set forth in 42 C.F.R § 455 which relates to
      #093                          Medicaid Fraud:                   Medicaid. Waste: The over utilization of services, or other
                                                       NC Division of
    SPECIAL                        Protect Your Tax                   practices that result in unnecessary costs generally not
                    11/21/2011                           Medical
IMPLEMENTATION                     Dollars—Why Is It                  considered caused by criminal negligent actions but rather the
                                                        Assistance
    UPDATE                             Important?                     misuse of resources. Abuse: Provider practices that are
                                                                      inconsistent with sound fiscal, business or clinical practices and
                                                                      result in an unnecessary cost to the Medicaid program, or in
                                                                      reimbursement for services that are not medically necessary or
                                                                      fail to meet recognized standards for health care or clinical policy.
                                                                      To report suspected Medicaid Fraud, Waste or Abuse, please call
                                                                      the North Carolina DHHS Customer Service
                                                                      Center toll-free number at 1-800-662-7030 or the North Carolina
                                                                      Medicaid Program Integrity Tip-Line at 1-877-DMA-TIP1 (1-877-
                                                                      362-8471).
                                                                      You may submit an Online Medicaid Fraud and Abuse
                                                                      Confidential Complaint Form using the website
                                                                      www.ncdhhs.gov/dma/fraud/reportfraudform.htm. Callers may
                                                                      request to remain anonymous.




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                                        Title (s)        Subject(s)                                     Summary
   Update #:        Update Date



                                                                         In accordance with Session Law 2011-399, Program Integrity authorized
                                                                         audits and post payment reviews conducted during the state fiscal year
                                                                         2011-2012 and will utilize extrapolation of findings to determine
                                                                         recoupment amounts. Providers who have been designated as high or
                                                                         moderate risk are subject to review during this fiscal year. In addition to
                                                                         moderate or high risk providers, other providers may be identified for
                                                                         review through the use of the analytical data mining software by
                                                                         identifying outlier billing patterns, irregular service or referral trends.
                                                                         Additional methods of identification for provider review include the
                                                                         receipt of complaints of credible allegations of fraud or abuse and tips
                                                                         received through the Fraud/Abuse Tip Line. Providers who receive post
                                    Audits and Post                      payment review will be subject to review for all services and codes
      #093
                                   Payment Reviews:     NC Division of   authorized by their participation agreement with DMA. The review or
    SPECIAL
                    11/21/2011     Medicaid and North     Medical        audit may take the form of a desk review of medical records or an onsite
IMPLEMENTATION                                                           review or a combination of both. The onsite review may be announced
                                     Carolina Health     Assistance
    UPDATE                                                               or unannounced. If the audit is a desk review, providers will receive a
                                    Choice Providers
                                                                         request for medical records as part of the post payment review process.
                                                                         The letter will outline the exact dates of medical records or claims to be
                                                                         reviewed, documentation being requested and the consequences for
                                                                         failure to comply with the request by the date identified in the letter.
                                                                         Based upon DMA or contractor post payment review of the submitted
                                                                         documentation, the desk review may lead to an onsite review or an
                                                                         expanded period of review. The results of the audits will be extrapolated
                                                                         to determine the final overpayment amount. The time period of
                                                                         extrapolation may go back for 36 months from date of payment of a
                                                                         provider’s claim or longer as allowed by federal law or regulation or in
                                                                         instances of credible allegations of fraud.




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 Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
   Update #:        Update Date

                                                                       In 1999, DMA Program Integrity started a Provider Self-Audit
                                                                       process, which offered Medicaid providers an opportunity to
                                                                       conduct internal compliance audits and have a mechanism for
                                                                       reporting their outcomes directly to Medicaid. This process still
                                                                       exists, and parts of it are being expanded and incorporated into
                                                                       new activities introduced through NC Session law 2011-399.
                                                                       Currently, a provider may request a Self-Audit packet from
                                                                       Program Integrity, which contains instructions and forms to be
                                                                       returned to DMA. Providers will be able to access the packet on
                                                                       our web site in the near future. The provider will submit a Notice
                                                                       of Intent to Conduct Self Audit form to Program Integrity, which
                                                                       includes a description of the intended type of audit and
      #093
                                                        NC Division of anticipated date of completion. This information is assigned to a
    SPECIAL                        Update to Provider
                    11/21/2011                            Medical      Program Integrity analyst, who works with you through the
IMPLEMENTATION                     Self Audit Process
                                                         Assistance    process. NC Session Law 2011-399 offers providers the
    UPDATE
                                                                       opportunity to conduct a self audit as a method for contesting the
                                                                       outcome of certain Program Integrity audits. As part of a provider
                                                                       investigation Program Integrity and its vendors review a random
                                                                       sample of claims from the “universe” of claims submitted by a
                                                                       provider over a period of time. Errors identified in the sample may
                                                                       be extrapolated across the full universe of claims. In cases where
                                                                       a “low risk” or “moderate risk” provider is notified of tentative
                                                                       findings of errors that could result in extrapolation, they may
                                                                       contest the extrapolation by conducting a self-audit. Providers
                                                                       should carefully review NC Session Law 2011-399, N.C.G.S. §
                                                                       108C-5(n) “Payment suspension and audits utilizing
                                                                       extrapolation” for further details.




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 Implementation   Implementation
                                        Title (s)         Subject(s)                                  Summary
   Update #:        Update Date


                                                                        Program Integrity has identified some trends in outpatient mental
                                                                        health non-physician practices, independent
                                                                        and group. Some providers are operating after-school programs,
                                                                        summer programs, or non-licensed day treatment programs and
                                                                        submitting claims for reimbursement from the North Carolina
      #093
                                                         NC Division of Medicaid Program. Medicaid only reimburses for services that
    SPECIAL                         Submitting Claims
                    11/21/2011                             Medical      are medically necessary, meets the criteria established through
IMPLEMENTATION                     for Reimbursement
                                                          Assistance    clinical policy and when the provider is qualified to provide the
    UPDATE
                                                                        services. Defrauding the NC Medicaid program is a serious
                                                                        offense and will be dealt with accordingly. Sometimes the penalty
                                                                        includes civil and/or criminal remedies. Medicaid providers may
                                                                        receive a federal indictment involving
                                                                        wire fraud, identity theft, and arson by the U.S. Attorney's Office.

                                                                        In accordance with the federal requirements set forth in 42 C.F.R
                                                                        § 455.23, the Medicaid agency is required to
                                                                        suspend payments of providers having a credible allegation of
                                                                        fraud. NC Session Law 2011-399 expands DMA’s responsibility
      #093
                                   Medicaid and Health   NC Division of to include suspending payments to providers who owe a final
    SPECIAL
                    11/21/2011      Choice Provider        Medical      overpayment, assessment or fine and who have not entered into
IMPLEMENTATION
                                        Payment           Assistance    an approved payment plan with DHHS. DHHS may suspend
    UPDATE
                                                                        payments to all provider numbers, who share the same IRS
                                                                        Employee Identification Number or corporate parent as the
                                                                        provider who owes the repayment or has a credible allegation of
                                                                        fraud.




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 Implementation   Implementation
                                         Title (s)          Subject(s)                                 Summary
   Update #:        Update Date

                                                                          Program Integrity (PI) reviews or audits may be conducted in
                                                                          person or by mail (referred to as a desk review).
                                                                          Onsite visits to providers and their recipients may be announced
                                                                          (this is a routine procedure) or unannounced.
                                                                          These reviews may be referred to as post payment reviews,
                                                                          quality assurance reviews or compliance audits.
                                                                          In order that these reviews run as smoothly as possible, providers
      #093                              Provider
                                                           NC Division of should adhere to the following steps when a
    SPECIAL                        Responsibilities in a
                    11/21/2011                               Medical      review has been initiated. PI will request medical and/or financial
IMPLEMENTATION                      Program Integrity
                                                            Assistance    records either by mail or in person. The
    UPDATE                           Review or Audit
                                                                          records must be provided upon request. The intent of the record
                                                                          request is to substantiate all services and
                                                                          billings to Medicaid or Health Choice adhere to the required
                                                                          medical record documentation standards, substantiate provider
                                                                          qualifications, delivery of service in accordance to policy,
                                                                          requirements and rules, and that business and administrative
                                                                          practices are within acceptable practices.




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 Implementation   Implementation
                                         Title (s)          Subject(s)                                  Summary
   Update #:        Update Date

                                                                          Financial or business record requests may include such
                                                                          documents as personnel and timekeeping records, invoices,
                                                                          chart of accounts, general ledger, minutes of committee
                                                                          meetings, audited or internally prepared financial statements, or
                                                                          bank loan documents. Failure to submit the requested records
                                                                          will result in recoupment of all payments for the services,
                                                                          suspension of payments, and may constitute further actions of
                                        Provider
      #093                                                                investigation resulting in termination from the Medicaid/Health
                                   Responsibilities in a   NC Division of
    SPECIAL                                                               Choice program and referral to the Medicaid Fraud Investigative
                    11/21/2011      Program Integrity        Medical
IMPLEMENTATION                                                            Unit for review for criminal or civil prosecution. For the purpose of
                                    Review or Audit -       Assistance
    UPDATE                                                                Medicaid and Health Choice billing, providers must maintain
                                       (CONTD)
                                                                          records for six years in accordance with the record keeping
                                                                          provisions of the Medicaid Provider Administrative Participation
                                                                          Agreement. Other record retention schedules may be required by
                                                                          other state or federal oversight agencies, funding streams or
                                                                          accrediting/certification bodies and Medicaid/Health Choice
                                                                          requirements do not override those requirements of other
                                                                          oversight bodies.




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 Implementation   Implementation
                                         Title (s)          Subject(s)                                Summary
   Update #:        Update Date

                                                                          Appeals - Informal - Reconsideration Review – A provider who
                                                                          disagrees with the decision may request an informal
                                                                          reconsideration review and submit additional relevant
                                                                          documentation for review. Please read the letter from DMA
                                                                          regarding the time frame for submitting a reconsideration review
                                                                          request. The reconsideration review is an informal procedure.
                                        Provider
      #093                                                                The case will be reviewed by an independent Hearing Officer who
                                   Responsibilities in a   NC Division of
    SPECIAL                                                               will send the provider a written decision.
                    11/21/2011      Program Integrity        Medical
IMPLEMENTATION                                                            Formal - Contested Case Hearing – If the provider is not satisfied
                                    Review or Audit -       Assistance
    UPDATE                                                                with the outcome of the informal review, or if the
                                       (CONTD)
                                                                          provider chooses not to have an informal review, the provider
                                                                          may file a request for a contested case hearing at the Office of
                                                                          Administrative Hearings (OAH). Pay close attention to the specific
                                                                          time frames and procedures for requesting a contested case
                                                                          hearing at OAH. Once the request is received, OAH will contact
                                                                          the provider regarding scheduling of the case.




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                                       Title (s)        Subject(s)                                 Summary
   Update #:        Update Date


                                                                      DMA is authorized by Section 1902 (a) (27) of the Social Security
                                                                      Act and 42 CFR §431.107 to access patient medical records for
                                                                      purposes directly related to the administration of the Medicaid
                                                                      Program. In addition, when applying for Medicaid benefits, each
                                                                      recipient signs a release which authorizes access to his/her
                                                                      Medicaid records by DMA and other appropriate regulatory
                                    Medical Record                    authorities. Therefore, no special recipient permission is
      #093                           Requests for                     necessary for release of records to DMA for post-payment
                                                       NC Division of
    SPECIAL                        Program Integrity                  reviews. Federal regulations and provider agreements with the
                    11/21/2011                           Medical
IMPLEMENTATION                     Post Payment and                   Division of Medical Assistance require the provider to keep any
                                                        Assistance
    UPDATE                           Pre Payment                      records necessary to disclose the extent
                                        Reviews                       of services furnished including but not limited to all information
                                                                      contained in recipient financial and medical records, agency
                                                                      personnel records and other agency administrative records.
                                                                      A provider on post payment review will receive an initial medical
                                                                      record request that requires copies of recipient records be sent to
                                                                      DMA or it’s agents within ten (10) business days of the provider’s
                                                                      receipt of the initial letter.




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                                        Title (s)        Subject(s)                                Summary
   Update #:        Update Date


                                                                        If records are not received by DMA or it’s agents within the
                                                                       allotted time, a final request will be sent, which states that the
                                                                       provider is required to provide the requested records by the end
                                                                       of the 5th business day from receipt of the final request letter.
                                                                       Failure to comply with this final request may result in a
                                                                       determination that the provider agency was improperly paid for all
                                     Medical Record                    services under review for the requested dates of service. In
      #093                            Requests for                     addition, failure to produce records will be considered a credible
                                                        NC Division of
    SPECIAL                         Program Integrity                  allegation of fraud and subject the provider to immediate payment
                    11/21/2011                            Medical
IMPLEMENTATION                     Post Payment and                    suspension and possible termination from Medicaid participation.
                                                         Assistance
    UPDATE                            Pre Payment                      A provider on prepayment review will receive medical record
                                   Reviews (CONTD)                     requests as noted above, for all recipients where they submit a
                                                                       claim for payment to Medicaid. With prepayment review, the initial
                                                                       medical records request allows five (5) business days for
                                                                       response. If records are not received within the allotted time, a
                                                                       final request will be sent that requires records to be received
                                                                       within five (5) business days of receipt of the letter. Payment of
                                                                       the claims will be denied if the documentation is not received.




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 Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
   Update #:        Update Date


                                                                       The N.C. Department of Health and Human Services created a
                                                                       poster http://www.ncdhhs.gov/dma/fraud/FraudPoster.pdf asking
                                                                       citizens to report Medicaid fraud and abuse. In a
                                                                       memo http://www.ncdhhs.gov/dma/fraud/FraudMemo.pdf dated
                                                                       June 4, 2010, DHHS Secretary Lanier Cansler asked all health
                                                                       care agencies and private health care providers to print and
                                                                       prominently display the poster in their offices. These efforts
      #093
                                                        NC Division of continue to be a priority for DHHS and the health care industry.
    SPECIAL                        Reporting Provider
                    11/21/2011                            Medical      Combating fraud/abuse and over use of services is an effective
IMPLEMENTATION                     Fraud and Abuse
                                                         Assistance    way to reduce health care costs without compromising
    UPDATE
                                                                       recipient care. You are encouraged to report matters involving
                                                                       Medicaid fraud and abuse. If you want to report fraud or abuse,
                                                                       you can remain anonymous; however, sometimes in order to
                                                                       conduct an effective investigation, staff may need to contact you.
                                                                       Your name will not be shared with anyone investigated. (In rare
                                                                       cases involving legal proceedings, we may have to reveal who
                                                                       you are.)




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                                    Title (s)   Subject(s)                                Summary
  Update #:        Update Date

                                                               The Critical Access Behavioral Health Agency (CABHA)
                                                               temporary rules expired on October 15, 2011. The
                                                               permanent rules and fiscal note are in the process of going
                                                               through the Office of State Budget and Management
                                                               (OSBM) and the Rules Review Commission. They will be posted
                                                               for public comment and will have a public
                                                               hearing in line with the permanent rule process. The CABHA
                                                               infrastructure, core services, and CABHA-only services are
                                                               delineated in the Medicaid State Plan and were approved by
                                                               CMS. The Medicaid State Plan also states, “A Critical Access
                                                               Behavioral Health Agency must meet all statutory, rule and policy
                                                               requirements for Medicaid mental health and substance abuse
                                                               service provision and monitoring; be determined to be in good
                                                               standing with the Department, and have a three year (or longer)
    #092           11/10/2011     CABHA Rules    CABHA         accreditation from an accrediting body recognized by the
                                                               Secretary of the DHHS. State statutory requirements regulating
                                                               the provision of mental health and substance abuse services are
                                                               in North Carolina General Statute, Chapter 122C; administrative
                                                               rules relating to these services are in 10A NCAC 27 and clinical
                                                               policy requirements are specified in Medicaid Clinical Policy
                                                               Section 8. Medicaid and enrollment policy require compliance
                                                               with Federal Medicaid Policy relating to confidentiality, record
                                                               retention, fraud and abuse
                                                               reporting and education, documentation, staff qualifications and
                                                               compliance with clinical standards for each
                                                               service.” Implementation updates and policy statements
                                                               regarding CABHA requirements are implicitly authorized by the
                                                               State Plan and must be adhered to by providers.




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                                        Title (s)        Subject(s)                                 Summary
  Update #:        Update Date



                                                                        The Division of Medical Assistance has asked CMS for an
                                                                        extension for the current 2008 CAP MR/DD waiver.
                                                                        The extension was requested because DMA and DMH/DD/SAS
                                                                        are working with CMS to review NC’s progress
                                                                        on our 2008 CAP MR/DD waiver transition plan for recipients
                                                                        residing in facilities with more than 16 beds and
                                                                        the Divisions are addressing final questions about transition to the
                                                                        new waiver requirements. When the waiver is approved by CMS,
                                                                        DMA will publish the final services with the effective start date of
                                                                        the waiver. The proposed implementation date for the renewal
    #092           11/10/2011     Extension of Current   CAP-MR/DD
                                                                        CAP I/DD waiver is January 1, 2012. We appreciate the amount
                                  CAP-MR/DD Waiver
                                                                        of time that recipients, families, case managers, and providers
                                                                        have spent working on developing transition plans. To that end,
                                                                        we have drafted the following guidelines in an attempt to minimize
                                                                        further disruption for recipients and their families. Please review
                                                                        the following bullets to determine if the case
                                                                        manager and recipient/family need to submit an updated revision
                                                                        (authorization request), including the person
                                                                        centered plan (PCP) revision form with appropriate signatures,
                                                                        CTCM form, and updated cost summary.




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  Update #:        Update Date



                                                                        Temporary Denial of Select Claims: Due to a systems start-up
                                                                        issue, the following codes denied for reimbursement as non-
                                                                        covered services for Health Choice recipients. These services are
                                                                        covered for Health Choice recipients and the systems’ problem
                                                                        has now been corrected. Providers may re-submit claims that
                                                                        were previously denied as non-covered services. This notice
                                                                        relates only to claims for Health Choice recipients and only for
                                                                        claims that denied for this reason. This notice does not impact
                                                                        claims denied for Medicaid recipients or claims denied for other
                                                                        reasons. Health Choice Requirements Prohibiting Retro
                                     Health Choice                      Authorization for Services: Please note: Health Choice is now
    #092           11/10/2011     Claims Denial/Retro   Health Choice   operating under the same policies as Medicaid: effective
                                         Auth.                          immediately, all authorization requests for behavioral health
                                                                        services for children and adolescents covered by Health Choice
                                                                        must be approved PRIOR to the delivery of the service. The
                                                                        ONLY exceptions are for emergency and crisis services, per
                                                                        current Medicaid policy, and for situations in which a recipient
                                                                        receives retro-eligibility for Health Choice and the service has
                                                                        already been delivered. These requirements are the same that
                                                                        apply to Medicaid recipients and include Outpatient Services,
                                                                        Residential Services, Enhanced Services, Psychiatric Residential
                                                                        Treatment Facilities, Targeted Case Management and Inpatient
                                                                        Services.




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                                      Title (s)       Subject(s)                                  Summary
  Update #:        Update Date




                                                                      As stated in the June 2011 Medicaid Bulletin and IU #087, the
                                                                      coverage of provisionally licensed providers delivering outpatient
                                                                      behavioral health services as a reimbursable service under
                                                                      Medicaid funds and billed through the local management entity
                                                                      (LME) has been extended to June 30, 2012. There have been
                                                                      concerns voiced that the new changes in Clinical Coverage Policy
                                                                      8C “Outpatient Behavioral Health Services Provided by Direct-
                                                                      Enrolled Providers” that will be implemented in January 2012,
                                                                      eliminate this option for provisionally licensed professionals. As
                                                                      has already been the case, provisionally licensed professionals
                                                                      can either bill the allowable CPT codes ‘incident to’ a physician,
                                                                      or, they can bill H codes through the LME (if the LME allows for
                                  H Code Limits for                   this type of billing). In line with the changes in 8C to be
                                                      Provisionally
    #092           11/10/2011       Provisionally                     implemented in January 2012, in keeping with generally accepted
                                                       Licensed
                                     Licensed                         guidelines for timeframes for outpatient services, and as a part of
                                                                      federal Medicaid fraud initiatives, the following limits will be
                                                                      placed on H codes billed through the LME: · Individual and family
                                                                      therapy – can bill up to four units (60 minutes) per date of service
                                                                      (DOS) of the
                                                                      following codes as clinically appropriate: H0004, H0004HR,
                                                                      H0004HS · Group therapy – can bill up to six units (90 minutes)
                                                                      per DOS of the following codes as clinically
                                                                      appropriate: H0004HQ, H0005 · Assessment – can bill up to
                                                                      eight units (120 minutes) per DOS of the following codes as
                                                                      clinically appropriate: H0001, H0031
                                                                      Providers are still responsible for counting unmanaged visits and
                                                                      obtaining prior authorization as needed.




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                                        Title (s)        Subject(s)                                Summary
  Update #:        Update Date

                                                                    DMA has determined system modifications were required to
                                                                    address the denial of claims billed through the
                                                                    LME for Therapeutic Foster Care and Outpatient Behavioral
                                                                    Health services provided by provisionally-licensed
                                                                    individuals. These denials began appearing in April up until the
                                                                    present. The system's issue has been resolved
                                  Resolution for IPRS   IPRS &      so that claims that were denied during that period may be
    #092           11/10/2011     & Medicaid Claims Medicaid Claims resubmitted. For denied therapeutic foster care claims
                                        Denial          Denial      for S5145, the LME should resubmit the claim with the correct
                                                                    attending National Provider Identifier (NPI) for the service
                                                                    provided. For denied outpatient claims for provisionally licensed
                                                                    professionals, the LME should return the claim to the provider
                                                                    and have them resubmit the claim under the enrolled NPI.
                                                                    Questions should be directed to HP Enterprise Services at 1-800-
                                                                    688-6696 or 919-851-8888.

                                                                        Effective July 1, 2010, all services provided in the emergency
                                                                        department (ED) during an admission with a primary discharge
                                                                        diagnosis of 290 through 319 were added to the Cardinal
                                                                        Innovations Health Plan 1915 b/c Waiver Capitation rate. The
                                                                        Cardinal Innovations Health Plan has been in operation in
                                                                        Cabarrus, Davidson, Rowan, Stanly, and Union counties.
                                                           Cardinal     Medicaid originating from Alamance and Caswell counties
                                  Cardinal Innovations
    #092           11/10/2011                            Innovations    became part of the Cardinal Innovations Health Plan effective
                                      Health Plan
                                                         Health Plan    October 1, 2011. Medicaid originating from Franklin, Granville,
                                                                        Halifax, Vance, and Warren counties will become part of the
                                                                        Cardinal Innovations Health Plan effective January 1, 2012.
                                                                        Medicaid originating from Orange, Person, and Chatham counties
                                                                        will become part of the Cardinal Innovations Health Plan effective
                                                                        April 1, 2012. The Cardinal Innovations
                                                                        Health Plan is administered by the area LME, PBH.




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                                      Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                     Outpatient         Outpatient    The presentation for the Outpatient Behavioral Health Seminars
    #092           11/10/2011     Behavioral Health     Behavioral    that will take place in early November can be found on the DMA
                                      Seminar         Health Training website: http://www.ncdhhs.gov/dma/provider/seminars.htm.

                                                                       Effective the date of this Implementation Update, LMEs are
                                                                       authorized to triple the endorsement time frames until further
                                                                       notice. With LMEs involved in merger activities and 1915 (b) (c)
                                                                       activities the extension of the endorsement process will help the
                                                                       LMEs adequately evaluate provider qualifications for
                                                                       endorsement. It is expect that LMEs will prioritize endorsement
                                                                       for evidence-based services or services that are critically needed
                                                                       within its catchment area. The authorization to triple the
                                  Endorsement Time
    #092           11/10/2011                         Endorsement      endorsement time lines apply to all time lines related to
                                   Frames Tripled
                                                                       the LME's completion of the endorsement process. The triple
                                                                       time frame does not apply to provider wait time to re-apply if an
                                                                       endorsement is denied or withdrawn or the three year re-
                                                                       endorsement requirements and appeal process. Please refer to
                                                                       the endorsement policy found at:
                                                                       http://www.ncdhhs.gov/mhddsas/providers/providerendorsement/
                                                                       policy-rev4-15-11providerendorse.pdf
                                                                       for the existing time frames.




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                                     Title (s)     Subject(s)                               Summary
  Update #:        Update Date


                                                                  The Department of Health and Human Services, Division of
                                                                  Medical Assistance (DMA) hereby provides notice
                                                                  of its intent to amend the Reimbursement sections of the
                                                                  Medicaid State Plan. To comply with SL 2011-145,
                                                                  section 10.37.(a) (6), DMA will be submitting State Plan
                                                                  Amendments for the purpose of revising rate
                                                                  methodology language to reflect for SFY 2011–2012 effective
                                  Notice of Rate
    #091           10/10/2011                        Rates        November 1, 2011 rates paid to North Carolina
                                   Reductions
                                                                  Medicaid service providers will be reduced by 2.67%. Nursing
                                                                  homes will have their rate reductions effective
                                                                  July 1, 2011. More detailed information will be posted on DMA
                                                                  website at
                                                                  http://www.ncdhhs.gov/dma/provider/budgetinitiatives.htm
                                                                  For questions concerning the reductions please call DMA Finance
                                                                  Management at 919-855-4180.




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                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date


                                                                     As a result of the legislatively mandated transition of Health
                                                                     Choice program benefits coverage to a Medicaid
                                                                     equivalent, service and visit limits will mirror those for Medicaid.
                                                                     As previously communicated in the September 2011 Medicaid
                                                                     Bulletin and Implementation Update #090, for Health Choice
                                                                     recipients, the count of 16 unmanaged outpatient treatment
                                                                     service visits will begin anew on October 1, 2011. It is advisable
                                   Health Choice                     to obtain prior approval for benefits with service limits as a means
    #091           10/10/2011                        Health Choice
                                    Transition                       of verifying that a recipient’s service limits will not be
                                                                     exceeded. For Health Choice recipients who have been enrolled
                                                                     exclusively in Health Choice over the course of the
                                                                     calendar year, those enhanced services that allow a “pass-
                                                                     through” or maximum units for the calendar year or
                                                                     another specified timeframe (e.g. Substance Abuse Intensive
                                                                     Outpatient Program [SAIOP]) will also begin anew
                                                                     on October 1, 2011.

                                                                     DMA has made provisions to allow Medicaid crossover claims
                                                                     processing for Critical Access Behavioral Health
                                                                     Agencies (CABHAs) who bill Medicare for outpatient behavioral
                                                                     health services. CABHA providers will receive a percentage of the
                                                                     Medicare coinsurance/deductible for the claim. The percentages
                                                                     can be found on the DMA website at
                                    Payment on       Professional    http://www.ncdhhs.gov/dma/fee/
    #091           10/10/2011       Professional      Crossover      This provision will be retro-active to July 1, 2010. CABHA
                                  Crossover Claims     Claims        Crossover claims for dates of service July 1, 2010
                                                                     and after, that were paid at $0.00, may be resubmitted
                                                                     electronically to Medicaid as an 837 void transaction and
                                                                     a new day claim, or resubmitted as a manual adjustment using
                                                                     the Medicaid Claim Adjustment form. In order for previously
                                                                     denied claims to process, they must be resubmitted on or before
                                                                     December 31, 2011.



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                                      Title (s)       Subject(s)                                Summary
  Update #:        Update Date

                                                                     Outpatient Behavioral Health Services provider seminars are
                                                                     scheduled for November 2011. Information presented will include
                                                                     a review of Clinical Coverage Policy 8C–Outpatient Behavioral
                                                                     Health Services Provided by Direct-Enrolled Providers and policy
                                                                     updates, billing procedures including billing “incident to” a
                                                                     physician, prior approval, National Correct Coding Initiative,
                                                                     Carolina Access for recipients under age 21, Health Choice, fraud
                                                                     and abuse. Pre-registration is required. Due to limited seating,
                                      Outpatient
                                                                     registration is limited to two staff members per office.
    #091           10/10/2011     Behavioral Health    Training
                                                                     Unregistered providers are welcome to attend if space is
                                  Services Seminars
                                                                     available. Providers may register for the Outpatient Behavioral
                                                                     Health Services seminars by completing and submitting
                                                                     the online registration form
                                                                     www.hp.com/go/medicaid_seminar_Nov. Sessions will begin at
                                                                     9:00 a.m. and end at 12:00 p.m. Providers are encouraged to
                                                                     arrive by 8:45 a.m. to complete registration. Lunch will not be
                                                                     provided at the seminars. Because meeting room temperatures
                                                                     vary, dressing in layers is strongly advised.




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                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                        NC Medicaid offers to all providers the ability to sign up for NC
                                                                        Medicaid Email Alerts. Email Alerts are used
                                                                        to send notices to providers on behalf of the NC Division of
                                                                        Medical Assistance, NC Medicaid and NC Health
                                                                        Choice programs. Email Alerts are sent to providers when there
                                                                        is important information to share outside of the
                                     Subscribe and
                                                                        general Medicaid provider bulletin. To receive Email Alerts you
                                  Receive Email Alerts   North Carolina
                                                                        must actively subscribe to the Email Alerts at
    #091           10/10/2011      on Important North      Medicaid
                                                                        www.hp.com/go/medicaidalert. Anyone, including providers and
                                   Carolina Medicaid       Updates
                                                                        their staff members, may subscribe to the
                                        Updates
                                                                        Email Alerts. The subscription process will only take a few
                                                                        moments and you must provide contact information
                                                                        including an email address and your provider type of specialty.
                                                                        You may unsubscribe at any time. Email
                                                                        addresses are never shared, sold or used for any purpose other
                                                                        than Medicaid Email Alerts.




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                                       Title (s)      Subject(s)                                   Summary
  Update #:        Update Date


                                                                     In an effort to avoid further budget reductions, it is critical that the
                                                                     Medicaid system achieve savings to preserve vital services. One
                                                                     of they primary ways to do so is to enroll all eligible Medicaid and
                                                                     Health Choice recipients into Community Care/Carolina Access
                                                                     “health homes.” These efforts need to be a priority if we are to
                                                                     preserve the existing range of optional Medicaid funded services.
                                                                     the existing range of optional Medicaid funded services. What
                                                                     providers can do to assist with enrollment to Community Care of
                                       Enrolling
                                                                     North Carolina (CCNC)/Carolina Access (CA): Check the
    #090            9/7/2011       Medicaid/Health    CCNC/CA
                                                                     recipient’s Medicaid card. If the card does not have a primary
                                  Choice in CCNC/CA
                                                                     care physician on it, refer the recipient to the local Department of
                                                                     Social Services (DSS) office to enroll in the CCNC/CA network.
                                                                     The recipient may choose a medical home with a primary doctor.
                                                                     The local county DSS has a complete list of participating doctors.
                                                                     A medical home can be chosen for each family member. If a
                                                                     recipient does not choose a medical home, one will be
                                                                     automatically assigned.




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                                        Title (s)          Subject(s)                                 Summary
  Update #:        Update Date

                                                                          DMA is working to align all Behavioral Health policies and service
                                                                          definitions for Health Choice recipients with Behavioral Health
                                                                          Medicaid policies. The target date for this transition is October 1,
                                                                          2011. All requests for authorization submitted to Value Options on
                                                                          or after October 1st will use the Medicaid service criteria. As a
                                                                          reminder, EPSDT Special Provision and the Important Notes on
                                                                          EPDST documented in Medicaid clinical coverage policies do not
                                                                          apply to NC Health Choice.
                                                                          For outpatient treatment services: The count of unmanaged visits
                                                                          will begin anew on October 1st under the 16 unmanaged
                                                                          limitations. This will occur again on January 1, 2012 and conform
                                      Changes in
    #090            9/7/2011                              Health Choice   to the standard calendar year limitation. These visits are defined
                                  Behavioral Health for
                                                                          by the number of procedure codes paid for services rendered to
                                     Health Choice
                                                                          the recipient and not by the individual units of service provided.
                                                                          The data system counts each procedure code as one visit with
                                                                          the exception of the following codes for group therapy: 90849,
                                                                          90853, 90857, H0005, and H004 HQ. These five codes are
                                                                          counted as ½ visits for the unmanaged unit counts. When the
                                                                          recipient reaches the maximum number of unmanaged units the
                                                                          following visits will be denied unless prior approval is obtained.
                                                                          Once prior approval is on file for the recipient, the system
                                                                          considers the unmanaged count as "used" for that calendar year,
                                                                          regardless of the amount of previous services provided.




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  Update #:        Update Date



                                                                          For Therapeutic Foster Care: On and after October 1, 2011, all
                                                                          Therapeutic Foster Care (TFC) authorizations for Health Choice
                                                                          will be made to the local management entity (LME) associated
                                                                          with the recipient’s county of eligibility on file with DMA eligibility
                                                                          as of the date of review. The authorization process for TFC for
                                                                          Health Choice will mirror the process for Medicaid. LMEs will
                                                                          access copies of TFC authorization letters and adverse
                                      Changes in          Health Choice
    #090            9/7/2011                                              determination letters online via the Utilization Review (UR)
                                  Behavioral Health for    (continued)
                                                                          vendor. For all Health Choice Behavioral Health services: Claims
                                     Health Choice
                                                                          adjudication for authorized services rendered prior to October 1,
                                                                          2011 will occur through Blue Cross Blue Shield (BCBS). Claims
                                                                          adjudication for authorized services rendered on or after October
                                                                          1, 2011 will occur through HP Enterprise Services. It is critical
                                                                          that providers use the October 1st date to separate their claims
                                                                          so that uninterrupted payment may occur.




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                                       Title (s)      Subject(s)                                 Summary
  Update #:        Update Date


                                                                     As per legislation, Session Law, House Bill 200 on pages 126
                                                                     –127: · Effective November 1, 2011, a comprehensive clinical
                                                                     assessment (CCA) completed and signed by a licensed mental
                                                                     health professional within 30 days of the requested admission
                                                                     date must be submitted with the ITR for initial reviews to assure
                                                                     the appropriateness of placement. Requests for transfer from
                                                                     one Level III or Level IV facility to another do not require a new
                                                                     CCA completed if the transfer is for the same level of care.
                                                                     Please see Implementation Update #36 for more information
                                                                     regarding comprehensive clinical assessments. · Effective
                                  New UR Guidelines
    #090            9/7/2011                          Residential    November 1, 2011, a psychiatric or psychological assessment is
                                    for Residential
                                                                     required for authorization requests past the 180 day mark, to be
                                                                     completed by a psychiatrist (MD/DO) or psychologist (PhD) within
                                                                     60 days of the requested start date of the requested re-
                                                                     authorization period. This psychiatric or psychological
                                                                     assessment must be completed by an independent practitioner
                                                                     who is not associated with the residential services provider if the
                                                                     provider is not a Critical Access Behavioral Health Agency
                                                                     (CABHA). If the residential services provider is a certified CABHA
                                                                     the assessment may be completed by a professional associated
                                                                     with the CABHA.




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                                       Title (s)      Subject(s)                                 Summary
  Update #:        Update Date


                                                                      The UR vendor will require a statement from the independent
                                                                     evaluator who completes the CCA for the non-CABHA attesting
                                                                     that he or she is independent from, and not employed by or under
                                                                     contract with, the residential provider seeking prior authorization
                                                                     for services. When prior authorization is being requested by a
                                                                     CABHA, the UR vendor will require a statement signed by the
                                                                     CABHA Clinical Director that the person completing the
                                                                     assessment is employed by or under contract with the CABHA.
                                  New UR Guidelines   Residential    Documentation in the request for an extension past the 180 day
    #090            9/7/2011
                                    for Residential   (continued)    mark must support that a Child and Family Team has reviewed
                                                                     goals and treatment progress and that the child or adolescent’s
                                                                     family or discharge setting is involved in treatment planning and
                                                                     engaged in the treatment interventions. Independent
                                                                     assessments for extensions on Level III and Level IV past the
                                                                     120 day mark are no longer required for requests for prior
                                                                     authorization. Providers will continue to submit an updated
                                                                     discharge summary but it will no longer need to be signed by the
                                                                     System of Care coordinator at the time of submission.




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                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date


                                                                       The new waiver, effective November 1, 2011, allows for a
                                                                       maximum total of 129 hours of habilitation per month. This
                                                                       includes Days Supports, Supported Employment, Long Term
                                                                       Vocational Support and Home and Community Supports. This is
                                                                       a firm limit FOR ADULTS over age 21. Requests to exceed the
                                                                       limit for children under age 21 will be reviewed under EPSDT. All
                                                                       requests authorized prior to October 31, 2011 that exceed the
                                                                       Utilization Criteria for habilitation will need to be in compliance by
                                                                       November 1, 2011. Because of the quantity of revisions that will
                                                                       be submitted, it is strongly
                                                                       recommended that services are transitioned prior to October, 31
                                  CAP-I/DD Policy for                  2011 or at least 15 business days prior to the effective date of the
    #090            9/7/2011                            CAP-MR/DD
                                  Exception/Extension                  request to allow the UR vendors ample time to complete the
                                                          Waiver
                                                                       authorizations. Billing of more than 129 hours a month of
                                                                       habilitation will result in denial of units above the maximum
                                                                       allowable regardless of prior approval, unless more units have
                                                                       been approved for a child under EPSDT. As of November 1,
                                                                       2011the 129 hours a month of habilitation will be a limitation for
                                                                       adults and therefore it cannot be appealed for recipients 21 and
                                                                       over. Requests submitted for recipients under the age of 21 will
                                                                       be reviewed under EPSDT and if denied, the recipient will be
                                                                       provided with an adverse decision notice that includes an appeal
                                                                       form and a description of how to appeal to the Office of
                                                                       Administrative Hearings.




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  Update #:        Update Date


                                                                       Effective October 1, 2011, the Appropriations Act of 2011 (House
                                                                       Bill 200) mandates that providers submit
                                                      Electronic Prior authorization requests electronically via the vendor’s website. For
                                   Electronic Prior
    #090            9/7/2011                             Approval      purposes of submitting mental health,
                                  Approval Requests
                                                         Requests      substance abuse, and developmental disability requests to the
                                                                       appropriate utilization review vendors, please note
                                                                       the submission requirements for each vendor in IU # 90.

                                                                       Budgetary issues has caused all CAP-MR/DD Comprehensive
                                                                       and Support Waiver slots to be frozen. This includes emergency
                                                                       slots, and deinstitutionalization (DI) slots. Slots allowing
                                                                       individuals to transfer from the Supports Waiver to the
                                  CAP-MR/DD Waiver                     Comprehensive Waiver have also been frozen. Despite current
    #090            9/7/2011                           CAP-MR/DD
                                   Slots/MFP Slots                     budget restraints, we have been fortunate to support 30 people
                                                         Waiver
                                       Update                          with Money Follows the Person (MFP) CAP-MR/DD slots as they
                                                                       transition into their communities. All 30 MFP CAP I/DD slots for
                                                                       this year have been allocated. No additional MFP slots will be
                                                                       available during this waiver year.




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                                    Title (s)    Subject(s)                                  Summary
  Update #:        Update Date


                                                                According to HIPPAA standards, an electronic signature means
                                                                the attribute affixed to an electronic document to bind it
                                                                to a particular party. An electronic signature secures the user
                                                                authentication (proof of claimed identity) at the time the signature
                                                                is generated; creates the logical manifestation of signature
                                                                (including the possibility for multiple parties to sign a document
                                                                and have the order of application recognized and proven);
                                                                supplies additional information such as time stamp and signature
                                                                purpose specific to that user; and ensures the integrity of the
                                                                signed document to enable transportability of data,
                                  Guidance for   Electronic
    #090            9/7/2011                                    interoperability, independent verifiability, and
                                   Electronic    Signatures
                                                                continuity of signature capability. Verifying a signature on a
                                   Signatures
                                                                document verifies the integrity of the document and associated
                                                                attributes and verifies the identity of the signer. If an entity uses
                                                                electronic signatures, the signature method must assure all of the
                                                                following features: message integrity (evidence that the document
                                                                has not been altered); no repudiation (strong and substantial
                                                                evidence that will make it difficult for the signer to
                                                                claim that the electronic representation is not valid), and user
                                                                authentication (evidence of the identity of the person signing). No
                                                                specific technology is mandated by HIPAA.




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                                        Title (s)        Subject(s)                                Summary
  Update #:        Update Date

                                                                        Program Integrity has identified some trends in outpatient mental
                                                                        health non-physician practices, independent and group. Some
                                                                        providers are operating after-school programs, summer
                                                                        programs, or non-licensed day treatment programs and
                                                                        submitting claims for reimbursement from the North Carolina
                                  Fraudulent Trends in   Fraud and
    #090            9/7/2011                                            Medicaid Program. Medicaid only reimburse for services that are
                                  Outpatient Services      Abuse
                                                                        medically necessary when the provider is qualified to provide the
                                                                        services. Providers should know that defrauding the NC
                                                                        Medicaid program is a serious offense and will be dealt with
                                                                        accordingly. Sometimes the penalty includes civil and/or criminal
                                                                        remedies.

                                                                        DHHS has created a poster,
                                                                        http://www.ncdhhs.gov/dma/fraud/FraudPoster.pdf, asking
                                                                        citizens to report Medicaid fraud and abuse. In a
                                                                        memo, http://www.ncdhhs.gov/dma/fraud/FraudMemo.pdf, dated
                                                                        June 4, 2010, DHHS Secretary Lanier Cansler asked all health
                                  Reporting Provider     Fraud and
    #090            9/7/2011                                            care agencies and private health care providers to print and
                                   Fraud & Abuse           Abuse
                                                                        prominently display the poster in their offices.
                                                                         If you want to report fraud or abuse, you can remain anonymous;
                                                                        however, sometimes in order to conduct an effective
                                                                        investigation, staff may need to contact you. Your name will not
                                                                        be shared with anyone.




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                                      Title (s)      Subject(s)                                  Summary
  Update #:        Update Date



                                                                    The General Assembly, via Senate Bill 437, extended the
                                                                    authority of the Secretary to waive the requirement that a first
                                                                    commitment examination be completed by a physician or eligible
                                                                    psychologist to allow licensed clinical social workers, master's
                                                                    level psychiatric nurses, or master's level certified clinical
                                                                    addictions specialists (LCAS) to also perform such examinations.
                                                                    In the case of LCASs, they will only be authorized to conduct the
                                                                    initial examination of individuals meeting the criteria of G.S. 122C-
                                                                    281(a). A waiver granted by the Secretary under this legislation
                                  First Commitment                  shall be in effect for a period of up to three years and may be
    #090            9/7/2011                            IVC
                                        Update                      rescinded at any time within this period. The Secretary shall
                                                                    review the request and may approve it upon finding all of the
                                                                    following: 1. The request meets the requirements of this section.
                                                                    2. The request furthers the purposes of State policy under G.S.
                                                                    122C-2 and mental health, developmental disabilities, and
                                                                    substance abuse services reform. LMEs which have heretofore
                                                                    applied and been approved (18 of the current 23 LMEs have
                                                                    applied and been approved to perform first examinations) will
                                                                    have until October 1, 2014 to exercise this waiver. If they wish to
                                                                    continue, they will need to reapply prior to this date.



                                                                    Changes regarding the three key staff positions within a CABHA
                                                                    (Medical Director, Clinical Director, and Quality
                                                                    Management/Training Director) must be submitted by hard copy
                                  CABHA Key Staff                   using trackable mail. If an email is sent with attached documents,
    #090            9/7/2011                          CABHA
                                     Changes                        a hard copy is still required to be sent by trackable mail. In the
                                                                    event that the provider has obtained a resignation letter from the
                                                                    Clinical Director or Medical Director a copy of the resignation
                                                                    letter must also be submitted with the change information.




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  Update #:        Update Date


                                                                    Stakeholder input will be received by DHHS in order to develop a
                                                                    draft Medicaid waiver strategic plan. This plan will delineate
                                                                    specific strategies and agency responsibilities for the successful
                                                                    achievement of statewide implementation of the 1915 b/c waiver
                                                                    as identified in House Bill 916. The North Carolina General
                                                                    Assembly through S.L. 2011-264, House Bill 916 instructed the
                                                                    DHHS to proceed with statewide restructuring of the
                                                                    management responsibilities for the delivery of services for
                                                                    individuals with mental illness, intellectual and developmental
                                                                    disabilities, and substance abuse disorders through expansion of
                                                                    the 1915 b/c Medicaid Waiver. It is the intent of the General
                                                                    Assembly that expansion of the 1915 b/c Medicaid Waiver will be
                                  Medicaid Waiver      1915 b/c
    #089            8/3/2011                                        completed by July 1, 2013, and will result in the establishment of
                                   Strategic Plan   Medicaid Waiver
                                                                    a system that is capable of managing all public resources that
                                                                    may become available for mental health, intellectual and
                                                                    developmental disabilities, and substance abuse services,
                                                                    including federal block grant funds, federal funding for Medicaid
                                                                    and Health Choice, and all other public funding sources. The
                                                                    Draft Plan is found at:
                                                                    http://www.ncdhhs.gov/mhddsas/waiver/draftwaiver.htm. Given
                                                                    the timelines with which we have to work to present the
                                                                    completed plan to the General Assembly by October 1, we
                                                                    request that your feedback to the plan by Monday, August 15.
                                                                    Feedback may be registered by sending it to:
                                                                    CommentsDraftWaiverStrategic@dhhs.nc.gov




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  Update #:        Update Date



                                                                    The toolkit was created to assist MH/DD/SA providers in
                                                                    collaborating with Community Care of North Carolina (CCNC) and
                                                                    primary care providers. Refer to the toolkit documents on the
                                                                    DMA website at
                                                                    http://www.ncdhhs.gov/dma/services/behavhealth.htm.
                                                                    Overview: 1) MH/DD/SA Integrated Care Flowchart – this
                                                                    document details for MH/DD/SA providers how to determine if a
                                                                    Medicaid recipient entering services has a CCNC medical home
                                                                    or other primary care provider and how to gather physical health
                                                                    information to incorporate into the recipient’s assessment and
                                                                    Person-Centered Plan of Care. It also offers guidance on when to
                                                                    contact the primary care providers. 2) Four Quadrant Care
                                                                    Management Model Responsibilities, this document defines the
                                    MH/DD/SAS                       expectations for collaboration between MH/DD/SA providers and
                                                    Integrated Care
    #089            8/3/2011      Integrated Care                   primary care providers in conjunction with LME/MCO and
                                                         Toolkit
                                       Toolkit                      Community Care of North Carolina networks. 3) Sample
                                                                    questions – this document offers sample questions for
                                                                    MH/DD/SA providers to ask recipients to determine their level of
                                                                    involvement with primary care and potential physical health
                                                                    needs. 4) Benefits of CCNC – this document, from the
                                                                    Department of Social Service (DSS) manual, explains the
                                                                    benefits of a CCNC medical home. This form, along with a
                                                                    Spanish version can be found on the DMA website
                                                                    http://info.dhhs.state.nc.us/olm/forms/forms.aspx?dc=dma. The
                                                                    forms are DMA- 9016 and DMA-9016sp. Only DSS can enroll
                                                                    Medicaid recipients into CCNC medical homes.
                                                                    5) Information from the Provider Portal/Informatics Center – this
                                                                    document is an example of information that can be accessed (via
                                                                    CCNC or the LMEs) from the Provider Portal/Informatics Center.




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  Update #:        Update Date


                                                                        The temporary CABHA Rules require that the CABHAs certified
                                                                        prior to January 1, 2011 be allowed a period of six (6) months of
                                                                        operation as a CABHA to come into compliance with the Medical
                                                                        Service and Certification and Staffing Requirements of the rules.
                                                                        Given the date of January 1, 2011 as the official start date for
                                                                        CABHA-only services going into effect, DHHS will begin CABHA
                                                        Critical Access
                                                                        monitoring during the last week of August, 2011. A sample of
                                                          Behavioral
                                                                        approximately 75 CABHAs statewide will be monitored by teams
    #089            8/3/2011      CABHA Monitoring       Healthcare
                                                                        led by the DMH/DD/SAS Accountability Team and include staff
                                                           Agencies
                                                                        from DMA and the LMEs. The sample is about 95% random,
                                                           (CABHA)
                                                                        supplemented by provider agencies referred to the DHHS due to
                                                                        significant issues of concern. The overall monitoring process will
                                                                        include the following four (4) components: 1. Data review
                                                                        completed at the DHHS level; 2. Onsite review by LME staff 3.
                                                                        Onsite review by DHHS staff; 4. Off site telephone contact by
                                                                        LME staff to individuals receiving services from the CABHAs.



                                                                         Effective October 1, 2011, the Appropriations Act of 2011 (House
                                                                         Bill 200) mandates that providers submit authorization requests
                                                                         electronically via the vendor’s website. For purposes of submitting
                                     Electronic                          mental health, substance abuse, and developmental disability
                                                            Prior
    #089            8/3/2011      Submission of Prior                    requests to the appropriate Utilization Review vendor. The
                                                        Authorization
                                    Authorization                        required information for submission has been provided along with
                                                                         contact websites for Value Options, Eastpointe Providers, The
                                                                         Durham Center Providers, Pathways LME Providers and
                                                                         Crossroads Behavioral Healthcare Providers.




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  Update #:        Update Date



                                                                    The DMH/DD/SAS and DMA have updated the Quality of Care
                                                                    process to assist in promoting quality of care
                                                                    provided to consumers. Quality of care refers to the health and
                                                                    safety of the consumer as well as to the clinically
                                                                    appropriate service(s) at the clinically indicated frequency and
                                                                    duration. DMH/DD/SAS and DMA collaborated, with input from
                                                                    various stakeholders, to create a plan incorporating
                                                                    guidelines for two complementary processes: quality of care
                                                                    oversight and independent assessments. As part of this process,
                                                                    recipients who have been in a service for an extensive length of
                                  Quality of Care
    #089            8/3/2011                        Quality of Care time may be referred for an Independent Assessment in order to
                                     Update
                                                                    ensure appropriate service delivery continues and all identified
                                                                    needs are met. The utilization review vendors (Value Options,
                                                                    Eastpointe, The Durham Center, Crossroads and Pathways)
                                                                    identify concerns for follow up by the LME and the
                                                                    DMA/DMHDDSAS Quality of Care Committee.
                                                                    The Quality of Care Guidelines and related documents can be
                                                                    found on the DMH/DD/SAS website at:
                                                                    http://www.ncdhhs.gov/mhddsas/statspublications/presenta
                                                                    tions .htm and the DMA website at:
                                                                    http://www.ncdhhs.gov/dma/services/behavhealth.htm .




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                                       Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                       Incident Response Improvement System (IRIS), the web-based
                                                                       incident reporting system, was updated in July in preparation for
                                                                       the fiscal year 2011-2012. Due to recent changes within our
                                                                       system, the medication error reporting process had to be
                                                                       updated. Any time that a provider learns that a consumer did not
                                                                       take or was not given medication as prescribed, the provider
                                                                       should contact the physician or pharmacist as required by 10A
                                                                       NCAC 27G .0209(h) to determine if this is a threat to health and
                                                                       safety and for directions for care of the person (including next
                                                                       medication). All medical issues as well as the provider’s contact
                                  IRIS Updates for FY
    #089            8/3/2011                               IRIS        with the physician should be documented in the individual’s chart
                                         2012
                                                                       (medication administration record (MAR) and/or notes as
                                                                       applicable). When a consumer is not taking medication, or not
                                                                       taking it as prescribed, it is a treatment issue and should be
                                                                       discussed with their doctor and appropriate clinical staff. Each
                                                                       agency should inform the consumer’s physician upon learning of
                                                                       any medication issue. If the physician or pharmacist indicates that
                                                                       the medication error does not threaten the consumer’s health or
                                                                       safety, the error should be documented as specified by the
                                                                       agency’s policies and procedures. See the article for details in
                                                                       the reporting of Level I, II and III medication errors.




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  Update #:        Update Date



                                                                      The final revised policy for Community Support Team (CST) will
                                                                      be posted in early August 2011. Although the policy had stated
                                                                      that there was a six-month per year hard limit for CST, the
                                                                      revision allows for exceptions to this limit when medical necessity
                                                                      is shown. The revisions states: Any request for an exception to
                                                                      this six month limit must be accompanied by a comprehensive
                                                                      clinical assessment completed by an independent licensed
                                                                      professional and an updated person centered plan (PCP) with
                                                                      new service order signed by a medical doctor ( MD), licensed
                                                                      psychologist, nurse practitioner (NP) or physician assistant(PA).
                                                                      The clinical assessment must meet the requirements as specified
                                                                      in Implementation Update #36 and clearly document medical
                                                                      necessity as defined in the continued stay criteria in this policy.
                                                          CST -
                                     Independent                      The independent licensed mental health professional must meet
    #089            8/3/2011                           Independent
                                  Assessment for CST                  the criteria included in 10A NCAC 27G .0104 and must not be
                                                       Assessment
                                                                      employed by the agency providing the Community Support Team
                                                                      service or have any financial or other interest in the agency
                                                                      providing the Community Support Team service. Beginning on
                                                                      and after October 1, 2011, all requests for concurrent
                                                                      authorizations that extend the authorization beyond a six month
                                                                      period for that consumer per that year, must be accompanied by
                                                                      an independent assessment indicating that CST continues to be
                                                                      medically necessary as well as an updated PCP as noted above
                                                                      and in the policy. The independent assessment must have been
                                                                      completed within 60 days of the new authorization request. The
                                                                      six months per calendar year are cumulative and include any time
                                                                      during that calendar year when the consumer received CST
                                                                      services.




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Implementation   Implementation
                                        Title (s)           Subject(s)                                  Summary
  Update #:        Update Date

                                                                          Outpatient Behavioral Health Services Provided by Direct-
                                                                          Enrolled Provider, have been posted for 45 days of public
                                  Proposed Changes
                                                          Medicaid Policy comment. The policy with proposed changes can be found on the
    #089            8/3/2011      to Medicaid Policy
                                                               8C         DMA website at
                                         8C
                                                                          http://www.ncdhhs.gov/dma/mpproposed/index.htm.



                                                                           As a reminder, per 8C policy
                                                                           (http://www.ncdhhs.gov/dma/mp/8C.pdf) all licensed
                                                                           professionals listed (i.e.LCSW, LMFT, LPC, LPA, PhD) must be
                                                                           enrolled with Medicaid. All components of this policy (8C
                                                                           Outpatient Behavioral Health Services Provided by Direct
                                                                           Enrolled Providers) must be followed by any licensed Outpatient
                                                                           Behavioral Health Provider listed in the policy, regardless of
                                                                           practice setting. Outpatient Behavioral Health Providers can only
                                  Clarification of NCCI      NCCI &
    #089            8/3/2011                                               provide and bill the psychiatric CPT codes listed in 8C, even if
                                      & Enrollment          Enrollment
                                                                           practicing “incident to" under the current policy.
                                                                           Please note that under the proposed revisions to Clinical Policy
                                                                           8C, licensed professionals will not be allowed to
                                                                           bill incident to a physician, but will need to enroll and submit
                                                                           claims under their own attending NPI number. To enroll as an
                                                                           independent Outpatient Behavioral Health Provider with NC
                                                                           Medicaid, the provider must fill out the Individual, In-State/Border
                                                                           Application found at NC Tracks http://www.nctracks.nc.gov/.




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                                      Title (s)         Subject(s)                                     Summary
  Update #:        Update Date


                                                                         The revisions to Clinical Policy 8C, when implemented, will
                                                                         explicitly prohibit “incident to” for licensed professionals billing
                                                                         services under a physician’s number. While the current policy has
                                                                         not disallowed this billing “Incident to” the physician, it does not
                                                                         allow a licensed professional listed in Clinical Policy 8C to bill
                                                                         incident to any other licensed professional. The licensed
                                                                         professionals listed in Clinical Policy 8C must the only ones
                                                                         providing services through their own Medicaid Provider Number
                                  Outpatient Billing
                                                       "Incident to" a   (MPN) and NPI. Allowing anyone else to use your Medicaid
    #089            8/3/2011       "Incident to" a
                                                          Physician      MPN/NPI is considered fraud and individuals doing so may run
                                      Physician
                                                                         the risk of losing his or her license in addition to losing the ability
                                                                         to provide Medicaid services. Outpatient Behavioral Health
                                                                         Providers are encouraged to read the July 2009 and the March,
                                                                         April, and June 2011 Medicaid Bulletins which give helpful
                                                                         guidance on prior authorization, NCCI, and unmanaged/managed
                                                                         visits. As a reminder, please contact Medicaid directly at (919)
                                                                         855-4290 with any questions regarding NC enrollment or billing
                                                                         questions in order to ensure accurate receipt of information.




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                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date


                                                                       The DMH/DD/SAS administers the Perception of Care (POC)
                                                                       survey annually to individuals with mental health and substance
                                                                       use problems who receive a publicly-funded service (including an
                                                                       admission) from a provider during a designated two-week period.
                                                                       DMH/DD/SAS uses three types of surveys: (1) The adult survey
                                                                       completed by those 18 and older. (2) The Youth Services Survey
                                                                       (YSS) completed by youth aged 12 through 17. (3) The Youth
                                                                       Services Survey - Family (YSS-F) completed by the parents or
                                  Perception of Care
    #089            8/3/2011                           Care Surveys    guardians of those 11 and under. The surveys are designed to
                                       Surveys
                                                                       collect information on five indicators related to services and
                                                                       outcomes (functioning, social connectedness, positive outcomes,
                                                                       accessibility of services, quality of services, and satisfaction with
                                                                       services). The surveys are required by the Community Mental
                                                                       Health Services Block Grant that use the POC indicators as part
                                                                       of the National Outcomes Measures that compare states with
                                                                       each other. LMEs will be distributing the surveys to providers to
                                                                       be completed in August.


                                                                     There have been questions regarding the budget and its impact
                                  CAP-MR/DD and
                                                        CAP-MR/DD on CAP-MR/DD slots as well as potential expansion of Money
    #089            8/3/2011        MFP Slots
                                                       and MFP Slots Follow the Person (MFP) slots. Information regarding CAP-
                                                                     MR/DD and MFP slots will be forthcoming.




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                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date

                                                                     A press release stated that Medicaid fraud can take on a variety
                                                                     of appearances and have serious consequences. A Winston-
                                                                     Salem couple were sentenced for Health Care Fraud and Tax
                                                                     Offenses which will draw 24 month sentences. United States
                                                                     Attorney Ripley Rand announced that a couple was sentenced in
                                                                     federal court. The couple were each sentenced to 24 months
                                                                     incarceration and three years of supervised release. They were
                                  Press Release on    Health Care    also ordered to pay restitution of $1,313,671.14 jointly and
    #089            8/3/2011
                                  Health Care Fraud     Fraud        severally to the Internal Revenue Service. The business owners
                                                                     were initially charged in a multi-count Indictment filed September
                                                                     27, 2010. On January 24, 2011, they entered pleas of guilty to
                                                                     Count One, conspiracy to defraud the United States, Count Nine,
                                                                     failure to pay over withholding taxes, Count Twelve, health care
                                                                     fraud, and Count Twenty-Five, tax evasion. In addition, one of the
                                                                     owners entered a plea of guilty to Count Eight, false entries
                                                                     involving a health care benefit program.




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                                        Title (s)         Subject(s)                                Summary
  Update #:        Update Date


                                                                      DHHS announced that Eastpointe, Pathways, and
                                                                      Smoky Mountain Center have been selected to be the next Local
                                                                      Management Entities (LMEs) to participate in the State’s
                                                                      Medicaid Waiver for mental health, developmental disabilities and
                                                                      substance abuse services. The waiver is commonly known as the
                                                                      1915 b/c waiver in reference to the sections of the Social Security
                                                                      Act that authorize such waivers. These LMEs were selected
                                                                      through a formal procurement process. DHHS appointed a ten-
                                  Selection of LMEs to                person review team comprised of staff from the DMA and DMH
    #088           7/26/2011       Participate in the 1915 b/c Waiver as well as assistance from seven consumers and family
                                    1915 b/c Waiver                   members. The review team in conjunction with Mercer
                                                                      Government Human Services Consulting performed a thorough
                                                                      desk review of all applications and conducted on-site reviews at
                                                                      the four (4)
                                                                      LMEs that passed the minimum requirements and met scoring
                                                                      requirements in the desk review process. It was through this
                                                                      process that the three new LMEs were selected as the LMEs that
                                                                      demonstrated the skills, ability, and infrastructure necessary to
                                                                      successfully implement and manage a 1915 b/c waiver.




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                                      Title (s)         Subject(s)                                   Summary
  Update #:        Update Date

                                                                        As clarified in the March 2011 Medicaid Bulletin and
                                                                        Implementation Update #86, beginning January 1,
                                                                        2011, children under the age of 21 have 16 unmanaged
                                                                        outpatient visits before prior authorization is required. · Adults
                                                                        (21 years and older) have 8 unmanaged outpatient visits before
                                                                        prior authorization is required. This visit count begins each
                                   Clarification of                     calendar year and runs from January-December. · For recipients
                                                       Unmanaged
     #087           6/7/2011        Unmanaged                           reaching their 21st birthday in a calendar year: these recipients
                                                      Outpatient Visits
                                  Outpatient Visits                     still count as ‘children’ for unmanaged visit counts until the end of
                                                                        that calendar year; therefore the 16 unmanaged visit limit applies
                                                                        to that calendar year. · Beginning January 1 of the next calendar
                                                                        year, the 8 adult unmanaged visit limit will apply. · Providers are
                                                                        responsible for recognizing when prior approval is required.




                                                                       The coverage of provisionally licensed providers delivering
                                                                       outpatient behavioral health services as a reimbursable service
                                                                       under Medicaid funds and billed through the Local Management
                                                                       Entity (LME) has been extended to June 30, 2012. Providers are
                                                                       strongly encouraged to review the Division of Medical Assistance
                                    Provisionally                      National Correct Coding
                                                        Provisionally
     #087           6/7/2011      Licensed Billing                     Initiative (NCCI) webpage at
                                                      Licensed Billing
                                  Extension/NCCI                       http://www.ncdhhs.gov/dma/provider/ncci.htm and the Centers for
                                                                       Medicare and Medicaid Services (CMS) National Correct Coding
                                                                       Initiative webpage at
                                                                       http://www.cms.gov/MedicaidNCCICoding/ for further information
                                                                       and to confirm which procedure code pair combinations are
                                                                       allowable.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                  Summary
  Update #:        Update Date

                                                                         DMA effectively implemented the federally-mandated NCCI edits
                                                                         on March 31, 2011. Procedure-to-procedure editing (CCI)
                                                                         identifies procedures and services performed by the same
                                                                         provider on the same date of service for the same recipient.
                                                                         Provisionally licensed professionals billing ‘incident to’ the
                                                                         physician, use the physician’s NPI number. If the physician were
                                                                         to provide medication management (i.e. 90862) and the
                                                                         provisionally licensed professional were to provide
                                                                         individual, family, or group, therapy on the same date of service,
                                                                         the second code would deny because the same
                                                                         attending NPI is billed for both services. There are certain
                                                                         services/codes that provisionally licensed professionals will be
                                  NCCI Update: Billing Billing "Incident able to provide on the same date of service that a physician
     #087           6/7/2011
                                    "Incident To"             To"        provides medication management. When billing the service/code
                                                                         rendered by the provisionally licensed professional, the NCCI
                                                                         modifier 59 should be appended to CPT codes 90801, 90802,
                                                                         90846, 99408, or 99409. The SC modifier should also be used
                                                                         (as it is used currently) to indicate that the service was rendered
                                                                         by a provisionally licensed professional billing ‘incident to.’
                                                                         Providers are strongly encouraged to review the DMA NCCI
                                                                         webpage at
                                                                         http://www.ncdhhs.gov/dma/provider/ncci.htm and the CMS NCCI
                                                                         webpage at
                                                                         http://www.cms.gov/MedicaidNCCICoding/ for further information
                                                                         and to confirm that code pair combinations
                                                                         are allowable.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date


                                                                     As of May 1, 2011, all requests for Alcohol and Drug Abuse
                                                                     Treatment Centers (ADATC) for consumers ages
                                                                     18-21 will be reviewed as “non covered services requests” by
                                                                     Eastpointe LME, a Medicaid utilization review
                                                                     (UR) vendor. All new requests should follow guidelines for
                                                                     requesting approval found at:
                                  Requests for Non-
                                                                     http://www.ncdhhs.gov/dma/epsdt/. Providers should fill out the
     #087           6/7/2011      Covered Services:    ADATC
                                                                     form on the website:
                                      ADATC
                                                                     http://www.ncdhhs.gov/dma/Forms/NonCoveredServicesRequest
                                                                     .pdf. Providers should not submit in-patient
                                                                     treatment reports (ITRs) or person centered plans (PCPs).
                                                                     All requests should be sent to:
                                                                     Eastpointe LME - Eastpointe - ATTN: Anna North
                                                                     PO Box 369 - Beulaville, NC 28518 - Fax: 910-298-7189


                                                                     Several frequently asked billing questions in reference to Critical
                                                                     Access Behavioral Health Agency (CABHA) have been received.
                                                                     The detailed answers to these questions can be found in the
                                                                     DHHS Implementation Update (IU) #73, the September 2010
                                                                     Medicaid Bulletin, the DMA CABHA webpage found at
                                  Frequently Asked
     #087           6/7/2011                           CABHA         http://www.ncdhhs.gov/dma/services/cabha.htm and the training
                                   CABHA Billing
                                                                     packet from the Fall 2010 CABHA Enrollment, Authorization, and
                                     Questions
                                                                     Billing Seminars found at
                                                                     http://www.ncdhhs.gov/dma/cabha/CABHAPresentation092010.p
                                                                     df. They have been provided here again in an effort to consolidate
                                                                     the information.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                         Division of Medical Assistance (DMA) in collaboration with the
                                                                         Computer Sciences Corporation (CSC)Enrollment Verification
                                     New CABHA                           Credentialing (EVC) Call Center conducted provider outreach to
     #087           6/7/2011       Provider Affiliation    CABHA         all Critical Access Behavioral Health Agency providers to verify
                                      Denial Code                        that the provider enrollment information on file with N.C. Medicaid
                                                                         is accurately linked to your Critical Access Behavioral Health
                                                                         Agency billing provider number.


                                                                     The Division of Medical Assistance adopted new prior approval
                                                                     and recipient due process (appeal) policies and
                                                                     procedures effective May 27, 2011; the specific details are noted
                                                                     in the May 2011 Special Bulletin located at:
                                                                     http://ncdhhs.gov/dma/bulletin/DueProcessSpecialBulletin5311.p
                                                                     df.
                                                                     Training is planned for June 2011. Seminars are intended to
                                                                     address changes in Medicaid’s prior approval
                                                      Medicaid Prior policies and procedures and the Medicaid recipient appeal
     #087           6/7/2011      Changes in Medicaid Approval and process when a Medicaid service is denied,
                                  PA and Due Process Due Process reduced, terminated, or suspended. The seminar will also focus
                                                                     on an overview of Early Periodic Screening,
                                                                     Diagnosis, and Treatment (EPSDT)-Medicaid for Children.
                                                                     The seminars are scheduled at the locations listed below.
                                                                     Sessions will begin at 9:00 a.m. and will end at
                                                                     4:00 p.m. Providers are encouraged to arrive by 8:45 a.m. to
                                                                     complete registration. Due to limited seating, registration is
                                                                     limited to two staff members per office. Unregistered
                                                                     providers are welcome to attend if space is available.




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                                     Title (s)      Subject(s)                                  Summary
  Update #:        Update Date

                                                                   A service definition was developed, to be provided only by
                                                                   CABHAs, and approved by CMS. Implementation
                                                                   was scheduled for July 1, 2011. The approval of the definition has
                                                                   raised numerous concerns, especially that the definition itself
                                                                   does not reflect true peer support and is too embedded in the
                                                                   medical model. Rate setting resulted in a rate that providers have
                                                                   indicated will result in substantial losses and they do not intend to
                                                                   offer the service. This feedback comes from providers who are
                                                                   fully supportive of peer support, train peer support specialists,
                                                                   and currently hire peer support specialists to work on team
                                                                   services such as Assertive
     #087           6/7/2011       Peer Support    Peer Support    Community Treatment Team (ACTT). This has led to the general
                                  Service Update                   sentiment in the provider and advocate
                                                                   community that this service will not be successful when
                                                                   implemented. Peer support can be offered as a (b)(3) service
                                                                   within the 1915 (b)(c) waiver. PBH has offered a very successful
                                                                   peer support program that is generally perceived as being more
                                                                   “true” to peer support than the definition
                                                                   approved by CMS. The Department is committed to supporting
                                                                   peer support and to ensure its success and viability. To achieve
                                                                   this goal and in response to the concerns raised by stakeholders,
                                                                   the peer support service definition previously approved by CMS
                                                                   will not be implemented July 1, 2011 as planned. Peer support
                                                                   will be offered through the 1915 (b)(c) waiver sites. In the interim,




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                                       Title (s)        Subject(s)                                Summary
  Update #:        Update Date

                                                                       Recent events have brought into question the lack of awareness
                                                                       of the out of state placement utilization review
                                                                       process. It is important that if adequate services cannot be
                                                                       accessed within the state, that the systems involved
                                                                       work in strong partnership to ensure appropriate placement and
                                                                       on-going monitoring. LMEs are critical to this
                                                                       process as they have access to paid claims and authorization
                                                                       data for the purpose of tracking the services consumers within
                                                                       their catchment area are receiving. In addition, two
                                                                       Implementation Updates (42 and 43) reference LME contact
                                  Protocol for Out of   Out of State
                                                                       persons with UR agencies (ValueOptions, Durham or Eastpointe)
     #087           6/7/2011       State Placement       Placement
                                                                       and the need for the LME Director and Community Collaborative
                                     /Enrollment        /Enrollment
                                                                       involvement in all out of state placements. This compliance
                                                                       verification protocol and Out of State Packet can be obtained by
                                                                       calling ValueOptions at 1-
                                                                       888-510-1150 extension 292466, The Durham Center at 919-560-
                                                                       7244, or Eastpointe LME at 800-513-4002 #2.
                                                                       Out of state packet forms can also be found at:
                                                                       http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/
                                                                       forms/forms-outofstplacement.pdf and
                                                                       questions concerning the forms/process can be directed to DMA
                                                                       Behavioral Health Section at 919-855-4290.




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                                    Title (s)    Subject(s)                                 Summary
  Update #:        Update Date


                                                                Effective July 2011, providers who submit consumer outcomes
                                                                information to NC-TOPPS will notice a more user-friendly and
                                                                streamlined design. Please be watching for more information to
                                                                come later this month on a user test site which will give providers
                                                                an opportunity to familiarize themselves with the new design. The
                                                                overall goal of the redesigned system was to make it more
                                   NC-TOPPS                     functional and efficient for users. In addition, we are pleased to
     #087           6/7/2011                     NC-TOPPS
                                  Enhancements                  announce new enhancements to the “Outcomes at a Glance 2.0”
                                                                online dashboard, including more user choices for time period
                                                                selection and improvements to methodology, which increases
                                                                data available for provider agencies. You can access the
                                                                dashboard by going to the NC-TOPPS homepage at:
                                                                http://www.ncdhhs.gov/mhddsas/nc-topps/ and clicking on the
                                                                icon “NC-TOPPS Outcomes at a Glance 2.0.”




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Implementation   Implementation
                                     Title (s)      Subject(s)                                Summary
  Update #:        Update Date

                                                                 The DMA and DMH recently completed an audit of Targeted
                                                                 Case Management (TCM) services. The audits were conducted
                                                                 from March 1, 2011 through March 31, 2011 for services
                                                                 delivered between the dates of November 1, 2010 and January
                                                                 31, 2011. The results of these audits indicate positive
                                                                 improvements in the delivery of services but also point out
                                                                 continuing areas of concern. Following are a summary of these
                                                                 findings:
                                                                 Mental Health and Substance Abuse Targeted Case
                                                                 Management
                                                                 Positive Trends and Findings
                                                                 · Service authorizations from the Medicaid vendors are in place
                                                                 for Mental Health and Substance Abuse Targeted Case
                                                                 Management · Service plans are in place and valid, meaning
                                   MH/SA TCM       MH/SA TCM -
                                                                 they have the appropriate signatures, are reviewed as
     #087           6/7/2011      Medicaid Audit   Targeted Case
                                                                 required and have the appropriate services indicated.
                                    Findings        Management
                                                                 · Eligibility criteria for Mental Health and Substance Abuse
                                                                 Targeted Case Management were met for people receiving the
                                                                 service. · Providers requiring disclosure of criminal convictions
                                                                 by prospective employees prior to hire were in
                                                                 place. · Health Care Personnel Registry checks prior to hire were
                                                                 in place. · The majority of case managers met the education and
                                                                 experience requirements to provide the service.
                                                                 Areas of Concern
                                                                 Service Plan Signatures
                                                                 · There continue to be issues with Person Centered Plans being
                                                                 signed prior to the plan date and signatures
                                                                 not being dated by the signatory. Signatures must be on or after
                                                                 the plan date and a signature is validated only after the signatory
                                                                 enters the date of the signature. · Guardianship also remains an
                                                                 issue. - A notarized statement from a parent allowing a person to




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                                      Title (s)        Subject(s)                                Summary
  Update #:        Update Date


                                                                    Intellectual/Developmental Disabilities (I/DD) Targeted Case
                                                                    Management (TCM)
                                                                    Positive Trends and Findings - Service authorizations are in place
                                                                    for I/DD- TCM - Service plans are in place and valid, meaning
                                                                    they have the appropriate signatures, are reviewed as required
                                                                    and have the appropriate services indicated. · Eligibility criteria
                                                                    for I/DD- TCM was met for people receiving the service. ·
                                                                    Providers requiring disclosure of criminal convictions by
                                                                    prospective employees prior to hire were in place. · HCPR
                                                       I/DD TCM -   checks prior to hire were in place. · The majority of case
                                  I/DD TCM Medicaid
     #087           6/7/2011                          Targeted Case managers met the education and experience requirements to
                                     Audit Findings
                                                       Management provide the service. Areas of Concern Service Plans- · There
                                                                    continues to be issues with non CAP-MR/DD PCPs being signed
                                                                    prior to the plan date and signatures not being dated by the
                                                                    signatory. · Guardianship remains an issue. - A notarized
                                                                    statement from a parent allowing a person to act pursuant to a
                                                                    health care power of attorney is not considered the equivalent of
                                                                    a PCP legally responsible person and that person cannot act in
                                                                    the place of a parent or guardian. - NC GS 122C-3 notes that a
                                                                    legally responsible person for a minor must be someone who has
                                                                    legal authority to act on behalf of the child, such as a parent,




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Implementation   Implementation
                                       Title (s)        Subject(s)                                Summary
  Update #:        Update Date

                                                                     guardian, someone standing in loco parentis, or a person granted
                                                                     specific authority either by law or by court order to make medical
                                                                     and psychiatric decisions for that child. - A person who has a
                                                                     health care power of attorney may not sign a service plan as the
                                                                     legally responsible person.
                                                                     Service Documentation
                                                        I/DD TCM -   · There was some concern of excessive monitoring and reviewing
                                  I/DD TCM Medicaid    Targeted Case of the PCPs and other documentation without a clear need being
     #087           6/7/2011
                                     Audit Findings     Management evident.
                                                         (continued) · Some provider’s “electronic signatures” failed to meet the
                                                                     requirements as noted in the RMDM (APSM-42), specifically that
                                                                     the system did not prevent the entry from being deleted or
                                                                     altered. Qualifications/Training · Lack of training as required by
                                                                     the State Plan Amendment and service definition was the major
                                                                     area of
                                                                     concern.

                                                                     Effective immediately, Critical Access Behavioral Health Agencies
                                                                     (CABHAs) have the following options to
                                                                     meet the 12 Hour Person Centered Thinking training
                                                                     requirements set forth in Intensive In-Home (IIH),
                                                                     Community Support Team (CST), Day Treatment and Mental
                                      Training
                                                                     Health/Substance Abuse (MH/SA) Targeted Case
                                   Requirements for
                                                                     Management (TCM) service definitions: Option A:
                                  CST, IIIH, Day Tx.
                                                     Person Centered Completion of the 12 hour Person-Centered Thinking training by
     #086           4/6/2011         and Mental
                                                         Thinking    a trainer certified through the Learning Community for Person
                                  Health/Substance
                                                                     Centered Practices that can be found at
                                   Abuse Targeted
                                                                     http://www.unc.edu/depts/ddti/pcttraining.html.
                                  Case Management
                                                                     Option B: Completion of the original 6 hour Person-Centered
                                                                     Thinking training requirement and the additional 6
                                                                     hour MH/SA Person-Centered Thinking/Recovery training.
                                                                     Required elements may be found at:
                                                                     http://www.ncdhhs.gov/mhddsas/cabha/recovpct.htm.



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                                        Title (s)         Subject(s)                                  Summary
  Update #:        Update Date


                                                                         The requirements for the introductory Motivational Interviewing
                                                                         training have not changed; however, the 13
                                      Training                           hour introductory Motivational Interviewing training requirement
                                   Requirements for                      may be completed with a Motivational Interviewing Network
                                  CST, IIIH, Day Tx.      Motivational   Trainer (MINT) or through an online or web based training only if
     #086           4/6/2011         and Mental           Interviewing   that training has been developed by a MINT trainer and is
                                  Health/Substance          Training     facilitated by a MINT trainer. This online or web based training will
                                   Abuse Targeted                        be portable when an employee changes jobs any time after
                                  Case Management                        completing the training as long as there is
                                                                         documentation of such training in the new employer’s personnel
                                                                         records.


                                                                         The Motivational Interviewing Network of Trainers (MINT) will
                                                                         provide a four-day MINT Training in October 2011 for New
                                                                         Trainers (TNT) sponsored by the DMH/DD/SAS that will be
                                                                         offered at no cost to approved applicants. The MINT TNT
                                                                         application process will begin on April 11, 2011. The MINT
                                                                         application approval process is determined by the MINT board.
                                  Training Opportunity:
                                                                         First priority will be given to applicants who are employed by a
                                       Motivational
                                                          Motivational   CABHA (especially those who provide IIH and CST services) and
     #086           4/6/2011      Interviewing Network
                                                          Interviewing   applicants employed by CABHAs and who have successfully
                                    Training for New
                                                                         completed the Wyoming Protocol Train-the-Trainer process. The
                                         Trainers
                                                                         first 40 applicants to meet criteria for the MINT TNT will be
                                                                         admitted to training. Applications will close on August 31, 2011 or
                                                                         whenever 40 candidates have been accepted for training,
                                                                         whichever comes first. A short waiting list may be retained in the
                                                                         event that an approved candidate withdraws prior to the
                                                                         beginning of training.




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                                       Title (s)        Subject(s)                                 Summary
  Update #:        Update Date




                                                                       The following revisions have been made to the DMH/DD/SAS
                                                                       Provider Endorsement Policy based on input and
                                                                       recommendations received at the CABHA regional trainings:
                                                                       - CABHA certified agencies seeking endorsement for a new
                                                                       service (not yet endorsed to deliver) that is
                                                                       related to their approved service continuum (adult mental health,
                                                                       child mental health, adult substance abuse or child substance
                                                                       abuse) must follow the endorsement process as outlined in the
                                                                       DMH/DD/SAS Provider Endorsement Policy with the exception of
                                                                       the desk review and clinical interview. - CABHA certified
                                                                       agencies seeking endorsement for a new service (not yet
                                                                       endorsed to deliver) that is not related to their approved service
     #086           4/6/2011      Endorsement Policy   Endorsement
                                                                       continuum (e.g. approved service continuum is child mental
                                                                       health and provider is seeking endorsement for Psychosocial
                                                                       Rehabilitation) must follow the endorsement process as outlined
                                                                       in the DMH/DD/SAS Provider Endorsement Policy with the
                                                                       exception of the desk review. - A CABHA certified agency
                                                                       currently endorsed and enrolled to provide a service seeking to
                                                                       expand by delivering the same service at a new site and that site
                                                                       location has not been endorsed; or seeking to expand by adding
                                                                       the same service at a currently endorsed site must follow the
                                                                       endorsement process as outlined in DMH/DD/SAS Provider
                                                                       Endorsement Policy with the exception of the desk review, clinical
                                                                       interview and onsite review.




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                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                      Consistent with 10A NCAC 22P .0302(e), CABHAs shall perform
                                                                      "first responder" crisis response 24 hours a
                                                                      day, 7 days a week, 365 days a year to all consumers accessing
                                                                      CABHA services, as follows: CABHAs shall
                                                                      serve as first responder when any consumer who has been
                                                                      assessed by the CABHA and is receiving services
                                                                      from the CABHA undergoes a crisis. For purposes of first
                                                                      responder requirements, crisis is defined as: a high
                                   Critical Access                    level of mental or emotional distress, or an episode, which without
                                  Behavioral Health   CABHA - First   immediate intervention will foreseeably result in the person’s
     #086           4/6/2011        Agency First       Responder      condition worsening, environmental instability or could result in
                                    Responder         Requirements    harm to self or others. All CABHAs shall be accessible 24/7/365
                                   Requirements                       to respond directly to consumers and to collaborate with and
                                                                      provide guidance to other crisis responders regarding
                                                                      coordination of treatment for CABHA consumers in crisis. All
                                                                      CABHAs shall have written policies and procedures in place that
                                                                      will be made available to all consumers, and shall include contact
                                                                      information for the consumer to first contact the CABHA rather
                                                                      than other crisis
                                                                      responders, such as hospital emergency departments and mobile
                                                                      crisis management teams.




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                                        Title (s)         Subject(s)                                Summary
  Update #:        Update Date


                                                                      As set forth in10A NCAC 22P .0501, the necessary supporting
                                                                      documentation to meet CABHA requirements
                                                                      includes: (10) A Certificate of Existence or Certificate of
                                                                      Authorization from the N. C. Secretary of State's Office in
                                   Update to Critical
                                                                      accordance with G. S. 55A-1-28 (for domestic and foreign
                                   Access Behavioral CABHA - Letter
                                                                      corporations) or G.S. 57C-1-28 (for domestic and
     #086           4/6/2011      Health Agency Letter of Attestation
                                                                      foreign limited liability companies). This rule also addresses
                                     of Attestation       Process
                                                                      other required supporting documents noted in (1) - (9) of the rule.
                                        Process
                                                                      The content form of the CABHA Letter of Attestation is updated to
                                                                      reflect this change and can be found at:
                                                                      http://www.ncdhhs.gov/mhddsas/cabha/index.htm. This
                                                                      requirement takes effect immediately.




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                                       Title (s)          Subject(s)                                Summary
  Update #:        Update Date

                                                                    Clarification has been provided on whether a qualified
                                                                    professional who is an applicant to be licensed can serve as the
                                                                    team leader in a service that allows the team leader to be
                                                                    licensed or provisionally licensed (e.g., CST or IIH)?
                                                                    In order to qualify to serve as a team leader in any enhanced
                                                                    service that allows a provisionally licensed individual to serve as
                                                                    the team leader, the professional must have already been
                                                                    granted the “provisional” status by their licensing board. The
                                                                    different licensing boards refer to this status of licensee by a
                                  Community Support                 variety of titles. The following list is the current title of the
                                  Team/Intensive In- CST/IIH - Team “provisionally” licensed professional according to
     #086           4/6/2011
                                  Home Team Leader       Lead       the following licensing boards.
                                     Clarification                  - North Carolina Psychology Board – Provisional Licensed
                                                                         Psychologist · North Carolina Social Work Certification and
                                                                         Licensure Board – Provisional Licensed Clinical Social
                                                                         Worker · North Carolina Substance Abuse Professional Practice
                                                                         Board – Provisional Licensed Clinical Addiction
                                                                         Specialist · North Carolina Marriage and Family Therapy Licensure
                                                                         Board – Licensed Marriage and Family
                                                                         Therapist Associate · North Carolina Board of Licensed
                                                                         Professional Counselors – Licensed Professional Counselor
                                                                         Associate.




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                                       Title (s)          Subject(s)                                Summary
  Update #:        Update Date



                                                                       For children (under the age of 21 years), outpatient behavioral
                                                                       health services require a referral from a Community Care of
                                                                       N.C./Carolina ACCESS (CCNC/CA) primary care provider (PCP),
                                                                       a Medicaid-enrolled psychiatrist, or the LME prior to beginning
                                                                       outpatient behavioral health services. Prior authorization from the
                                                                       utilization review (UR) vendor (ValueOptions, Eastpointe LME or
                                                                       The Durham Center) is required for any visits beyond the initial 16
                                    Clarification of                   unmanaged visits. Please see the March 2011 Medicaid Bulletin
                                      Outpatient                       (http://www.ncdhhs.gov/dma/bulletin/0311bulletin.htm) for
                                  Behavioral Health       Outpatient   guidance on counting unmanaged visits for children. The
                                   CPT Codes, E/M        Behavioral    unmanaged visits are per the individual recipient per calendar
     #086           4/6/2011
                                    Codes, Annual       Health Codes - year, January 1 through December 31. There is no annual visit
                                  Limits, Referrals,       Children    limit for children. Enrolled licensed clinicians may bill the codes
                                          and                          listed in DMA Clinical Coverage Policy 8C
                                  Prior Authorization                  (http://www.ncdhhs.gov/dma/mp/). Provisionally licensed
                                                                       clinicians may provide services ‘incident to’ the physician or may
                                                                       provide services and bill through the LME. Please see the March
                                                                       2009 Medicaid Bulletin
                                                                       (http://www.ncdhhs.gov/dma/bulletin/0309bulletin.htm) and DHHS
                                                                       Implementation Update #70
                                                                       (http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdat
                                                                       es/) for additional information.




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                                       Title (s)          Subject(s)                                Summary
  Update #:        Update Date



                                                                       For adults (ages 21 years and older), no referral is needed for
                                                                       outpatient behavioral health services if only the
                                                                       behavioral health codes listed in Clinical Coverage Policy 8C
                                                                       (http://www.ncdhhs.gov/dma/mp/) are billed
                                                                       (i.e., 90806, 90853). Prior authorization from the UR vendor
                                    Clarification of                   (ValueOptions, Eastpointe LME or The Durham
                                      Outpatient                       Center) is required for any visits beyond the initial eight
                                  Behavioral Health       Outpatient   unmanaged visits. Please see the March 2011 Medicaid
                                   CPT Codes, E/M        Behavioral    Bulletin (http://www.ncdhhs.gov/dma/bulletin/0311bulletin.htm) for
     #086           4/6/2011
                                    Codes, Annual       Health Codes - guidance on counting unmanaged visits for
                                  Limits, Referrals,        Adults     adults. The unmanaged visits are per the individual recipient per
                                          and                          calendar year, January 1 through December 31.
                                  Prior Authorization                  The behavioral health CPT codes listed in Clinical Coverage
                                                                       Policy 8C do not count towards the 22 annual visit
                                                                       (per State fiscal year July 1 through June 30) limit for adults.
                                                                       Information on the annual visit limit for adults is
                                                                       found at
                                                                       http://www.ncdhhs.gov/dma/provider/AnnualVisitLimit.htm.




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                                       Title (s)          Subject(s)                                 Summary
  Update #:        Update Date


                                                                       All billable CABHA codes, including E/M codes, are listed in
                                                                       DHHS Implementation Update #73
                                                                       (http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdat
                                                                       es/). All of the E/M codes (i.e., 99213, 99201)
                                                                       billed by a psychiatrist, CABHA physician/psychiatrist, nurse
                                                                       practitioner or physician assistant billing ‘incident
                                                                       to’ the physician, count against the 22 annual visit limit for adults
                                                                       (per State fiscal year July 1 through June 30).
                                                                       Only CPT code 90862 does not count toward the annual visit
                                    Clarification of
                                                                       limit. All of the codes that count towards the
                                      Outpatient
                                                                       annual visit limit for adults can be found at
                                  Behavioral Health       Outpatient
                                                                       http://www.ncdhhs.gov/dma/provider/AnnualVisitLimit.htm.
                                   CPT Codes, E/M        Behavioral
     #086           4/6/2011                                           Because these E/M codes count towards the 22 annual visit limit,
                                    Codes, Annual       Health Codes -
                                                                       psychiatrists, CABHA physicians/psychiatrists, nurse
                                  Limits, Referrals,      CABHAs
                                                                       practitioners, and physician assistants, must obtain a referral
                                          and
                                                                       from the CCNC/CA PCP to bill for these codes. Some recipients
                                  Prior Authorization
                                                                       with specific mental health diagnoses are exempt from the annual
                                                                       visit limit. The list of excluded diagnoses can be found at
                                                                       http://www.ncdhhs.gov/dma/provider/AnnualVisitLimit.htm and
                                                                       include schizophrenia and bipolar disorder. These E/M codes
                                                                       (99213, 99201, etc.), which are not specific to mental health, do
                                                                       not require prior authorization from the UR vendors
                                                                       (ValueOptions, Eastpointe LME, and The Durham Center)
                                                                       because they are not behavioral
                                                                       health-specific codes.




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                                      Title (s)          Subject(s)                               Summary
  Update #:        Update Date



                                                                      The National Correct Coding Initiative (NCCI) became operational
                                                                      with date of service March 31, 2011. Attending (rendering)
                                                                      providers will not be able to bill certain pairs of codes for an
                                  National Correct                    individual recipient on the same date of service.
                                   Coding Initiative                  In general, assessment codes (for example, 90801, 90802,
                                     Update for        Correct Coding H0001, H0031) cannot be billed by the same attending provider
     #086           4/6/2011
                                     Outpatient           Initiative  on the same date of service as individual, group, and family
                                  Behavioral Health                   therapy codes (for example, 90804 through 90808, 90847, 90849,
                                     Providers                        H0004) or other assessment or psychological or developmental
                                                                      testing codes (for example, 96101, 96111). In preparation for this
                                                                      implementation, testing of the NCCI edits was performed to
                                                                      determine the scope and volume of resulting denials.




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                                       Title (s)         Subject(s)                                    Summary
  Update #:        Update Date

                                                                        DMA has evaluated the data processing requirements for dually
                                                                        eligible (Medicare/Medicaid) recipients and for
                                                                        those recipients with private insurance who receive enhanced
                                                                        behavioral health services. The majority of all
                                                                        enhanced services bypass the requirement for first billing to
                                                                        Medicare and Third Party Liability (TPL) payors as
                                                                        these services and associated procedure codes are not covered
                                                                        under Medicare Part B and through private
                                                                        carriers. It was intended that claims for HCPCS code T1023
                                  Medicare and Third
                                                                        (diagnostic assessment) and H0035 (partial hospitalization)
                                    Party Liability
                                                                        be submitted to Medicare and private insurance as unbundled
                                     Bypass for         Medicare and
                                                                        CPT codes. DMA has made the decision to retract
     #086           4/6/2011         Diagnostic          Third Party
                                                                        this requirement. Therefore, denied claims for these two services
                                   Assessment and      Liability Bypass
                                                                        may be resubmitted for payment if the reason
                                       Partial
                                                                        for the denial is based on the recipient’s dual eligibility for dates of
                                    Hospitalization
                                                                        service on March 20, 2004, and after. For
                                                                        claims that subsequently deny based on EOB 0018 or EOB 8918,
                                                                        the provider may follow the direction provided
                                                                        in Section 11 of the Basic Medicaid Billing Guide
                                                                        (http://www.ncdhhs.gov/dma/basicmed/) for time limit
                                                                        override. The Medicaid Resolution Inquiry Form is used to submit
                                                                        these claims for time limit overrides. No
                                                                        further retroactive reviews will be allowed, except based upon
                                                                        recipient eligibility.




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                                        Title (s)         Subject(s)                                Summary
  Update #:        Update Date

                                                                         Providers interested in submitting mental health and substance
                                                                         abuse service requests via ValueOptions
                                                                         ProviderConnect are encouraged to participate in regularly
                                    ValueOptions:                        scheduled webinar training. To register for an
                                    Advantages of                        upcoming session, visit
     #086           4/6/2011                             Value Options
                                  Online Authorization                   http://www.valueoptions.com/providers/Network/North_Carolina_
                                  Request Submission                     Medicaid.htm and scroll to the section titled Provider Training
                                                                         Opportunities. Click on the date you wish to attend and complete
                                                                         the registration form. The website is routinely updated with
                                                                         additional webinar dates.

                                                                         Many questions from providers about the new Due Process and
                                      Attention All                      Prior Authorization Policies and Procedures. These polices and
                                                         Due Process
                                    Providers: Due                       procedures go into effect on May 1, 2011. DMA will be issuing a
                                                           and Prior
                                   Process and Prior                     Special Medicaid Bulletin on prior authorization within the next
     #086           4/6/2011                             Authorization
                                     Authorization                       two weeks. This bulletin will contain critical information for
                                                         Policies and
                                      Policies and                       providers of mh/dd/sa services. Medicaid administrative
                                                          Procedures
                                      Procedures                         participation agreements require providers to be in compliance
                                                                         with all Implementation Updates and Medicaid Bulletins.




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                                      Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                        The National Correct Coding Initiative (NCCI) was developed by
                                                                        the Centers for Medicare and Medicaid (CMS) to prevent
                                                                        improper payments when a provider would submit incorrect code
                                                                        combinations or to avoid payments of units of service that are
                                                                        medically unlikely to be correct. The requirement from CMS
                                                                        through the Affordable Care Act (ACA) is for all state Medicaid
                                                                        programs to be compliant with NCCI in claims processing
                                                                        by March 31, 2011. NCCI edits supersede the Medicaid State
                                                        Centers for     Plan, all N.C. Medicaid policies, bulletin articles, and other
                                                       Medicare and previous guidance provided on procedure-to-procedure and units-
     #085                         Implementation of
                                                      Medicaid (CMS) - of-service edits. For behavioral health services, NCCI edits apply
                    2/9/2011          the NCCI
                                                      National Correct to Independent Practitioners, Medical Practices, Outpatient
                                                      Coding Initiative Hospital services and Critical Access Behavioral Health Agencies
                                                          (NCCI)        in the provision of Current Procedural Terminology (CPT) codes.
                                                                        The basic elements are designed to eliminate duplicate billing as
                                                                        defined by:
                                                                        · Recipient Medicaid Identification (MID), same date of service,
                                                                        same procedure code, same Attending
                                                                        Provider number and
                                                                        · Inter-range procedure-to-procedure edits that define pairs of
                                                                        CPT codes that should not be reported
                                                                        together.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                  Summary
  Update #:        Update Date



                                                                     Critical Access Behavioral Health Agencies (CABHAs) after you
                                                                     have completed the Medicaid provider enrollment process and
                                                                     received your CABHA Medicaid Provider Number
                                                                     (MPN) you must complete and submit an Electronic Funds
                                                       CABHA-
                                  CABHA Electronic                   Transfer (EFT) Authorization Agreement for Automatic Deposits
                                                      Electronic
   #085             2/9/2011        Commerce                         to initiate the process for electronic payment of claims billed with
                                                      Commerce
                                   Requirements                      the National ProviderIdentifier (NPI) associated with your CABHA
                                                     Requirements
                                                                     MPN. A separate EFT Authorization Agreement must be
                                                                     submitted for each MPN issued to a provider. A copy of the EFT
                                                                     Authorization Agreement can be obtained on DMA website at
                                                                     http://www.ncdhhs.gov/dma/provider/forms.htm.




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                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                                                          When a provider becomes CABHA-certified and has submitted
                                                                          their Medicaid enrollment application but has not yet received
                                                                          their CABHA Medicaid number, at their own risk, they may
                                                                          choose to begin providing services. On the enrollment
                                                                          application they would list a date for enrollment to begin (this date
                                                                          can be the date of certification or a later date of the provider’s
                                                                          choosing). If the provider does not choose a date of enrollment,
                                                                          CSC will choose the date the enrollment application is received.
                                                                          Upon receiving the CABHA MPN, they could submit requests for
                                  Auth/Billing prior to    CABHA -        authorization to the UR vendor for dates with a start date for the
   #085             2/9/2011      CABHA Enrollment        Authorization   authorization that must not be before the enrollment date. Any
                                                           and Billing    requests for authorization for services that took place prior to
                                                                          receiving the CABHA MPN should include the enrollment letter
                                                                          from CSC. In this process, providers run the risk that the UR
                                                                          vendor may not approve services as medically necessary or that
                                                                          an issue could arise in the enrollment process. Certification does
                                                                          not necessarily guarantee enrollment. Once a provider receives
                                                                          the authorization (but not before) they may submit claims for
                                                                          services rendered during that time period after certification but
                                                                          prior
                                                                          to enrollment.




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                                      Title (s)          Subject(s)                                   Summary
  Update #:        Update Date



                                                                         Providers who want to become a CABHA after January 1, 2011,
                                                                         will follow the steps detailed in 10A NCAC 22P.0101 through
                                                                         .0603 [found on the Office of Administrative Hearings (OAH)
                                                                         website. These steps include submitting a letter of attestation
                                                                         (see Implementation Update #75 for information on this process),
                                                                         which must include evidence of the three core services
                                                                         (Comprehensive Clinical Assessment, Medication Management,
                                                                         and Outpatient Behavioral Health Therapy), two endorsed
                                                                         enhanced services to create an age and disability specific
                                                                         continuum, key leadership positions (medical director, clinical
                                                                         director, quality management/training director), 3-year national
                                                                         accreditation, etc. If, during a desk review, the attestation packet
                                                        CST, IIH, DT -
                                  CST, IIH, DT after                     is found to be complete, the next step is the clinical interview
                                                           CABHA
   #085             2/9/2011       January 1, 2011                       followed by an on-site verification.Providers that are currently
                                                       Certification and
                                                                         endorsed for CST, IIH, and/or DT will be able to remain endorsed
                                                        Endorsement
                                                                         (as long as the NEA doesn't expire). However, they will not be
                                                                         eligible to receive authorizations or bill for services until they are
                                                                         CABHA-certified and enrolled. If an LME has recently involuntarily
                                                                         withdrawn a provider’s endorsement for CST, IIH, and/or DT
                                                                         because the provider was not going to achieve certification as a
                                                                         CABHA, and the expiration date on the NEA has not occurred yet,
                                                                         the LME should reinstate the endorsement. Per the endorsement
                                                                         policy, effective January 1, 2011, providers will need to be serving
                                                                         consumers within 60 calendar days of the date of the DMA
                                                                         enrollment letter and if not serving consumers within 60 calendar
                                                                         days of the date of the DMA enrollment letter, endorsement will
                                                                         be withdrawn.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                Summary
  Update #:        Update Date



                                  Endorsement Triple                    This is to clarify that with the implementation of the new
   #085             2/9/2011        Time Frames         Endorsement     Endorsement Policy on January 1, 2011, the triple time
                                                                        frames outlined in Implementation Update #62 no longer apply.




                                                                        Critical Access Behavioral Health Agencies must notify N.C.
                                                                        Medicaid when acquiring a Community Intervention Agency’s
                                                                        services. The CABHA must also notify the LME(s) in the counties
                                                         CABHA: -       impacted by the change in ownership. The acquisition of a non-
                                  CABHA: Changes of
                                                        Changes of      CABHA Community Intervention Service Agency is a two-step
                                  Ownership, Mergers,
   #085             2/9/2011                             Ownership,     process. The first step is for the CABHA to complete a new
                                   and Acquisitions
                                                        Mergers, and    enrollment application and indicate that it is being
                                                        Acquisitions    submitted due to a change of ownership. The second step is to
                                                                        complete a CABHA Addendum to Add Services to affiliate the
                                                                        Community Intervention Services with the CABHA. The two step
                                                                        process is detailed and outlined in the IU.




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                                        Title (s)            Subject(s)                                 Summary
  Update #:        Update Date


                                                                             Physician assistants, direct-enrolled licensed behavioral health
                                                                             professionals (per DMA Clinical Coverage
                                                                             Policy 8C) and provisionally licensed professionals providing any
                                                                             of the CABHA core services (comprehensive
                                                                             clinical assessments, outpatient therapy, medication
                                                                             management) within their scope of practice may render the
                                   Billing "Incident to"       CABHA -       service “incident to” a physician. This physician may be the
   #085             2/9/2011              the MD           "Incident to" the CABHA medical director or another CABHA
                                                                 MD          physician as long as the guidelines for billing “incident to,”
                                                                             outlined in the March 2009 Medicaid Bulletin and
                                                                             the May 2005 Special Medicaid Bulletin are followed. As a
                                                                             reminder, the behavioral health professionals listed
                                                                             in DMA Clinical Coverage Policy 8C must be direct-enrolled with
                                                                             Medicaid. All Medicaid direct-enrolled
                                                                             providers may bill with their own “attending number.”


                                                                       System of Care Coordinator (SOC) is required to sign all plans
                                                                       signifying receipt and review checkboxes have been added to
                                                                       allow the SOC to note whether they agree or disagree with the
                                                                       plan that has been developed. As a reminder, Implementation
                                                                       Update #60 notes for all new admissions to Level III and IV
                                     Revision to Level
                                                         Residential - child residential services, length of stay is limited to no more than
   #085             2/9/2011      III/IV Discharge Plan
                                                        Discharge Plan 120 days. All new admission and concurrent requests for Level III
                                                                       and IV child residential services must include a Child/Adolescent
                                                                       Discharge/Transition Plan in order for the request to be
                                                                       considered complete. Failure to submit a complete discharge
                                                                       plan will result in the request being returned as “Unable to
                                                                       Process.”




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                                        Title (s)        Subject(s)                               Summary
  Update #:        Update Date


                                                                   A couple of questions have arisen in regards to the
                                                                   implementation of Multisystemic Therapy (MST) as funded
                                                                   by Medicaid in North Carolina. The information below offers
                                                                   clarification. Question #1: Is a full-time (1.0 FTE) MST
                                                                   supervisor required for each MST team? Answer #1: Yes, the
                                                                   current definition is based on one FTE for the supervisor in MST.
                                  FAQ Regarding MST                This is different from what is published by MST Inc. but reflects
                                                     Multisystemic
   #085             2/9/2011        Implementation                 the current MST policy found in Clinical Coverage Policy 8A.
                                                    Therapy (MST)
                                                                   Question #2: The service definition requires a minimum of three
                                                                   (3) therapists for each MST team. Is it acceptable to have four (4)
                                                                   full-time (1.0 FTE) therapists on each team? Answer #2 The
                                                                   definition requires four staff per team (including the supervisor)
                                                                   and it would be allowable to have an additional QP but the team
                                                                   member to family ratio of 1:5 remains the same and the limit of
                                                                   20 families per team would not change.


                                                                      The required elements for the development of a 6-hour MH/SA
                                                                      Person-Centered Thinking (PCT)/Recovery training may be found
                                                                      at: http://www.ncdhhs.gov/mhddsas/cabha/recovpct.htm. This 6-
                                                          Training -  hour training can be provided to meet the 12-hour total
                                         6-Hour
                                                          Person-     requirement for PCT for Child and Adolescent Day Treatment,
                                    PCT/Recovery
   #085             2/9/2011                              Centered    Intensive In-Home, Community Support Team and MH/SA
                                   Training elements
                                                       Thinking (PCT) Targeted Case Management staff who have already completed
                                                         /Recovery    the 6-hour PCT training under the old requirement, per
                                                                      Implementation Update #82. All elements in the set chosen must
                                                                      be included in the training curriculum. Resources that may be
                                                                      used in developing training are also presented.




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                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date



                                                                        DMA Clinical Coverage Policy 8C has been updated to reflect the
                                                                        new 16 unmanaged visits for children. The effective date of the
                                                                        policy is January 1, 2011. DMA Clinical Coverage Policy 8A will
                                                                        be updated later this month to include the new policy for Peer
                                    Medicaid Policy                     Support Services and policy updates to Community Support
   #085             2/9/2011          Updates             Medicaid      Team, Intensive In-Home, Child and Adolescent Day Treatment,
                                                                        and Outpatient Opioid Treatment. Please see Section 8.0 Policy
                                                                        Implementation/Revision Information for a complete list of
                                                                        changes. The effective date of the policy is January 1, 2011. Both
                                                                        policies can be accessed at
                                                                        http://www.ncdhhs.gov/dma/mp/index.htm.



                                                                       Periodically a provider may submit a request without sufficient
                                                                       clinical information for DMA or the vendor to make a decision on
                                                                       the request. Medicaid's policy is that DMA or the vendor must
                                                                       request the specific information needed in writing. The provider
                                     Prior Approval
                                                                       must respond to this request by submitting the needed
                                       Additional
   #085             2/9/2011                            Prior Approval information within 10 business days of the date of the written
                                  Information Request
                                                                       notice. There is no extension beyond the 10 business days. If the
                                                                       provider does not submit the information within 10 business days,
                                                                       the request is denied, and a written notice with appeal rights is
                                                                       generated. Even if the recipient files an appeal, a new request
                                                                       with the needed information may be submitted at any time.




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Implementation   Implementation
                                       Title (s)        Subject(s)                            Summary
  Update #:        Update Date


                                                                   CAP/MR-DD services will be provided by LMEs beginning
                                                                   January 20, 2011. Please note that fax numbers for
                                                                   the LMEs providing these services have been updated and are as
                                                                   follows:
                                                                   Crossroads Behavioral Health Center
                                                                   Contact Number: 336-835-1000
                                                     Utilization   Fax Number: 336-827-8027
                                  CAP/MR-DD UR by
                                                   Review by Local Eastpointe LME
   #085             2/9/2011      LMEs FAX Numbers
                                                    Management Contact number: 1-800-513-4002
                                                       Entities    Fax Number: 910-298-7194
                                                                   The Durham Center
                                                                   Contact number: 919-560-7100
                                                                   Fax Number: 919-560-7377
                                                                   Pathways LME
                                                                   Contact number: 704-884-2501
                                                                   Fax Number: 1-855-728-4329




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                                      Title (s)        Subject(s)                                  Summary
  Update #:        Update Date



                                                                      In early November the DMH/DD/SAS and the Developmental
                                                                      Disabilities Training Institute welcomed Robin Snead, MSW,
                                                                      LCSW to the Supports Intensity Scale™ Coordinator position. In
                                                                      this position Robin provides leadership and coordination of the
                                                                      implementation of the Supports Intensity Scale™ (SIS)
                                                                      throughout North Carolina through collaboration with the
                                                                      DMH/DD/SAS and LMEs. As North Carolina moves from the
                                                                      Pilot Phase to statewide implementation of the SIS, Robin is
                                                                      involved in providing technical assistance, training and support to
                                  Supports Intensity
                                                                      the LMEs, case managers, and SIS examiners. Robin is available
   #085             2/9/2011        Scale Update
                                                                      to provide training events at the local level in order to increase the
                                                                      knowledge and awareness of the SIS, the use of the SIS in North
                                                                      Carolina, and the benefit of information gathered through the SIS
                                                                      assessment for
                                                                      use in the Person Centered Planning process.
                                                                      To learn more about the SIS or to schedule training please
                                                                      contact Robin at: 919-715-2774 or rsnead@email.unc.edu.
                                                                      Information about the Supports Intensity Scale™ is located on the
                                                                      DMH/DD/SAS website:
                                                                      http://www.ncdhhs.gov/mhddsas/sis/index.htm




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  Update #:        Update Date



                                                                  We are pleased to announce the implementation of the Self
                                                                  Direction option within the CAP-MR/DD Supports
                                                                  Waiver. This is a new option available to individuals who are
                                                                  participants in the Supports Waiver and who
                                                                  choose to self-direct their waiver services and supports. This
                                  CAP-MR/DD                       option is designed to provide choice to participants
                                  Update: Self   CAP-MR/DD -      in managing their own waiver services and supports to live their
   #085             2/9/2011
                                   Direction     Self Direction   best life. Based on an approved person centered
                                                                  plan and budget which include community-based services,
                                                                  supports, goods, and traditional services, participants
                                                                  in Self Direction will choose to direct some or all of their services.
                                                                  Information about Self-Direction in the CAP-MR/DD Supports
                                                                  Waiver can be found on the DMH/DD/SAS
                                                                  website at: http://www.ncdhhs.gov/mhddsas/selfdirect/index.htm.




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                                       Title (s)         Subject(s)                                  Summary
  Update #:        Update Date



                                                                       Effective April 30, 2011, LMEs Will No Longer Bill for T1999
                                                                       Supplies for CAP MR/DD Waiver Recipients. Effective July 1,
                                                                       2010, durable medical equipment (DME) providers became
                                                                       eligible to enroll with DMA as Community Alternatives Program
                                                                       (CAP) providers and bill for CAP-MR/DD waiver supplies (T1999).
                                                                       The UR Vendors will provide a service authorization to the CAP
                                                                       DME provider, which authorizes the amount and codes that are
                                                                       approved on the CAP Cost Summary. The case manager is
                                  T1999 Supplies for    CAP-MR/DD -
                                                                       responsible for securing the signed and dated physician order
   #085             2/9/2011        CAP-MR/DD          Durable Medical
                                                                       and retaining it on file. The order must detail the specific quantity
                                                         Equipment
                                                                       and frequency of the supplies. The DME vendor must send a
                                                                       copy of the itemized monthly invoice to the CAP-MR/DD case
                                                                       manager. Case managers are responsible for ensuring that DME
                                                                       providers comply with the authorized quantity. Case managers,
                                                                       DMA and applicable UR vendors will conduct random audits of
                                                                       DME CAP-MR/DD waiver charges. Any reimbursement for
                                                                       unauthorized supplies will be subject to recoupment by Program
                                                                       Integrity.




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                                     Title (s)      Subject(s)                                  Summary
  Update #:        Update Date


                                                                   Public Consulting Group (PCG) has been assisting DMA’s
                                                                   Program Integrity, Behavioral Health Review Section, in
                                                                   eliminating a backlog of cases and maintaining a steady rate of
                                                                   case reviews, preventing a future backlog of cases. PCG will
                                                                   continue to provide full scale operations, beginning with the
                                                                   receipt of a case file, conducting the administrative/clinical review,
                                                                   establishing a statistically valid claim review sample for review,
                                                                   and extrapolating these findings to calculate the overpayment.
                                   Post-Payment    Post-Payment
   #085             2/9/2011                                       PCG will continue to initiate contact with the provider by sending
                                  Reviews by PCG     Reviews
                                                                   the provider a certified cover letter from DMA and a PCG
                                                                   introduction letter with the request for records. PCG will inform
                                                                   the provider of the post payment review process requirements
                                                                   and work closely with the provider and DMA. Providers are asked
                                                                   to submit documentation electronically via PCG secure web-
                                                                   based application. PCG will provide detailed instructions on how
                                                                   to submit records for the review, and will address provider
                                                                   questions regarding the post payment review process.




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 Implementation   Implementation
                                       Title (s)        Subject(s)                                   Summary
   Update #:        Update Date


                                                                       Effective January 20, 2011, utilization review for CAP MR/DD
                                                                       services will be provided by local management entities (LMEs).
                                                                       The LMEs will be responsible for CAP MR/DD requests for
                                                                       recipients with eligibility listed in the counties identified below. ALL
                                                                       CAP requests, including revision requests, must be sent to the
                                                                       appropriate LME utilization review (UR) vendor as listed below.
                                                                       Case managers will submit CAP MR/DD requests to the
                                                                       appropriate LME effective January 20, 2011 based on the
                                                                       Medicaid county of eligibility of the recipient. LME's Providing
                                                                       UR:
                                                                       Crossroads Behavioral Health Center - Contact Number:
                                                                       (336) 835-1000 - Buncombe, Davie, Forsyth, Henderson, Iredell,
                                                                       Madison, Mitchell, Polk, Rockingham, Rutherford, Stokes, Surry,
      #084                                                             Transylvania, Yadkin, Yancey
    SPECIAL                          CAP-MR/DD                         Eastpointe -Contact number: (800) 513-4002 - Beaufort, Bertie,
                    12/14/2010                          CAP-MR/DD
IMPLEMENTATION                     Utilization Review                  Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven,
    UPDATE                                                             Cumberland, Currituck, Dare, Duplin, Edgecombe, Gates, Greene,
                                                                       Hertford, Hyde, Johnston, Jones, Lenoir, Martin, Nash, New Hanover,
                                                                       Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt,
                                                                       Robeson, Sampson, Scotland, Tyrrell, Washington, Wayne, Wilson
                                                                       The Durham Center- Contact number: (919) 560-7200 -
                                                                       Alamance, Anson, Caswell, Chatham, Durham, Franklin, Granville,
                                                                       Guilford, Halifax, Harnett, Hoke, Lee, Montgomery, Moore, Orange,
                                                                       Person, Randolph, Richmond, Vance, Wake, Warren
                                                                       Pathways LME - Contact number: (704) 884-2501 - Alexander,
                                                                       Alleghany, Ashe, Avery, Burke, Caldwell, Catawba, Cherokee, Clay,
                                                                       Cleveland, Gaston, Graham, Haywood, Jackson, Lincoln, Macon,
                                                                       McDowell, Mecklenburg, Swain, Watauga, Wilkes

                                                                       Fax numbers will be provided in the January Medicaid Bulletin.




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                                        Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                         Peer Support Services (PSS) has been approved by the Centers
                                                                         for Medicare and Medicaid Services (CMS). Due to budgetary
                                     Peer Support
                                                                         concerns, PSS will be implemented July 1, 2011. In the interim,
    #083           12/16/2010          Services         Peer Support
                                                                         the Divisions will develop a plan to facilitate a thoughtful
                                    Implementation
                                                                         implementation and will involve consumers, providers, advocates
                                                                         and local management entities (LMEs) in the planning process.



                                                                         This section addresses frequently asked questions (FAQs)
    #083           12/16/2010     FAQ on MH/SA TCM          TCM          regarding Mental Health/Substance Abuse Targeted Case
                                                                         Management (MH/SA TCM).



                                                                     Effective December 1, 2010, the required documentation for
                                                                     persons receiving only medication administration will be a
                                                                     completed Medication Administration Record. The following
                                                                     replaces the documentation requirements for Opioid Treatment
                                                                     Services. Outpatient Opioid Treatment Documentation
                                                                     Requirements ; A Medication Administration Record (MAR)
                                                                     shall be utilized to document each administration or
                                  Outpatient Opioid Tx   Outpatient
                                                                     dispensing of methadone. In addition, a modified service note
    #083           12/16/2010       Documentation        Opioid Tx
                                                                     shall be written at least weekly, or per date of service if the
                                                       Documentation
                                                                     recipient receives the service less frequently than weekly. Refer
                                                                     to Division of Medical Assistance (DMA) Clinical Coverage Policy
                                                                     8A and the Division of Mental Health, Developmental Disabilities,
                                                                     and Substance Abuse Services’ (DMH/DD/SAS) Records
                                                                     Management and Documentation Manual for a complete listing of
                                                                     documentation requirements. DMA Clinical Coverage Policy 8A
                                                                     will be updated to reflect this policy change.




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                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date

                                                                       Through correspondence with providers, DMA has been able to
                                                                       identify and remedy an error in the data payment system for
                                                                       procedure code H2011, Mobile Crisis Management. Since
                                                                       September 1, 2008 an audit was in place which denied payment
                                  Behavioral Health
                                                      Mobile Crisis    of this service on the same date as inpatient treatment in an
    #083           12/16/2010       Mobile Crisis
                                                      Management       Institution of Mental Disease (IMD) resulting in an EOB 9080
                                    Management
                                                                       which reads, “enhanced benefit service not allowed on the same
                                                                       day
                                                                       as inpatient.” These claims may now be resubmitted for
                                                                       reimbursement.

                                                                       The ValueOptions ProviderConnect online provider portal
                                                                       remains the preferred method for submitting service requests.
                                                                       Online submission reduces errors and returns, speeds approval
                                                                       time, and provides immediate confirmation of receipt. For
                                     VO Request                        providers who still submit requests via fax, IU #72 advised
    #083           12/16/2010                         Value Options
                                  Submission Update                    providers of ValueOptions’ new toll-free fax numbers. Note that
                                                                       the grace period for the old fax numbers will end in late
                                                                       December. The 25% of fax users
                                                                       still using the old numbers should switch immediately to the new
                                                                       fax numbers.




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                                     Title (s)     Subject(s)                                Summary
  Update #:        Update Date


                                                                  Only certified CABHAs may deliver Community Support Team
                                                                  (CST), Intensive Inhome Services (IIH) and Child and Adolescent
                                                                  Day Treatment Services (DT) effective January 1, 2011. On and
                                                                  after that date, only CABHAs are authorized under the N.C. State
                                                                  Plan for Medical Assistance to be reimbursed for the provision of
                                  CST, IIH, & DT
                                                     Claims       CST, IIH and DT. Any claims submitted for these services under
    #083           12/16/2010      Claims after
                                                   Submission     National Provider Identifiers (NPIs) associated with Community
                                    12/31/10
                                                                  Intervention Service Agency (CISA) MPNs will be denied as of
                                                                  January 1, 2011. Therefore, it is very important that CABHAs
                                                                  complete the enrollment process and get a CABHA billing MPN
                                                                  as soon as possible. Please see complete CABHA billing
                                                                  guidelines in IU #73.




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                                       Title (s)        Subject(s)                                 Summary
  Update #:        Update Date



                                                                       Provider agencies required to transition consumers to a certified
                                                                       CABHA should already have submitted their transition plans to
                                                                       the appropriate LME. The LME should have reviewed, approved,
                                                                       or revised submitted plans. Consumers identified as needing to
                                                                       continue to receive Intensive In-Home, Community Support
                                                                       Team, Day Treatment, or case management services should be
                                                                       in the process of being transitioned to a CABHA. In some cases,
                                                                       agencies transitioning consumers have submitted requests for
                                                                       concurrent authorizations that go beyond the date for transition
                                  Consumer Transition                  of those consumers. As ValueOptions does not have the
    #083           12/16/2010          Update            CABHA         capability of monitoring and matching the concurrent
                                                                       authorizations requested with the transition dates for the agency
                                                                       making the request, it is incumbent upon the LME to monitor the
                                                                       accepted/imposed transition plans and ensure that consumers
                                                                       are indeed being transitioned per those plans. The fact that an
                                                                       authorization may have been made that goes beyond the date of
                                                                       transition does not in any way sanction the continuance of that
                                                                       service by the agency past the point of the agreed upon transition
                                                                       dates. Agencies may not “re-open” their services to continue
                                                                       consumer care based on a concurrent authorization that goes
                                                                       beyond the transition date




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                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date



                                                                        If a CABHA provider applicant has a key staff change (Medical
                                                                        Director, Clinical Director, QM/Training
                                                                        Director) the provider must resubmit the complete attestation
                                                                        letter packet with all the required supporting documents per IU
                                                                        #75 (including the content form, attestation letter and all
                                                         CABHA -
                                                                        documents to match the content form). This resubmission due to
                                  Protocol for CABHA     Agencies
                                                                        a change in a key staff position will count as one of the three
    #083           12/16/2010     Personnel Changes      Pursuing
                                                                        submissions for the desk review. Attestations with updated staff
                                                          CABHA
                                                                        information will be processed in the order that they are received.
                                                        Certification
                                                                        If a provider has met the desk review requirements and is in the
                                                                        interview or verification phase, the review process will be stopped
                                                                        until the staff changes are reviewed and approved. When a
                                                                        provider has changed any of the three key personnel qualified to
                                                                        fill the vacant position, documentation outlined in IU #75 should
                                                                        be submitted to the DMH/DD/SAS LME Team.



                                                                      When a provider's Medical Director or Clinical Director changes,
                                                                      the provider must notify the DMH/DD/SAS Director or designee in
                                                         CABHA -
                                  Protocol for CABHA                  writing of the vacancy within ten business days of said vacancy.
                                                         Certified
    #083           12/16/2010     Personnel Changes                   Failure to notify DMH/DD/SAS within ten business days of a
                                                       Agencies Staff
                                                                      Medical Director or Clinical Director vacancy shall result in
                                                         Changes
                                                                      termination of CABHA certification. Notification must be made by
                                                                      email and include the provider name, position vacancy and date
                                                                      of vacancy.




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                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date


                                                                     Community Support authorizations will be end-dated no later than
                                                                     December 31, 2010, regardless of the start date of an
                                                                     authorization. Currently, persons receiving Community Support
                                                                     services are receiving the services only for case management,
                                                                     except in cases where rehabilitative services under Community
                                                                     Support continue through EPSDT exceptions. Recipients
                                                                     currently receiving Community Support services should be
                                                                     transitioned by January 1, 2011, to the appropriate rehabilitative
                                  CS Authorizations   Community      or case management service. Community Support will no longer
    #082           11/12/2010
                                                       Support       be a covered service under Medicaid as of January 1, 2011. All
                                                                     new requests for this service for recipients under 21 years of age
                                                                     are considered non covered services requests and should be
                                                                     requested on the Non-Covered State Medicaid Plan Services
                                                                     Request Form for Recipients under 21 Years Old following Early
                                                                     Periodic Screening, Diagnostic, and Treatment (EPSDT)
                                                                     guidelines. The guidelines and the form are available on the
                                                                     Division of Medical Assistance (DMA) website at
                                                                     http://www.ncdhhs.gov/dma/epsdt/.




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                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                        Critical Access Behavioral Health Agency (CABHA) transition
                                                                        benchmarks outlined in Implementation Update (IU) #79,
                                                                        Intensive In-Home, Day Treatment, and Community Support
                                                                        service providers who did not successfully pass the Desk Review
                                                                        by September 30, 2010, will no longer receive initial or concurrent
                                                                        authorizations for these services after November 1, 2010. Non-
                                                                        CABHA providers who have failed to meet the stipulated CABHA
                                    Authorization
                                                       Authorizations - benchmarks are strongly encouraged to submit a discharge ITR
    #082           11/12/2010     Reminder for: CST,
                                                            CST         for recipients who are transitioning to a CABHA. When submitting
                                     IIH, DT, CS
                                                                        a discharge ITR, it must be submitted to the utilization review
                                                                        vendor that initially authorized the service. ValueOptions, The
                                                                        Durham Center, and Eastpointe LME will end-date existing
                                                                        authorizations for non-CABHA providers for individual recipients
                                                                        when they receive an authorization request for the same services
                                                                        for that recipient from a CABHA, regardless of whether or not a
                                                                        discharge ITR has been received.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                        Critical Access Behavioral Health Agency (CABHA) transition
                                                                        benchmarks outlined in Implementation Update (IU) #79,
                                                                        Intensive In-Home, Day Treatment, and Community Support
                                                                        service providers who did not successfully pass the Desk Review
                                                                        by September 30, 2010, will no longer receive initial or concurrent
                                                                        authorizations for these services after November 1, 2010. Non-
                                                                        CABHA providers who have failed to meet the stipulated CABHA
                                    Authorization
                                                       Authorizations - benchmarks are strongly encouraged to submit a discharge ITR
    #082           11/12/2010     Reminder for: CST,
                                                             IIH        for recipients who are transitioning to a CABHA. When submitting
                                     IIH, DT, CS
                                                                        a discharge ITR, it must be submitted to the utilization review
                                                                        vendor that initially authorized the service. ValueOptions, The
                                                                        Durham Center, and Eastpointe LME will end-date existing
                                                                        authorizations for non-CABHA providers for individual recipients
                                                                        when they receive an authorization request for the same services
                                                                        for that recipient from a CABHA, regardless of whether or not a
                                                                        discharge ITR has been received.




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                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date



                                                                        Critical Access Behavioral Health Agency (CABHA) transition
                                                                        benchmarks outlined in Implementation Update (IU) #79,
                                                                        Intensive In-Home, Day Treatment, and Community Support
                                                                        service providers who did not successfully pass the Desk Review
                                                                        by September 30, 2010, will no longer receive initial or concurrent
                                                                        authorizations for these services after November 1, 2010. Non-
                                                                        CABHA providers who have failed to meet the stipulated CABHA
                                    Authorization
                                                       Authorizations - benchmarks are strongly encouraged to submit a discharge ITR
    #082           11/12/2010     Reminder for: CST,
                                                             DT         for recipients who are transitioning to a CABHA. When submitting
                                     IIH, DT, CS
                                                                        a discharge ITR, it must be submitted to the utilization review
                                                                        vendor that initially authorized the service. ValueOptions, The
                                                                        Durham Center, and Eastpointe LME will end-date existing
                                                                        authorizations for non-CABHA providers for individual recipients
                                                                        when they receive an authorization request for the same services
                                                                        for that recipient from a CABHA, regardless of whether or not a
                                                                        discharge ITR has been received.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                        Critical Access Behavioral Health Agency (CABHA) transition
                                                                        benchmarks outlined in Implementation Update (IU) #79,
                                                                        Intensive In-Home, Day Treatment, and Community Support
                                                                        service providers who did not successfully pass the Desk Review
                                                                        by September 30, 2010, will no longer receive initial or concurrent
                                                                        authorizations for these services after November 1, 2010. Non-
                                                                        CABHA providers who have failed to meet the stipulated CABHA
                                    Authorization
                                                       Authorizations - benchmarks are strongly encouraged to submit a discharge ITR
    #082           11/12/2010     Reminder for: CST,
                                                            CS          for recipients who are transitioning to a CABHA. When submitting
                                     IIH, DT, CS
                                                                        a discharge ITR, it must be submitted to the utilization review
                                                                        vendor that initially authorized the service. ValueOptions, The
                                                                        Durham Center, and Eastpointe LME will end-date existing
                                                                        authorizations for non-CABHA providers for individual recipients
                                                                        when they receive an authorization request for the same services
                                                                        for that recipient from a CABHA, regardless of whether or not a
                                                                        discharge ITR has been received.




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                                        Title (s)        Subject(s)                               Summary
  Update #:        Update Date


                                                                         Please note that changes that have been made to the following
                                                                         forms: · The Certificate of Need (CON) for Psychiatric
                                                                         Residential Treatment Facilities (PRTFs) · The Certificate of
                                                                         Need (CON) for Inpatient Psychiatric Hospitalization · The
                                                                         Criterion V Request and Instruction Forms These revised forms
                                                                         can be accessed from DMA’s website at
                                  PRTF/             In- Authorizations - http://www.ncdhhs.gov/dma/services/inpatientbh.htm.
    #082           11/12/2010     Patient Authorization     PRTF/        The updated forms can also be accessed from the utilization
                                    Request Forms         In-Patient     review (UR) vendors’ websites as follows:
                                                                         · ValueOptions:
                                                                         http://www.valueoptions.com/providers/Network/North_Carolina_
                                                                         Medicaid.htm
                                                                         · The Durham Center:
                                                                         http://www.durhamcenter.org/index.php/provider/ur_resources/m
                                                                         hsa




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Implementation   Implementation
                                        Title (s)         Subject(s)                                   Summary
  Update #:        Update Date

                                                                          Adverse determination letters from ValueOptions, The Durham
                                                                          Center, and Eastpointe LME will no longer include alternate
                                                                          recommendations. Letters will advise that recipients may also be
                                                                          eligible for other Medicaid services and recipients may check with
                                                                          their physician, other licensed clinician, or provider to determine if
                                                                          other Medicaid services are appropriate. If the provider believes
                                                                          that medical necessity exists for an alternate service and the
                                                                          recipient wishes the request submitted, the provider may submit
                                         Adverse
                                                                          the request at any time. The adverse action outstanding remains
                                     Determination         Adverse
    #082           11/12/2010                                             in effect and, if the recipient and/or legal representative disagree
                                  Notification Changes   Determination
                                                                          with that decision, they may appeal the decision to the Office of
                                                                          Administrative Hearings and the Department of Health and
                                                                          Human Services (DHHS) as described in the adverse notice. If a
                                                                          provider calls customer service after the adverse notice has been
                                                                          mailed to request the alternate recommendations, they will be
                                                                          transferred to a clinical care manager, who may provide the
                                                                          requested
                                                                          information and may discuss appropriate clinical and educational
                                                                          issues relevant to the recommendations.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                        An additional approved training, equivalent to the trainings noted
                                                                        in IU #73, has been added to provide System of Care training as
                                                                        required by the Day Treatment and Intensive In-Home definitions.
                                                                        The North Carolina Collaborative Training Institute
                                                                        (www.nccti.org) has launched a comprehensive online training
                                                                        site that offers
                                                                        specific courses designed to meet the required 11 contact hours
                                    Additional SOC                      of System of Care training. The course titles that meet the
    #082           11/12/2010                           SOC Training
                                  Training Site Added                   required hours (all courses are required) are:
                                                                        CFT 101 – Introduction to System of Care and Child and Family
                                                                        Teams CFT 201 – Introduction to Child and Family Teams
                                                                        Coordination CFT 202 – Strengths, Needs, and Culture
                                                                        Discovery for Child and Family Teams CFT 203 – Creating
                                                                        Natural Supports through Child and Family Team Planning CFT
                                                                        204 – Individualized Plan Development for Child and Family
                                                                        Teams
                                                                     The most comprehensive information on accessing the required
                                                                     12 hour Person-Centered Thinking training by a trainer certified
                                                                     through the Learning Community for Person Centered Practices
                                                                     can be found here: http://www.unc.edu/depts/ddti/pct-
                                                         Training
                                    CTS, IIH, Day                    training.html. There is also a link to this website on the
                                                      Requirements -
    #082           11/12/2010     Treatment Training                 Person-Centered Information page of the Division of Mental
                                                     Person Centered
                                    Requirements                     Health, Developmental Disability, and Substance Abuse Services’
                                                         Thinking
                                                                     (DMH/DD/SAS) website:
                                                                     http://www.ncdhhs.gov/mhddsas/pcp.htm.
                                                                     · Additional information can be found on the Learning Community
                                                                     website, found here: http://www.learningcommunity.us/work.html.




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                                       Title (s)         Subject(s)                              Summary
  Update #:        Update Date

                                                                      Effective January 1, 2011
                                                                      · All new hires for IIH and CST must receive 12 hours of PCT
                                                                      training within 90 days of hire, from a Learning Community for
                                                                      Person Centered Practices certified PCT trainer. · Staff who
                                                                      previously worked in the same service (IIH or CST) for another
                                                                      agency and had six (6) hours of PCT training under the old
                                                                      requirement will have to meet the 12 hour requirement when
                                                                      moving to a new company. · The 12 hour PCT training will be
                                                                      portable if an employee changes jobs any time after completing
                                                                      the 12 hour requirement, as long as there is documentation of
                                                                      such training in the new employer’s personnel records. · By
                                                                      March, 2011, enhanced curriculum elements for the 12 hour PCT
                                    CST, IIH, Day          Training   training, with a greater emphasis on recovery, will be available
    #082           11/12/2010     Treatment Training   Requirements - for use by certified PCT trainers. · For IIH and CST staff who
                                    Requirements        IIH and CST have already completed the prior requirement of the six hour PCT
                                                                      training, and who remain with the same provider, the following
                                                                      timelines apply:
                                                                      o By March 31, 2011, existing IIH/CST leaders or by June 30,
                                                                      2011, existing non-supervisory IIH/CST staff may take either the
                                                                      12-hour course described above, or complete the additional six
                                                                      (6)
                                                                      hour PCT/Recovery training curriculum. o The curriculum
                                                                      elements for the six hour PCT/Recovery training will be:
                                                                        developed by a group of stakeholders proficient in PCT and
                                                                      Recovery practices; available from the Department by mid-
                                                                      December, 2010; introduced no later than early January, 2011
                                                                      via a statewide web-based training orientation.




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                                       Title (s)         Subject(s)                                Summary
  Update #:        Update Date

                                                                      Effective January 1, 2011 · All new hires for Day Tx must receive
                                                                      12 hours of Person-Centered Thinking (PCT) training within 90
                                                                      days of hire, from a Learning Community for Person Centered
                                                                      Practices certified PCT trainer. · Staff who previously worked in
                                                                      Day Tx for another agency and had six (6) hours of PCT training
                                                                      under the old requirement will have to meet the 12 hour
                                                                      requirement when moving to a new company. · The 12 hour PCT
                                                                      training will be portable if an employee changes jobs any time
                                                                      after completing the requirement as long as there is
                                                                      documentation of such training in the new employer’s personnel
                                                                      records. · By March, 2011, the enhanced curriculum elements for
                                    CTS, IIH, Day         Training
                                                                      the 12 hour PCT training, with a greater emphasis on recovery,
    #082           11/12/2010     Treatment Training   Requirements -
                                                                      will be available for use by certified PCT trainers. · Day Tx staff
                                    Requirements       Day Treatment
                                                                      who have already completed the prior requirement of the six (6)
                                                                      hour PCT training, and who have remained with the same
                                                                      agency, may either take the 12-hour course described above, or
                                                                      complete the additional six (6) hour PCT/Recovery training
                                                                      curriculum between January 1, 2011 and June 30, 2011 in order
                                                                      to meet the requirements. The curriculum elements for the six
                                                                      hour PCT/Recovery training will be:
                                                                      o developed by a group of stakeholders proficient in PCT and
                                                                      ecovery practices; o available from the Department by mid-
                                                                      December, 2010; o introduced no later than early January, 2011
                                                                      via a statewide web-based training orientation.




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  Update #:        Update Date



                                                                           Mental Health/Substance Abuse (MH/SA) Targeted Case
                                                                           Managers who have already completed the prior
                                                                           requirement of the six hour PCT training, and who remain with
                                                                           the same provider, may count those six hours toward the 12-hour
                                                                           requirement. This change will be effective when the new six hour
                                       Mental             TCM - Mental
                                                                           PCT/Recovery training curriculum elements become available in
                                  Health/Substance          Health/
    #082           11/12/2010                                              January 2011. All Targeted Case Management staff who are
                                   Abuse Targeted          Substance
                                                                           new to the provider agency are required to complete (or show
                                  Case Management           Abuse
                                                                           evidence of having completed) the 12-hour PCT training as
                                                                           outlined in DMA Clinical Coverage Policy 8L. The 12 hour PCT
                                                                           training will be portable if an employee changes jobs any time
                                                                           after completing the 12 hour requirement, as long as there is
                                                                           documentation of such training in the new employer’s personnel
                                                                           records.

                                                                            The contract with the statewide utilization review vendor expires
                                                                            on January 19, 2011. Utilization review for CAP/MR-DD services
                                                                            will not be included in the new contract for whoever is chosen at
                                                                            the end of the bid process for a statewide vendor. These services
                                                                            will be returned to the local level. To this end, the DMA in
                                                                            collaboration with the DMH/DD/SAS recently sent out a request
                                                                            for response from qualified LMEs who are interested in providing
                                  Utilization Review for
                                                                            utilization review functions for CAP/MR-DD services for recipients
                                       CAP/MR-DD          CAP-MR/DD -
    #082           11/12/2010                                               who reside in the LME’s catchment area. Several LMEs
                                         Services        Utilization review
                                                                            expressed an interest in providing these services as evidenced by
                                                                            submission of proposal packets by the October 18, 2010
                                                                            deadline. The proposal review was completed on Monday,
                                                                            October 25, 2010. Pathways and Crossroads have been selected
                                                                            to perform the CAP-MR/DD function, along with Eastpointe and
                                                                            The Durham Center. Counties not covered by these LMEs will be
                                                                            divided among
                                                                            them for performance of the CAP-MR/DD UR function.


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                                       Title (s)       Subject(s)                                  Summary
  Update #:        Update Date


                                                                       Due to the number of individuals who will be affected by the
                                                                       implementation of the utilization review guidelines posted in IU
                                                                       #76 on July 7, 2010, a decision has been made to extend the
                                                                       transition period specific to Residential Supports and Home
                                                                       Support services (direct contact hour requirements) to October
                                                                       31, 2011.
                                    CAP/MR-DD
                                                                       This extension serves to ensure there is no interruption in
    #082           11/12/2010     Residential/ Home    CAP-MR/DD
                                                                       services. Therefore, for issues specific to Residential Supports
                                  Support Services
                                                                       and Home Support services (direct contact hour requirements)
                                                                       there is no need to complete the extension/exception process at
                                                                       this time.
                                                                       The REVISED CAP-MR/DD Policy Requirements:
                                                                       Extension/Exception Request Form and instructions are
                                                                       located at: http://www.ncdhhs.gov/mhddsas/cap-mrdd/index.htm


                                   Rules for CABHA
                                                                       The CABHA rules are now posted on Office of Administrative
    #082           11/12/2010           Posted        CABHA - Rules
                                                                       Hearings website (http://www.ncoah.com/rules/).


                                                                       The NC DHHS Policies and Procedures for Critical Access
                                                                       Behavioral Health Agencies
                                                                       (http://www.ncdhhs.gov/mhddsas/cabha/) requires CABHAs to
                                  Performance Bonds     CABHA -        obtain a performance bond within 30 days of certification or, for
    #082           11/12/2010         for CABHAs       Performance     those CABHAs that were certified prior to the policy, within 30
                                                          Bonds        days of the adoption of the policy. Implementation of this
                                                                       requirement has been delayed until further notice. Providers will
                                                                       be notified of the implementation of the requirement through the
                                                                       Medicaid Bulletin and the DHHS Implementation Updates.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                   Summary
  Update #:        Update Date

                                                                          Peer Support Services have been approved by the Center for
                                     Peer Support        Peer Support     Medicare and Medicaid Services (CMS). An implementation date
    #082           11/12/2010
                                     Service Status        Services       has not been determined. Further information will be available in
                                                                          future correspondence.



                                                                        DHHS announced that Western Highlands Network has been
                                                                        selected as the next Local Management Entity (LME) to
                                                                        participate under the State’s Medicaid Waiver for mental health,
                                  Selection of the Next
                                                                        developmental disabilities and substance abuse services. The
                                  LME to Participate in   1915 (b)(c)
    #081           10/8/2010                                            waiver is the 1915 b/c waiver in reference to the sections of the
                                      the 1915b/c       Medicaid Waiver
                                                                        Social Security Act that authorize such waivers. DHHS will work
                                   Medicaid Waiver
                                                                        with WHN and all stakeholders in the counties served by WHN
                                                                        (Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford,
                                                                        Transylvania, and Yancey) to plan a successful implementation.



                                                                        As a result of action by the General Assembly, the 26 unmanaged
                                                                        outpatient behavioral health therapy visits limit for children will
                                                                        decrease to 16 unmanaged visits. Prior authorization will be
                                      Update on            Outpatient
                                                                        required for all outpatient services for children after the 16th visit.
    #080           10/5/2010       Unmanaged Visits       Behavioral
                                                                        As a reminder, prior authorization will continue to be required for
                                     for Children        health therapy
                                                                        adults after the 8th visit. To ease the transition for providers and
                                                                        recipients, this change will now be effective January 1, 2011, to
                                                                        correspond with the new benefit year.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                         Existing authorizations for MH/SA TCM recipients currently
                                                                         receiving the case management component of Community
                                                                         Support (CS) services may be transferred from a CS
                                                                         authorization to a MH/SA TCM authorization when a valid Critical
                                                                         Access Behavioral Health Agency (CABHA) submits a Letter of
                                                                         Attestation. Recipients who have completed the full authorization
                                                                         period of the case management component of CS and have not
                                   Service Orders for                    used the MH/SA TCM attestation process, or for those recipients
    #080           10/5/2010                            TCM - MH/SA
                                     MH/SA TCM                           new to case management (who have never had case
                                                                         management via CS), any request for MH/SA TCM will be
                                                                         considered an initial authorization request for a new service. In
                                                                         these instances, an updated PCP with goals related to MH/SA
                                                                         TCM including a new signed service order for MH/SA TCM and
                                                                         an ITR must be submitted to the appropriate utilization review
                                                                         (UR) vendor (ValueOptions, The Durham Center, or Eastpointe)
                                                                         for this initial authorization request.


                                                                         Providers must register their Medicaid Provider Number (MPN)
                                                                         on ProviderConnect in order submit authorization requests
                                                                         electronically, view authorizations, and retrieve authorization
                                                        Valua Options    letters online. Providers interested in submitting enhanced,
                                  VO ProviderConnect
    #080           10/5/2010                              Provider       residential, mental health /substance abuse (MH/SA) and
                                      Reminders
                                                          Connect        intellectual/developmental disabilities (I/DD) Targeted Case
                                                                         Management (TCM), and outpatient requests via
                                                                         ProviderConnect are encouraged to participate in regularly
                                                                         scheduled webinar training.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date

                                                     Valua Options
                                                        Provider
                                                        Connect -       For Community Support Team (CST) providers that now have a
                                                       Community        new alpha suffix (V) appended to their MPN, direct enrolled
                                                     Support Team,      providers of I/DD TCM, and CABHA organizations who have
                                  VO ProviderConnect
    #080           10/5/2010                         I/DD Targeted      received their MPN for MH/SA TCM: it is important to note that
                                      Reminders
                                                          Case          those new MPNs for CST, I/DD TCM, and MH/SA TCM must be
                                                     Management,        registered on ProviderConnect in order to submit authorization
                                                       and MH/SA        requests, view authorizations, and retrieve authorizations online.
                                                     Targeted Case
                                                      Management

                                                                      Outpatient authorizations have been entered to the attending
                                                                      MPN since July 1, 2010. Providers must search under the
                                                                      Attending MPN to retrieve authorization letters online. Per
                                                                      Implementation Update #77, providers may submit outpatient
                                                       Valua Options requests with up to three MPNs on the ORF2 to allow for “reserve
                                                         Provider     therapists” to receive authorization in addition to the primary
                                  VO ProviderConnect
    #080           10/5/2010                             Connect -    attending therapist. Such requests may also be submitted online
                                      Reminders
                                                        Outpatient    via ProviderConnect. The Attending MPNs (up to three) seeking
                                                       Authorizations authorization should be entered into the “Attending Provider
                                                                      Medicaid #” field separated by commas with no
                                                                      spaces. All Attending MPNs listed will be authorized for identical
                                                                      service codes, frequencies, and durations if the service request is
                                                                      deemed medically necessary.




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Implementation   Implementation
                                       Title (s)       Subject(s)                                 Summary
  Update #:        Update Date


                                                                      For children admitted to Residential Level III and IV services,
                                                                      length of stay is limited to no more than 120 days. If providers are
                                                                      submitting concurrent (reauthorization) requests for additional
                                                                      treatment after these 120 days, the provider must follow the
                                                                      authorization requirements for concurrent (reauthorization)
                                                                      requests aschildren currently in Level III and Level IV residential
                                                                      treatment must have an
                                                                      independent (meaning independent of the residential provider
                                      Level III/IV
                                                       Residential    and its provider organization) psychiatric evaluation as one of the
    #080           10/5/2010      Independent Psych.
                                                        Services      requirements for concurrent (reauthorization) requests. The
                                      Evaluations
                                                                      psychiatric evaluation must be performed by a psychiatrist,
                                                                      psychiatric physician’s assistant (PA) who is working under a
                                                                      psychiatrist’s
                                                                      protocol or an Advanced Practice Nurse Practitioner (APN) only.
                                                                      The psychiatric evaluation shall determine the clinical needs of
                                                                      the child and make recommendations for the appropriate level of
                                                                      treatment such as residential, Psychiatric Residential Treatment
                                                                      Facilities (PRTF), or other level of care.




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                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                         Agencies that have already achieved national accreditation, then,
                                                                         per Implementation Update #53 (February 3, 2009), that agency
                                                                         is not required to have the TCM service accredited until the
                                                                         accrediting agency for the provider schedules and performs the
                                                                         next regular review of the agency. However, if the agency has not
                                                                         been previously accredited, the agency is then subject to the
                                                                         guidance in GS.122C-81, “National accreditation Benchmarks.”
                                                                         Those benchmarks specify that the agency must be accredited
                                  Accreditation of TCM      TCM -
    #080           10/5/2010                                             within one year, and that the
                                       Services          Accreditation
                                                                         interim benchmarks identified in the statute must be met. Failure
                                                                         to meet any of those interim benchmarks, in addition to failure to
                                                                         meet the one-year requirement for accreditation, will result in the
                                                                         withdrawal by the LME of the endorsement to provide the service.
                                                                         For the purpose of identification of the specific timelines for each
                                                                         agency, the required year begins with the enrollment by the
                                                                         Division of Medical Assistance (DMA) of the provider for the
                                                                         provision of the service.




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Implementation   Implementation
                                     Title (s)      Subject(s)                                 Summary
  Update #:        Update Date


                                                                   Pproviders of MH/SA TCM are required to participate in the NC-
                                                                   Treatment Outcomes and Program Performance System (NC-
                                                                   TOPPS), as MH/SA TCM is an outcome-focused service.
                                                                   Responsibility for completing NC-TOPPS interviews lies with the
                                                                   consumer’s primary provider agency. This is the provider agency
                                                                   that provides a qualifying mental health and/or substance abuse
                                   MH/SA TCM                       service to the consumer and is providing case management
    #080           10/5/2010      Providers & NC-   NC-TOPPS       functions for the consumer (including the consumer’s
                                      TOPPS                        PCP/treatment plan. The
                                                                   revised NC-TOPPS Service Codes Criteria can be found in
                                                                   Appendix A of the SFY 2010-11 NC-TOPPS Implementation
                                                                   Guidelines and is published on the Division of Mental Health,
                                                                   Developmental Disabilities, and Substance Abuse Services
                                                                   (DMH/DD/SAS) web page: http://www.ncdhhs.gov/mhddsas/nc-
                                                                   topps/systemuser/nc-toppsguidelinesoctober10.pdf



                                                                   Changes to the Incident Response Improvement System (IRIS)
                                                                   were implemented on September 23, 2010 to
                                                                   address reporting issues identified by providers. Details of these
                                                                   changes can be found in an updated version of
                                                                   “IRIS Frequently Asked Questions” at
                                                     Incident      http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/
    #080           10/5/2010      NC-IRIS Update
                                                    Reporting      irisfaq-
                                                                   condensed.pdf, including:
                                                                   · Downloading IRIS data to provider IT systems
                                                                   · Changes to required fields
                                                                   · Expanded directions and “Help” information
                                                                   · Schedule for future system changes




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                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                       DMH/DD/SAS in partnership with DMA has been working on
                                                                      finalizing the required operational details to implement Self-
                                                                      Direction in the CAP-MR/DD Supports Waiver. With this model of
                                                                      Self-Direction there are two required functions, the Financial
                                                                      Management Services Agency and the Support Broker. The
                                                                      Support Broker function is called the Community Resource
                                                                      Consultant. The DMH/DD/SAS has selected, through a RFA
                                  Self-Direction for                  process, two vendors to provide the services of Community
    #080           10/5/2010       CAP-MR/DD           CAP-MR/DD      Resource Consultant (CRC). The two vendors selected to
                                  Supports Waiver                     provide the CRC services are: 1) The Arc of North Carolina and,
                                                                      2) Central State of the Carolinas. Efforts have begun to inform
                                                                      eligible individuals of the Self-Direction option. More information
                                                                      about the implementation of Self-Direction will be provided in
                                                                      future Implementation Updates. Information about Self-Direction
                                                                      in the CAP-MR/DD Supports Waiver can be found on the
                                                                      DMH/DD/SAS website at:
                                                                      http://www.ncdhhs.gov/mhddsas/selfdirect/index.htm.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                    Summary
  Update #:        Update Date

                                                                   In order for Mental Health/Substance Abuse Targeted Case
                                                                   Management (MH/SA TCM) claims to adjudicate appropriately,
                                                                   when submitting claims for MH/SA TCM, please ensure that prior
                                                                   authorization has been received from the appropriate utilization
                                                                   management vendor (ValueOptions, The Durham Center or
                                                                   Eastpointe local management entity [LME]). If the authorization
                                                                   request has not been approved, when a claim is submitted,
                                                                   it will be denied. To request prior authorization for recipients who
                                  CABHAs Providing
     #79           9/29/2010                           CABHA - TCM are being transitioned from the case management component
                                    MH/SA TCM
                                                                   of Community Support Services (CS) to MH/SA TCM, providers
                                                                   must submit a Letter of Attestation to ValueOptions for each
                                                                   recipient who will be transitioned. Eastpointe and The Durham
                                                                   Center WILL NOT be able to process these attestation requests.
                                                                   Detailed information on submitting Letters of Attestation can be
                                                                   found in Implementation Update #77
                                                                   (http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdat
                                                                   es/).

                                                                        Three more enrollment/authorization/billing seminars have been
                                                                        scheduled in the coming weeks at the sites listed below.
                                                                        Information presented at the seminars is applicable to all
                                                                        providers who have been certified as CABHAs or are in the
                                                                        process of certification.
                                  CABHA Enrollment       CABHA -
                                                                        Attendees are encouraged to review Implementation Updates
     #79           9/29/2010      Seminars Sept./Oct    Enrollment
                                                                        #73, #75, #76, #77 and #078 in preparation. An updated training
                                                        Seminars
                                                                        packet will be available on the Division of Medical Assistance
                                                                        (DMA) website the week of the trainings:
                                                                        http://www.ncdhhs.gov/dma/provider/seminars.htm Please print
                                                                        the packet and bring it to the training as there will be only limited
                                                                        copies available.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                        The Division of Medical Assistance (DMA), in conjunction with
                                                                        their vendors (CSC, ValueOptions, and HP Enterprise Services),
                                                                        have developed a list of Frequently Asked Questions (FAQs)
                                    FAQ for CABHA         CABHA -
     #79           9/29/2010                                            related to the key areas of enrollment, authorization, and billing.
                                      Enrollment         Enrollment
                                                                        These FAQs can be found on the DMA Behavioral Health
                                                                        CABHA webpage:
                                                                        http://www.ncdhhs.gov/dma/services/cabha.htm

                                                                        A provider’s obligation to safeguard records accrued during the
                                                                        course of providing publicly-funded mental health, developmental
                                                                        disabilities, or substance abuse services is outlined in various
                                                                        agreements, policies, and state and federal laws that address the
                                                                        provider’s responsibility for the proper maintenance, retention,
                                                                        and
                                                                        disposition of records. This includes making certain that records
                                                                        are stored in an environment that ensures preservation of the
                                  Provider Contractual                  records and that safeguards the privacy, security, and
                                        and Legal                       confidentiality of the records. Such obligations are binding and
                                                          Record
     #79           9/29/2010          Responsibility                    extend beyond the time that the provider is enrolled or under
                                                         Retention
                                    for Safeguarding                    contract, regardless of whether discontinuation as a provider is
                                         Records                        voluntary or involuntary. The abandonment of records and the
                                                                        failure to safeguard the privacy, security, and disposition of
                                                                        records is a violation of state and federal laws and is subject to
                                                                        sanctions and penalties. Upon discovering that provider records
                                                                        have been abandoned, the records officer at the LME should be
                                                                        immediately notified. The records officer for each LME and a full
                                                                        list of the following agreements, policies and laws
                                                                        address the provider’s responsibility for the maintenance,
                                                                        retention and disposition of records. can be located on the




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Implementation   Implementation
                                      Title (s)      Subject(s)                                   Summary
  Update #:        Update Date



                                                                     The Centers for Medicare and Medicaid Services (CMS)
                                                                     approved a State Plan Amendment which allows only certified
                                                                     CABHAs to deliver Community Support Team (CST), Intensive In-
                                                                     home Services (IIH)
                                                                     and Day Treatment Services (DT) effective January 1, 2011. On
                                                                     and after that date, only CABHAs authorized to be reimbursed
                                                                     for the provision of CST, IIH and DT. Additionally, CS will no
                                                                     longer be a covered service, effective January 1, 2011.
                                                      CABHA -        Recipients in need of continued case management who meet the
                                  CABHA Transition
     #79           9/29/2010                          Transition     eligibility requirements for MH/SA TCM may need to be
                                    Benchmarks
                                                     Benchmarks      transitioned to MH/SA TCM. Only CABHAs are authorized to be
                                                                     reimbursed for the provision of MH/SA TCM. While most
                                                                     providers currently providing services may continue service
                                                                     delivery until December 31, 2010, it is critically important that all
                                                                     providers understand the benchmarks established so that
                                                                     consumers receiving CS, CST, DT and IIH services from non-
                                                                     CABHA certified agencies experience a timely and seamless
                                                                     transition to CABHA certified agencies or other basic outpatient
                                                                     services.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                      For provider agencies with an endorsement expiration date
                                                                      between now and December 31, 2010 of CST, IIH, DT, or CS,
                                                                      DHHS will automatically extend the endorsement to December
                                                                      31, 2010 for provider agencies that are not expected to receive
                                                                      CABHA certification by December 31st. LMEs will not be required
                                  CST, IIH, DT, CS Re-                to re-endorseproviders of CST, IIH, DT, or CS (that are not
     #79           9/29/2010                           Re-endorsement
                                     endorsement                      expected to receive CABHA certification by December 31, 2010)
                                                                      as outlined in the NC DHHS Policy and Procedures for
                                                                      Endorsement of Providers of M edicaid Reimbursable MH/DD/SA
                                                                      services, effective December 3, 2007 and Implementation Update
                                                                      #54. A Notification of Endorsement Action (NEA) letter will not be
                                                                      required for this purpose.



                                                                         Any new applications for endorsement for CST, IIH, or DT will be
                                     Endorsement                         terminated by LMEs effective September 30, 2010 for any
     #79           9/29/2010        Applications for    Endorsement      providers that have not submitted a completed Letter of
                                    CST, IIH, or DT                      Attestation and application on or before August 31, 2010 to obtain
                                                                         CABHA certification.



                                                                       If a CABHA provider applicant has a continuum or key staff
                                                                       change (Medical Director, Clinical Director, QM/Training Director)
                                                                       the provider must resubmit the attestation letter and the required
                                                                       supporting documents per Implementation Update #75. This
                                  CABHA Attestation     CABHA -
     #79           9/29/2010                                           resubmission due to a change in the continuum or key staff
                                   Letters Update   Attestation Letter
                                                                       position will count as one of the three submissions. Please note
                                                                       this change took effect per the posting on the CABHA Webpage
                                                                       (http://www.ncdhhs.gov/MHDDSAS/cabha/) on September 28,
                                                                       2010.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                Summary
  Update #:        Update Date



                                                                        DMH/DD/SAS and DMA will consider all feedback from
                                                                        individuals receiving CAP-MR/DD waiver services, parents and
                                                                        guardians of
                                                       CAP-MR/DD -
                                                                        individuals receiving services, service providers, advocates or
                                                          Waivers
                                                                        others having direct experience with the current CAP-MR/DD
    #078            9/8/2010      CAP-MR/DD Update     Development
                                                                        waivers to improve the waivers to be implemented in November
                                                        Stakeholder
                                                                        2011. To participate in the survey, go to
                                                          Survey
                                                                        http://www.ncdhhs.gov/mhddsas/cap-mrdd/index.htm and follow
                                                                        the instructions provided there. All responses are due by
                                                                        September 30, 2010.


                                                                  In Implementation Update #76, posted July 7, 2010, under
                                                                  “Implementation Plan for the CAP-MR/DD Clinical Policy, CAP
                                                                  MR/DD Comprehensive Waiver and Supports Waiver Manuals
                                                    CAP-MR/DD -
                                                                  and Technical Amendment Number One,” paragraph three, it was
                                                    Correction to
    #078            9/8/2010      CAP-MR/DD Update                incorrectly noted that notices of adverse action/due process of
                                                   Implementation
                                                                  appeals rights must be mailed at least 30 days prior to the
                                                     Update #76
                                                                  effective date of the adverse action. The correct time frame is
                                                                  that notices must be mailed at least 10 days prior to the effective
                                                                  date of the adverse action.


                                                                       As part of the DMH/DD/SAS Supports Intensity Scale (SIS)
                                                       CAP-MR/DD -
                                                                       implementation, UNC-Chapel Hill is recruiting a
    #078            9/8/2010      CAP-MR/DD Update        Supports
                                                                       SIS Coordinator for the project. The job posting can be found at
                                                       Intensity Scale
                                                                       http://jobs.unc.edu/2500294.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date

                                                                     DMA has received approval to implement a new procedure code
                                                                     and rate for Targeted Case Management for individuals with
                                                                     intellectual and developmental disabilities (TCM-IDD) for direct
                                                                     enrolled providers. Effective with date of service August 1, 2010,
                                  Providers of TCM-                  or the date of enrollment, whichever is later; direct enrolled
    #078            9/8/2010             IDD          TCM-IDD        providers may
                                                                     be reimbursed for T1017HE at the new weekly rate of $62.26.
                                                                     T1017HE may be billed only by the direct enrolled providers. HP
                                                                     Enterprise Services will not process any systematic recoupment
                                                                     of T1017 HI and
                                                                     repayment for code of T1017 HE.
                                                                     The effective date of enrollment for direct enrolled providers for
                                                                     TCM-IDD will be the date requested by the provider but no earlier
                                                                     than August 1, 2010, or the date a complete and accurate
                                                                     enrollment package is received by Computer Sciences
                                                                     Corporation (CSC), if a date is not requested by the provider.
                                                                     Until providers are directly enrolled with DMA, they may continue
                                                      TCM-IDD -
                                  Providers of TCM-                  to bill TCM-IDD services through the local management entities
                                                        Provider
    #078            9/8/2010             IDD                         (LMEs) with T1017 HI and T1017 HI SC, at the current rate of
                                                      Enrollment
                                                                     $17.67 per unit. Effective January 1, 2011, LMEs will no longer
                                                      Information
                                                                     process TCM-IDD claims for Medicaid.
                                                                     For state-funded TCM-IDD the process is the same as with
                                                                     Medicaid TCM-IDD. When the state-funded provider receives its
                                                                     enrollment number from Medicaid, that provider should inform the
                                                                     LME with whom the provider is contracted to provide TCM-IDD as
                                                                     soon as that number is received.




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Implementation   Implementation
                                      Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                       This service must be prior authorized for non-CAP Waiver
                                                                       recipients prior to submitting claims. (TCM for CAP Wavier
                                                                       recipients does not require prior authorization.) Following
                                                                       enrollment, the provider will be able to request authorization for
                                                                       TCM-IDD for new non-CAP Waiver recipients in accordance with
                                                                       current procedures and documentation requirements. Providers
                                                                       may fax authorization requests to ValueOptions at 877-339-8754.
                                  Providers of TCM-     TCM-IDD -      For current recipients with an existing authorization, providers
    #078            9/8/2010             IDD             Service       may request transfer of authorizations from
                                                       Authorization   T1017 HI to T1017 HE and transfer of the authorization from an
                                                                       LME to their TCM-IDD Medicaid provider number through the
                                                                       ValueOptions’ TCM Provider Change Request Form at
                                                                       http://www.valueoptions.com/providers/Network/North_Carolina_
                                                                       Medicaid.htm. ValueOptions will authorize the new code as
                                                                       requested and begin the authorization start date on August 1,
                                                                       2010, or the actual provider enrollment date, whichever is later.
                                                                       There will be no charge to providers for this transfer of
                                                                       authorizations.
                                                                    Documentation must reflect each contact. A full service note for
                                                                    each contact, or a full service note for each date of service (if
                                                                    there are multiple contacts within a day), written and signed by
                                  Providers of TCM-
                                                       TCM-IDD -    the person(s) who provided the service, is required. For more
    #078            9/8/2010             IDD
                                                      Documentation details on what to include in the service note, please refer to the
                                                                    Records Management and Documentation Manual,
                                                                    http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/
                                                                    rmd09/rmdmanual-final.pdf




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Implementation   Implementation
                                      Title (s)       Subject(s)                                  Summary
  Update #:        Update Date


                                                                     Claims Submission: The billing limit is one unit per week which
                                                                     runs from Sunday to Saturday. If the claim identifies a span of
                                                                     dates, (e.g. August 2-6, 2010), the claim will be denied. In order
                                                                     to bill, providers must provide at least 15 minutes of service per
                                                                     week. The service must be provided and documented according
                                                       TCM-IDD -
                                                                     to the needs of the recipient. Electronic claims submitted by direct
                                  Providers of TCM-    Additional
                                                                     enrolled providers prior to the 8/19/2010 cutoff for procedure
    #078            9/8/2010             IDD            Claims
                                                                     code T1017 HE will have adjudicated on the 8/26/2010 check
                                                      Processing
                                                                     write. Claims processed after the 8/19/2010 cutoff will adjudicate
                                                      Information
                                                                     according to the current check write schedule. Please note:
                                                                     system audits have been developed to deny claims billed with
                                                                     T1017 HE or T1017 HI if billed during the same calendar week.
                                                                     The first claim processed and paid for a recipient will result in the
                                                                     denial of any other claim for TCM during the same week.

                                                                     Electronic Funds Transfer: Providers must submit to HP
                                                                     Enterprise Services a completed Electronic Funds Transfer (EFT)
                                                      TCM-IDD -      form specific to TCM-IDD. Claims will suspend if this EFT form is
                                  Providers of TCM-    Additional    not on file. Although many providers have completed the
    #078            9/8/2010             IDD            Claims       enrollment process and been issued a Medicaid provider number,
                                                      Processing     many have not
                                                      Information    completed an EFT Authorization Agreement for Automatic
                                                                     Deposit form needed for payment. You can access the form from
                                                                     DMA’s website at




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Implementation   Implementation
                                       Title (s)           Subject(s)                                 Summary
  Update #:        Update Date



                                                                          Providers must submit to HP Enterprise Services a completed
                                                                          Electronic Funds Transfer (EFT) form specific to TCM-IDD.
                                                                          Claims will suspend if this EFT form is not on file. Although many
                                                            TCM-IDD -
                                  Providers of TCM-IDD                    providers have completed the enrollment process and been
     #078           9/8/2010                             Electronic Funds
                                                             Transfer:
                                                                          issued a Medicaid provider number, many have not completed an
                                                                          EFT Authorization Agreement for Automatic Deposit form needed
                                                                          for payment. You can access the form from DMA’s website at
                                                                          http://www.ncdhhs.gov/dma/provider/forms.htm.



                                                                      As per Implementation Update #77, Mental Health/Substance
                                                                      Abuse Targeted Case Management (MH/SA TCM) has a weekly
                                                                      (Sunday-Saturday) case rate. In order to bill this weekly rate,
                                   Update on TCM-        TCM -MH/SA -
    #078            9/8/2010                                          case managers must provide at least 15 minutes of case
                                       MH/SA              Weekly Rate
                                                                      management activity (assessment, person centered plan (PCP)
                                                                      development,
                                                                      linkage/referral, monitoring) per week.

                                                                       Documentation must reflect each contact. Per the service
                                                                       definition, a full service note for each contact, or a full service
                                   Update on TCM-        TCM -MH/SA -
    #078            9/8/2010                                           note for each date of service (if there are multiple contacts within
                                       MH/SA             Documentation
                                                                       a day), written and signed by the person(s) who provided the
                                                                       service, is required.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                  Summary
  Update #:        Update Date



                                                       TCM - MH/SA -     MH/SA TCM is a service that can only be provided by a Critical
                                                          Medicaid       Access Behavioral Health Agency (CABHA). Once a provider is
                                   Update on TCM-         Provider       certified as a CABHA, they will need to complete the NC Medicaid
    #078            9/8/2010
                                       MH/SA           Number/National   Enrollment application. The downloadable enrollment application
                                                          Provider       is available on the NCTracks website,
                                                          Identifier     (http://www.nctracks.nc.gov).


                                                                     DMA has been instructed by the NC Department of Health and
                                                                     Human Services (DHHS) Secretary to reverse the proposed rate
                                                                     reductions that were effective September 1, 2010.
                                                                     Notwithstanding any further directives, the rates in effect as of
                                      Medicaid                       August 31, 2010 shall remain in effect on September 1, 2010,
                                                         Medicaid -
    #078            9/8/2010       Reimbursement
                                                       Reimbusrement and thereafter. DMA is in the process of replacing the published
                                    Rate Update                      September 1, 2010, fee schedules with the previously published
                                                                     fee schedules. The Fiscal Agent has been instructed to continue
                                                                     with the current rates on and after September 1,
                                                                     2010. If you have any questions, please call the DMA Finance
                                                                     Management Section at 919-855-4180.
                                                                     All new authorizations for Community Support Team (CST) shall
                                                                         be based upon medical necessity as defined by DMA Clinical
                                                                         Coverage Policy 8A and shall not exceed 32 hours (128 units) per
                                                                         60-day
                                                                         period for adults. Existing authorizations for CST will remain
                                                                         effective until the end of the current authorization period. Please
                                  CST Revised Limits
    #078            9/8/2010                                CST          note that maintenance of service (MOS) authorizations will not
                                                                         exceed the benefit limit of 32 hours (128 units) per 60 days for
                                                                         adverse decisions appealed on or after September 1, 2010. As a
                                                                         reminder,
                                                                         children under the age of 21 may qualify for this service if
                                                                         medically necessary under Early and Periodic Screening,
                                                                         Diagnosis and Treatment (EPSDT).



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Implementation   Implementation
                                       Title (s)         Subject(s)                                   Summary
  Update #:        Update Date


                                                                         Medicaid and N.C. Health Choice recipients are notified of benefit
                                                         Medicaid -
                                  Medicaid Recipient                     and coverage changes through monthly mailings. Copies of the
    #078            9/8/2010                              Recipient
                                    Notifications                        notifications are available on DMA’s website at
                                                         Notification
                                                                         http://www.ncdhhs.gov/dma/pub/consumerlibrary.htm.

                                                                         Effective September 20, 2010, ALL CAP requests, including
                                                                         revision requests, must be sent to the appropriate LME utilization
                                                                         review (UR) vendor for processing; recipients with eligibility in
                                                                         Durham Center’s catchment area must be sent to the Durham
                                                                         Center and recipients with eligibility in Duplin, Lenoir, Sampson,
                                                                         and Wayne Counties must be sent to Eastpointe. As a point of
                                                                         clarification, requests for additional units of CAP/MR-DD services
                                                                         above the current authorized amount are considered “revision
                                                       LME - Utilization requests.” When submitting CAP/MRDD revision requests or
    #078            9/8/2010       LME UR Update
                                                          Review         provider change requests for CNRs that have been approved by
                                                                         ValueOptions (VO), the targeted case managers are required to
                                                                         submit the following documents: 1. A complete revision request
                                                                         including CTCM forms, cost summary, and signature page, as
                                                                         well as any other documentation required per service definitions.
                                                                         2. A complete copy of the last CNR packet including cost
                                                                         summary, signature page, and MR-2. 3. Copies of any revisions
                                                                         that were approved by VO after the last CNR and prior to the
                                                                         revision being requested.

                                                                         Adverse determination letters will no longer include
                                                                         recommendations for alternate services. The new Adverse
                                     UR Adverse
                                                          Utilization    Determination Letters will advise that recipients may also be
    #078            9/8/2010        Determination
                                                           Review        eligible for other Medicaid services and recipients may talk with
                                       Letters
                                                                         their physician, other licensed clinician, or provider to determine if
                                                                         other Medicaid services are appropriate.




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                                      Title (s)      Subject(s)                                 Summary
  Update #:        Update Date

                                                                    Two reports have been developed to assist in planning and
                                                                    facilitating a smooth transition for individuals who will need
                                                                    Community Support Team (CST), Day Treatment (DT), or
                                                                    Intensive In-Home (IIH) services after December 31, 2010, at
                                                                    which time these services can only be provided by CABHAs.
                                                                    These reports, the Service Continuum for CABHA Applicants at
                                                                    the Verification Stage Report and the Service Authorization
                                                                    Report, have been posted on the CABHA web page
                                  CABHA Transition                  (http://www.dhhs.state.nc.us/mhddsas/cabha/index.htm). Both
    #078            9/8/2010                          CABHA         reports
                                      Data
                                                                    will be updated at least once a month. Please note that in order
                                                                    to produce an unduplicated count of providers and individuals
                                                                    served, certain personal identifying information (PII) and personal
                                                                    health information (PHI) were used in the preliminary analysis,
                                                                    however, all PII (e.g., employer identification numbers and
                                                                    provider #s) and PHI (e.g., the recipient’s Medicaid ID #) were
                                                                    redacted before these reports were posted. Due to the size of the
                                                                    reports, they have been bookmarked to assist in navigating
                                                                    through each report for a specific analysis.

                                                                    All CABHA enhanced and residential services must be under the
                                                                    single business ownership of the CABHA. All staff who provide
                                                                    residential and enhanced services for the CABHA must be
                                                                    employees of the CABHA. Individual enhanced or residential
                                                                    service sites cannot provide services for more than one CABHA.
                                  CABHA Business
                                                                    Individual, direct-enrolled behavioral health practitioners (i.e.,
    #078            9/8/2010        Ownership         CABHA
                                                                    LCSW, LPC, LMFT, APN) of “core” services—outpatient therapy,
                                                                    assessments, and medication management—may be employed
                                                                    by multiple CABHAs. Upon receiving the certification letter from
                                                                    DMH/DD/SAS that certifies their agency as a CABHA, the
                                                                    CABHA must complete and submit the In-State/Border
                                                                    Organization Provider Enrollment Application to enroll.




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Implementation   Implementation
                                      Title (s)     Subject(s)                                  Summary
  Update #:        Update Date

                                                                   Pending written approval from the Centers for Medicare and
                                                                   Medicaid (CMS), the new weekly rate for Targeted Case
                                                                   Management for individuals with intellectual and developmental
                                                                   disabilities (I/DD) is $62.26 per week with an anticipated effective
                                                                   date of August 1, 2010. The new service code is T1017HE. This
                                                                   service is reimbursed at a weekly rate based on the billing of at
                                                                   least one unit per week. The expectation is that in order to bill for
    #077            8/3/2010        TCM for IDD     IDD - TCM      that week, a minimum of 15 minutes of service is provided.
                                                                   Although this is the minimum service provision required for billing,
                                                                   case managers are expected to provide the amount of service
                                                                   that is needed by the individual. Case managers must document
                                                                   all service that is provided and include the amount of time spent
                                                                   during each contact in the progress note. This documentation of
                                                                   services will be used to substantiate the weekly rate for audit
                                                                   purposes.
                                                                   Mental Health/Substance Abuse Targeted Case Management
                                                                   (MH/SA TCM) was implemented effective with date of service
                                                                   July 1, 2010 with a weekly case rate of $81.25. The procedure
                                                                   code for MH/SA TCM is H0032 and the billing limit is one unit per
                                                                   week (Sunday through Saturday). Prior approval is required for
                                                                   this service. To bill this weekly case rate, the case manager must
                                  Update on MH/SA
    #077            8/3/2010                        MH/SA TCM      provide at least 15 minutes of case management activity per
                                       TCM
                                                                   week (assessment, person centered plan (PCP) development,
                                                                   linkage/referral, monitoring). The case manager must provide all
                                                                   services necessary to meet the case management needs of the
                                                                   recipient. For audit and rate setting purposes, each contact must
                                                                   be documented, and documentation must include the amount of
                                                                   time spent during the contact.




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Implementation   Implementation
                                      Title (s)      Subject(s)                                  Summary
  Update #:        Update Date

                                                                     CSC will issue each certified and enrolled CABHA a statewide
                                                                     MH/SA TCM Medicaid Provider Number (MPN) until site-specific
                                                                     enrollment can be achieved (more information on site-specific
                                                                     enrollment will be provided in future communications). CSC will
                                                                     contact those CABHAs that have already enrolled to assist with
                                                                     the completion of an additional application addendum for a
                                  Update on MH/SA   Enrollment -
    #077            8/3/2010                                         statewide MH/SA TCM MPN. CABHAs that have not yet enrolled
                                       TCM          MH/SA TCM
                                                                     must indicate on the enrollment application that they will be
                                                                     providing MH/SA TCM by checking, “Targeted Case
                                                                     Management for Mental Health and Substance Abuse,” on the
                                                                     enrollment application. The downloadable enrollment application
                                                                     is available on the NCTracks website
                                                                     (http://www.nctracks.nc.gov).

                                                                    On September 1, 2010, CABHAs may begin to request prior
                                                                    authorization for MH/SA TCM after receiving a MH/SA TCM
                                                                    MPN. Submission of authorization requests must follow one of
                                                                    two procedures: 1. CABHAs may submit a MH/SA TCM
                                                        Prior       Attestation Letter (see attached) for those recipients who were
                                  Update on MH/SA
    #077            8/3/2010                        authorization - seen under a Community Support (CS) authorization IF service
                                       TCM
                                                     MH/SA TCM provided to those recipients followed all the MH/SA TCM policy
                                                                    guidelines, including those for entry criteria and service provision.
                                                                    Providers must submit an Attestation Letter for each CS recipient.
                                                                    2. CABHAs may submit prior authorization requests for recipients
                                                                    new to case management services.




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Implementation   Implementation
                                      Title (s)      Subject(s)                                  Summary
  Update #:        Update Date

                                                                     System implementation for payment of the weekly rate for MH/SA
                                                                     TCM is expected to be completed by September 1, 2010.
                                                                     Providers should not submit claims for MH/SA TCM prior to
                                                                     September 1, 2010. In the interim weeks, providers may continue
                                                       Claims        to provide and bill the case management component of CS, if
                                  Update on MH/SA
    #077            8/3/2010                         Submission -    authorized for a recipient under the CISA MPN. MH/SA TCM
                                       TCM
                                                     MH/SA TCM       claims will always be billed using the professional (CMS-
                                                                     1500/837P) claim type. For claims submission the National
                                                                     Provider Identifier (NPI) associated with the CABHA MPN will
                                                                     always be the "billing" number and the NPI associated with the
                                                                     MH/SA TCM MPN will always be the "attending" number.
                                                                     The implementation of CABHA requirements is designed to
                                                                     improve the quality of care and likelihood of positive outcomes for
                                                                     consumers. CABHA-certified providers pass a rigorous review
                                                                     process in order to achieve that designation. In order to assure
                                                                     that CABHAs continue to meet quality-of-care and patient-
                                                                     outcome standards, an outcome-based monitoring protocol has
                                                      CABHA -        been developed with input from consumers, families,CABHAs,
    #077            8/3/2010      CABHA Monitoring
                                                      Monitoring     and LMEs, including LME Medical Directors. The monitoring will
                                                                     address specific CABHA infrastructure requirements such as
                                                                     medical and clinical oversight and quality management and
                                                                     quality areas such as integration with physical health care and
                                                                     achievement of personal outcomes for consumers. A grid is
                                                                     attached which lays out the general areas to be addressed and
                                                                     includes both outcome and process measures.




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Implementation   Implementation
                                       Title (s)       Subject(s)                                   Summary
  Update #:        Update Date

                                                                       Information presented at the seminars is applicable to all
                                                                       providers who have been certified as a CABHA or are in the
                                                                       process of certification. Materials will be provided at the training
                                                                       though you are encouraged to review Implementation Updates
                                                                       #73,#75,Information presented at the seminars is applicable to all
                                                                       providers who have been certified as a CABHA or are in the
                                                                       process of certification. Materials will be provided at the training
                                                                       though you are encouraged to review Implementation Updates
                                  CABHA Enrollment       CABHA -
    #077            8/3/2010                                           #73,#75, #76, and #77 in preparation. Pre-registration is
                                     Workshop           enrollment
                                                                       required. Due to limited seating, registration is limited to two staff
                                                                       members per office. Unregistered providers are welcome to
                                                                       attend if space is available. Providers are to register for the
                                                                       seminars by completing and submitting the online registration
                                                                       form (http://www.ncdhhs.gov/dma/provider/seminars.htm) or
                                                                       providers may register by fax using the form attached (fax it to the
                                                                       number listed on the form). Please indicate the session you plan
                                                                       to attend on the registration form.


                                                                       East Carolina Behavioral Health (ECBH) and Albemarle Mental
                                                                       Health Center (AMHC) have merged. Effective July 1, 2010, all
                                  AMHC Authorization     Merger -      authorizations for DD Case Management, Therapeutic Foster
    #077            8/3/2010
                                   Changes to ECBH     AMHC/ECBH       Care, and services provided by provisionally licensed providers
                                                                       for recipients that were previously enrolled with the AMHC will
                                                                       now be transferred to ECBH’s MPN by ValueOptions.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                  Summary
  Update #:        Update Date

                                                                       As of September 20, 2010, Medicaid services for mental health,
                                                                       developmental disabilities, and substance abuse will be reviewed
                                                                       for prior authorization by The Durham Center and Eastpointe
                                                           Prior
                                                                       LME for their respective catchment areas only. All LMEs will
                                   PA for Medicaid     Authorization -
                                                                       continue to authorize State funded services as is their current
                                  Funded Services in      Medicaid
    #077            8/3/2010                                           practice.                                        Submission of
                                      Durham &          Funded - The
                                                                       prior authorization requests to The Durham Center can be done
                                   Eastpointe LMEs     Durham Center
                                                                       through The Durham Center’s LME ProviderConnect web-based
                                                           LME
                                                                       system or to their dedicated fax number at 919-560-7377. The
                                                                       Durham ProviderConnect system can be accessed via the LME
                                                                       website, www.durhamcenter.org.

                                                                       As of September 20, 2010, Medicaid services for mental health,
                                                                       developmental disabilities, and substance abuse will be reviewed
                                                                       for prior authorization by The Durham Center and Eastpointe
                                                           Prior
                                   PA for Medicaid                     LME for their respective catchment areas only. All LMEs will
                                                       Authorization -
                                  Funded Services in                   continue to authorize State funded services as is their current
    #077            8/3/2010                             Medicaid
                                      Durham &                         practice. Submission of prior authorization requests to
                                                         Funded -
                                   Eastpointe LMEs                     Eastpointe can be done through Eastpointe’s LME
                                                       Eastpoint LME
                                                                       ProviderConnect web-based system or dedicated fax number at
                                                                       910-298-7189. The Eastpointe ProviderConnect system can be
                                                                       accessed via the LME website, www.eastpointe.net.

                                                                        As stated in the June 2010 Medicaid Bulletin and Implementation
                                                                        Update #73 and #76, effective July 1, 2010, prior authorizations
                                                                        for all outpatient services, with dates of services July 1, 2010, and
                                  Update on New PA     Provisionally    forward, will be created for the "Attending Provider
    #077            8/3/2010        guidelines for       Licensed       Name/Medicaid #" on the ORF2 form. Providers must enter the
                                     Outpatient        Professionals    Attending MPN associated with the Attending NPI with which they
                                                                        will submit their claims (do not submit NPI on the ORF2). Prior
                                                                        authorization requests will no longer be made for group providers.
                                                                        This applies to all direct-enrolled licensed professionals.



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Implementation   Implementation
                                      Title (s)        Subject(s)                                   Summary
  Update #:        Update Date


                                                                         Provisionally licensed professionals who bill through the LME will
                                                       Provisionally     continue to request prior authorization with the LME’s MPN as the
                                                          Licensed       "attending provider" and should continue to bill through the LME.
                                  Update on New PA    Professionals      To ease the transition to the new authorization process, providers
    #077            8/3/2010        guidelines for   Billing through a   will only need to list the "Attending Provider Name/Medicaid #" on
                                     Outpatient             Local        the ORF2 form. The "Billing Provider Name/Medicaid #" field is
                                                      Management         not required through December 31, 2010. ORF2s submitted
                                                            Entity       without the “Attending Provider Name/Medicaid #” will be returned
                                                                         by ValueOptions as “Unable to Process.”

                                                                       Provisionally licensed professionals who bill "incident to" a
                                                                       physician should request prior authorization with the MPN of the
                                                                       individual physician as the "attending provider." This individual
                                                      Provisionally physician MPN is the individual physician that the provisionally
                                  Update on New PA       Licensed      licensed professional practices "incident to." To ease the
    #077            8/3/2010        guidelines for    Professionals transition to the new authorization process, providers will only
                                     Outpatient      Billing “Incident need to list the "Attending Provider Name/Medicaid #" on the
                                                     to” a Physician ORF2 form. The "Billing Provider Name/Medicaid #" field is not
                                                                       required through December 31, 2010. ORF2s submitted without
                                                                       the “Attending Provider Name/Medicaid #” will be returned by
                                                                       ValueOptions as “Unable to Process.”




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Implementation   Implementation
                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date

                                                                     Prior authorizations for all outpatient services, with dates of
                                                                     services July 1, 2010, and forward, will be created for the
                                                                     "Attending Provider Name/Medicaid #" on the ORF2 form.
                                                                     Providers must enter the attending Medicaid Provider Number
                                                       Outpatient    (MPN) associated with the attending National Provider Identifier
                                                        Services     (NPI) with which they will submit their claims (do not submit NPI
                                  Update on New PA
                                                      Provided in a on the ORF2). Prior authorization requests will no longer be made
    #077            8/3/2010        guidelines for                   for group providers. This applies to all directly enrolled licensed
                                                       CABHA by
                                     Outpatient
                                                     Direct-Enrolled professionals. If clinically appropriate, providers may submit up to
                                                        Providers    three MPNs on the “Attending Provider” line on the ORF2 for
                                                                     “reserve” attending therapists for a recipient in addition to the
                                                                     primary attending therapist. Each provider MPN must be
                                                                     separated by a comma. All MPNs/providers will be authorized
                                                                     identical service codes, frequencies, and durations if the service
                                                                     request is deemed medically necessary.

                                                                      This is a correction to guidance provided in Implementation
                                                      Provisionally   Update #76 is provisionally licensed providers offering services
                                  Update on New PA
                                                        Licensed      under a CABHA may bill “incident to” a physician in the CABHA or
    #077            8/3/2010        guidelines for
                                                      Professionals   may bill through the LME using “H codes.” All current
                                     Outpatient
                                                     under a CABHA    authorizations for outpatient services provided by provisionally
                                                                      licensed providers under a CABHA will remain in effect.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date
                                                                    NC START provides community based crisis prevention and
                                                                    intervention services for people with intellectual and
                                                                    developmental disabilities who experience crises due to mental
                                                                    health or complex behavioral health issues. There are six NC
                                                                    START clinical teams across the state; two teams per region.
                                                                    The clinical teams became fully operational in January of 2009. In
                                                                    addition to the clinical teams, NC START includes three respite
                                                                    homes, one per region. Each respite home contains two
                                  NC START Annual   Annual Report - designated emergency respite beds, and two planned respite
    #077            8/3/2010
                                      Report          NC START      beds. The first NC START annual report was submitted to the
                                                                    DMH/DD/SAS and the Division of State Operated Healthcare
                                                                    Facilities (DSOHF) by the three regional NC START Directors.
                                                                    The report provides a summary of information regarding NC
                                                                    START activities during their first year of operation. The complete
                                                                    annual report can be found on the DMH/DD/SAS website on the
                                                                    Statewide Crisis Services page at
                                                                    http://www.ncdhhs.gov/mhddsas/crisis_services/index.htm




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                       The Patient Protection and Affordable Care Act (PPACA), the
                                                                       national health reform legislation, will have significant impact on
                                                                       mental health, developmental disabilities and substance abuse
                                                                       services in the coming years. The income and family size data of
                                                                       the consumers we are currently serving with state funds to
                                                                       estimate how many of those individuals will become Medicaid-
                                                                       eligible under the new guidelines. The income and family size
                                                            Patient    data currently in our system appears to be of questionable
                                  Income and Family    Protection and accuracy. To accurately estimate the future impact of PPACA,
    #077            8/3/2010
                                    Size Information   Affordable Care we must improve the quality and reliability of our income and
                                                        Act (PPACA) family size data. To that end, we are requesting LMEs to work
                                                                       with their providers to pay special attention to the income and
                                                                       family size information for every consumer served during the
                                                                       month of October, 2010. Income and who should be counted in
                                                                       the family should be determined based upon the guidelines. The
                                                                       data collected on clients served in October 2010 will become the
                                                                       initial step for improved data integrity in the family income and
                                                                       size fields.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                Summary
  Update #:        Update Date

                                                                     Effective immediately, if a provider which is actively endorsed to
                                                                     provide a Medicaid funded behavioral health service in one LME
                                                                     area, makes a request to any LME for a signed Memorandum of
                                                                     Agreement (MOA) to render that service to recipients residing in
                                                                     the LME area, the LME to which the MOA request is being made
                                                                     must sign the MOA with the requesting provider. The LME will
                                                                     have ten business days to honor such a request. The request by
                                                           MOA -
                                                                     the provider must be made in writing, accompanied by an existing
    #077            8/3/2010        MOA Update         Memorandum of
                                                                     standard agreement for those services, and sent by return
                                                         Agreement
                                                                     receipt/certified mail. The LME must respond in writing within the
                                                                     ten day time period with a signed MOA sent to the requesting
                                                                     provider by return receipt/certified mail. The purpose of the MOA
                                                                     with the non-endorsing LME is to ensure that the provider and the
                                                                     LME acknowledge and document their respective roles and
                                                                     responsibilities regarding consumers from the non-endorsing
                                                                     LME’s catchment area.

                                                                         The Notification of Endorsement Action (NEA) letter has been
    #077            8/3/2010      NEA Letter Update      NEA Letter      updated, and an updated form was provided as an attachment
                                                                         with this IU.

                                                                         The N.C. Department of Health and Human Services (DHHS) has
                                                                         created a poster asking citizens to report Medicaid fraud and
                                  Reporting provider      Fraud and      abuse. In a memo dated June 4, 2010, DHHS Secretary Lanier
    #076            7/8/2010
                                  Fraud and Abuse           Abuse        Cansler asked all health care agencies and private health care
                                                                         providers to print and prominently display the poster in their
                                                                         offices For more information, refer to the DMA website at
                                                                         http://www.ncdhhs.gov/dma/provider/fraud.htm.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                    Summary
  Update #:        Update Date

                                                                         DHHS has worked with representatives from provider agencies
                                                                         and local management entities (LME) over the past fiscal year to
                                                                         find ways to make paperwork requirements and processes more
                                                                         efficient in response to 2009 legislation (SL 2009-451 Section
                                      Changes to                         10.18b), As a result, changes have been implemented and
                                                       Administrative
                                     Administrative                      have been reported in previous Implementation Updates. The
    #076            7/8/2010                           Requirements
                                   Requirements for                      provider and LME workgroups also identified additional areas to
                                                         Change
                                  Providers and LMEs                     be streamlined in the coming year. DMH will work with the NC
                                                                         Council of Community Programs and providers in SFY 2010-11 to
                                                                         determine the best methods for addressing these additional areas
                                                                         for improvement. Questions and suggestions may be submitted
                                                                         to ContactDMHQuality@dhhs.nc.gov.



                                                                         The new policies contained in this Implementation Update
                                                                         (inclusive of the Clinical Policy) will be effective February 1, 2011
                                                                         unless otherwise noted. This IU is formal notice of the release
                                                                         and implementation of the CAP-MR/DD Clinical Policy in
                                  CAP-MR/DD Clinical
                                                       CAP-MR/DD -       conjunction with the manuals for the CAP-MR/DD Supports
                                   Policy/Manuals &
                                                       Clinical Policy   Waiver and the Comprehensive Waiver. The CAP-MR/DD
    #076            7/8/2010           Technical
                                                       and Technical     Clinical Policy contains the service definitions, the utilization
                                  Amendment Number
                                                        Amendment        review guidelines and other clinical elements of the CAP MR/DD
                                          One
                                                                         Comprehensive Waiver and Supports Waiver. The CAP MR/DD
                                                                         Comprehensive Waiver and Supports Waiver Manuals contain all
                                                                         the operational details and expectations related to the waivers, in
                                                                         addition to the information contained in the Clinical Policy.




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Implementation   Implementation
                                         Title (s)          Subject(s)                               Summary
  Update #:        Update Date

                                                                           System changes for direct billing of DD targeted case
                                                                           management (TCM) are in process but not yet completed and
                                                                           tested. To ensure cash flow for DD TCM providers, providers
                                  Direct Billing for I/DD   TCM - DD -     must continue billing though the LMEs until August 1, 2010. DMA
    #076            7/8/2010                                               is close to receiving the Centers for Medicaid and Medicare
                                     TCM Providers            billing
                                                                           Services (CMS) approval for a case rate for DD TCM. It is
                                                                           imperative that DD TCM providers complete and submit their
                                                                           Medicaid enrollment applications immediately in order to access
                                                                           this rate when it is approved.
                                                                     NON-CABHA - Effective July 1, 2010, prior authorizations for all
                                                                     outpatient services, with dates of services July 1, 2010 and
                                                                     forward, will be created for the "Attending Provider
                                                                     Name/Medicaid #" on the ORF2 form. Providers must enter the
                                                                     Attending Medicaid Provider Number (MPN) associated with the
                                                                     Attending National Provider Identifier (NPI) with which they will
                                  Update on New PA Directly Enrolled
                                                                     submit their claims (do not submit NPI on the ORF2). Prior
    #076            7/8/2010        Guidelines for     Licensed
                                                                     authorization requests will no longer be made for group providers.
                                     Outpatient     Professionals
                                                                     This applies to all directly enrolled licensed professionals CABHA
                                                                     - For outpatient services, directly enrolled providers operating
                                                                     under a CABHA are required to submit a new request for prior
                                                                     approval to ValueOptions service for any recipient that will be now
                                                                     seen under a CABHA. new authorizations will only be required
                                                                     for “CABHA” clients.




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Implementation   Implementation
                                      Title (s)        Subject(s)                                     Summary
  Update #:        Update Date

                                                                     NON-CABHA - Provisionally licensed professionals that bill
                                                                     through the LME will continue to request prior authorization with
                                                                     the LME Medicaid Provider Number (MPN) as the "Attending
                                                                     Provider" and should continue to bill through the LME. CABHA -
                                                      Provisionally Provisionally licensed providers providing services under a
                                  Update on New PA      Licensed     CABHA must bill ‘incident to’ a physician in the CABHA.
    #076            7/8/2010        Guidelines for   Professionals Provisionally licensed staff employed by a CABHA will not bill
                                     Outpatient      Billing through through the LME; services will be billed as ‘incident to’ a physician
                                                          an LME     in the CABHA. For outpatient services, provisionally licensed
                                                                     professionals operating under a CABHA are required to submit a
                                                                     new request for prior approval to ValueOptions for any recipient
                                                                     that will be now seen under a CABHA. New authorizations will
                                                                     only be required for “CABHA” consumers.

                                                                         Provisionally licensed professionals that bill "incident to" a
                                                      Provisionally
                                                                         physician should request prior authorization with the Medicaid
                                  Update on New PA       Licensed
                                                                         Provider Number (MPN) of the individual physician as the
    #076            7/8/2010        Guidelines for    Professionals
                                                                         "Attending Provider." This individual physician MPN is the
                                     Outpatient      Billing “Incident
                                                                         individual physician that the provisionally licensed professional
                                                     to” a Physician
                                                                         practices "incident to."

                                                                         Several CABHAs have completed the Medicaid enrollment
                                                        CABHA            process and may begin billing with the NPI associated with the
                                  CABHA Transition     Medicaid          CABHA on July 1, 2010. CABHAs can continue to bill with current
    #076            7/8/2010
                                     Updates            Provider         NPI numbers for outpatient and enhanced services until they
                                                     Numbers (MPN)       receive their MPN. Outpatient and Enhanced MPNs will not be
                                                                         end dated at this time.




                                                          148 OF 366
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Implementation   Implementation
                                      Title (s)       Subject(s)                                 Summary
  Update #:        Update Date

                                                                      Providers do not need to request a new authorization for an
                                                                      enhanced service that will now be delivered under a CABHA. All
                                                                      current authorizations for enhanced services will remain valid.
                                                                      When it is time for a new authorization for an enhanced service,
                                                                      CABHAs should submit requests for all enhanced services with
                                                                      the current Medicaid Provider Number (MPN) of the enhanced
                                                       CABHA
                                                                      service. The MPN for an enhanced service is identified by the
                                                     Authorization
                                  CABHA Transition                    alpha suffix appended to the core MPN (for example
    #076            7/8/2010                         Requests for
                                     Updates                          "8300005B"). All authorizations will be made to that current MPN.
                                                      Enhanced
                                                                      This is the MPN that providers currently list on the ITR as the
                                                       Services
                                                                      “Facility ID. Providers should continue to request authorizations
                                                                      in the same way as they do today. Authorizations will not be
                                                                      made to the CABHA MPN. Providers should not request
                                                                      authorization with the CABHA MPN. Requests submitted only
                                                                      with the CABHA MPN and not the MPN of the enhanced service
                                                                      will be returned Unable to Process.

                                                                   HP Enterprise Services will be contacting providers to schedule
                                                                   conference calls to discuss billing guidelines for CABHAs.
                                                                   Seminars will be held at LMEs in the Eastern, Central, and
                                  CABHA Transition   CABHA Billing Western portions of the state. Site locations and dates will be
    #076            7/8/2010
                                     Updates           Seminars    announced in future Implementation Updates. In addition, on site
                                                                   visits will be provided by HP upon request. Medicaid claims
                                                                   questions may be directed to HP Enterprise Services, 1-800-688-
                                                                   6696.




                                                         149 OF 366
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Implementation   Implementation
                                      Title (s)        Subject(s)                                  Summary
  Update #:        Update Date



                                                                  Claims for all CABHA enhanced and outpatient services will be
                                                                  billed using the professional claim (CMS-1500/837P) format. This
                                                                  is the same claim type that is used today for billing enhanced and
                                                                  outpatient services. The CABHA NPI should be listed as the
                                  CABHA Transition   CABHA Claims
    #076            7/8/2010                                      'billing provider." The “attending provider number" should be the
                                     Updates          Submission
                                                                  NPI associated with the directly enrolled "attending"
                                                                  provider/physician or the enhanced service for which prior
                                                                  authorization was obtained. Medicaid claims questions may be
                                                                  directed to HP Enterprise Services, 1-800-688-6696.




                                                                    The order of the activities which make up the process for
                                                                    completing CABHA certification has changed. The processes will
                                                                    be completed in this order: 1. Desk Review 2. Interview 3.
                                                                    Verification Review . Once a provider receives notification of
                                                                    having successfully met the requirements of the Desk Review,
                                                                    they will be contacted to arrange the interview portion of the
                                                                    process. If the elements of the interview are met, the provider will
                                   CABHA Review         CABHA -     receive notification and they will be contacted to arrange the site
    #076            7/8/2010
                                     Process         Review Process visit for a verification review. Following the verification review, the
                                                                    provider will receive a final notification of whether or not they will
                                                                    be certified as a CABHA. If a provider fails to meet the elements
                                                                    of any of the phases of the review process, resubmission of the
                                                                    attestation letter and supporting documentation they are required
                                                                    to reinitiate the CABHA certification process. Please refer to IU
                                                                    #75 for information on resubmissions and how and when that
                                                                    may occur.




                                                          150 OF 366
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Implementation   Implementation
                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date



                                                                        CABHA applicant agencies that are endorsed for the services that
                                                                        make up their continuum but have not had a response to their
                                  Medicaid Enrollment                   application(s) for enrollment for one or both of their continuum
                                                        Enrollment -
    #076            7/8/2010          for CABHA                         services, or for core services, must contact CVS EVC Call Center
                                                          CABHA
                                       Applicants                       at 866-844-1113 or email NCMedicaid@csc.com. Priority will be
                                                                        given to issue provider enrollment numbers so that the agency
                                                                        can continue through the CABHA certification process



                                                                        Effective July 1, 2010, all MH/DD/SAS providers who are required
                                                                        to participate in the DHHS incident reporting system are required
                                                                        to use NC-IRIS for Level II and III incident submission. The link to
                                  Incident Response
                                                          Incident      IRIS is https://iris.dhhs.state.nc.us/Default.aspx. Providers should
    #076            7/8/2010       and Improvement
                                                         Reporting      contact their LME if they have questions about using this new
                                        System
                                                                        system. The IRIS Technical Manual is located on the
                                                                        DMH/DD/SAS under manuals. Effective July 1, 2010 the DHHS
                                                                        Incident and Death Report form QM02, will be discontinued.




                                                           151 OF 366
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 Implementation   Implementation
                                         Title (s)       Subject(s)                                 Summary
   Update #:        Update Date


                                                                        DMA has completed the re-verification of Notifications of
                                                                        Endorsement Actions (NEA) letters for Community Intervention
                                                                        Services and specifically for providers of Community Support
                                                                        Team (CST). CST providers were required to submit the
                                                                        verification packet with appropriate credentials including all
                                                                        current NEAs to qualify for continued enrollment as a provider of
                                    Community Support                   CST services. Further verification has also occurred through the
     #076            7/8/2010                              CST
                                     Team Providers                     endorsing LMEs. New provider enrollment numbers have been
                                                                        issued for CST using the provider's core number with a V suffix to
                                                                        provide a unique provider number for CST (H2015 HT) separate
                                                                        from other Community Support services (H0036 HA, HB and HQ)
                                                                        beginning July 1, 2010. With this separation, all new service
                                                                        authorization requests submitted to ValueOptions on July 1st and
                                                                        thereafter must include the V suffix.
                                                                        The timeframe for full implementation of Critical Access
                                                                        Behavioral Health Agencies (CABHA) has been extended to
                                                                        occur between July 1, 2010 and December 31, 2010. This
                                                                        transition period will enable CABHAs who have been certified,
      #075                             Transition                       enrolled, and endorsed for specific service (s) to begin or
                                                          CABHA -
    SPECIAL          6/29/2010      Timeframe for Full                  continue providing Intensive In-Home Services (IIH), Community
                                                         Transition
IMPLEMENTATION    REVISED 6/30/10       CABHA                           Support Team (CST), and Child and Adolescent Day Treatment
                                                         Timeframe
    UPDATE                           Implementation                     effective July 1, 2010. This will also allow currently endorsed and
                                                                        enrolled providers of these services to continue to provide
                                                                        services between July 1, 2010 and December 31, 2010, if
                                                                        necessary to either complete the certification process to become
                                                                        a CABHA or to transition consumers to a CABHA.




                                                           152 OF 366
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 Implementation   Implementation
                                           Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                      A revised process for CABHA Letter of Attestation submissions,
                                                                      resubmissions, and desk reviews will be utilized effective July 1,
                                                                      2010. The revised process includes a prescribed format for
                                                                      submission and can be found on the CABHA webpage at:
                                                                      http://www.ncdhhs.gov/mhddsas/cabha/index.htm. In order for a
                                                                      Letter of Attestation to proceed to a desk review, it must follow
                                                                      the prescribed format including an attached Content Form
      #075
                                   Revised CABHA        CABHA Revised indicating the documents enclosed and the corresponding page
    SPECIAL          6/29/2010
                                  Letter of Attestation   Submission  number of each document. Any new submission or resubmission
IMPLEMENTATION    REVISED 6/30/10
                                  Submission Process       Process    of a Letter of Attestation that does not meet the requirements of
    UPDATE
                                                                      the prescribed format will NOT be processed. A letter indicating
                                                                      the format was not followed will be sent to the provider. The
                                                                      provider has the opportunity during the entire review process to
                                                                      submit a total of three times (including the initial attestation letter).
                                                                      If after the third attempt a provider is unable to achieve CABHA
                                                                      certification, their attestation will be denied. The provider must
                                                                      wait six months before reapplying.

                                                                        Initial Letters of Attestation or resubmissions received by
                                                                        DMH/DD/SAS before July 1, 2010 will be processed based on the
                                                                        requirements previously noted in Implementation Update #64 and
                                                                        #70. If the packets or resubmissions do not meet previous
                                                                        requirements based on a desk review, the provider will be notified
      #075                                                 CABHA -      and at that point would need to resubmit per the revised process.
                                   Revised CABHA
    SPECIAL          6/29/2010                            application   This means that all attestation letters that are currently in process
                                  Letter of Attestation
IMPLEMENTATION    REVISED 6/30/10                       submitted prior will be treated as the first submission. Thus, if the current
                                  Submission Process
    UPDATE                                              to July 1, 2010 submission does not meet requirements, the provider will have
                                                                        two additional opportunities to achieve certification. The dated
                                                                        signature on the Letter of Attestation attests that the provider
                                                                        meets the 30 - day CABHA infrastructure requirements and is in
                                                                        compliance with the requirements necessary for CABHA
                                                                        certification.



                                                                 153 OF 366
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 Implementation   Implementation
                                          Title (s)         Subject(s)                                Summary
   Update #:        Update Date

                                                                        Current providers of CST, IIH, and Day Treatment services that
                                                                        apply on or after July 1, 2010 for CABHA certification must submit
                                                                        a completed Letter of Attestation on or before August 31, 2010 in
                                                           CABHA -
      #075                                                              accordance with the benchmarks established to allow sufficient
                                   Revised CABHA          application
    SPECIAL          6/29/2010                                          time for completion of the three-stage-review process. This
                                  Letter of Attestation submitted on or
IMPLEMENTATION    REVISED 6/30/10                                       deadline will provide adequate time for DHHS to complete the
                                  Submission Process      after July 1,
    UPDATE                                                              desk review portion of the CABHA certification process by
                                                              2010
                                                                        September 30, 2010. This process is in place in order for
                                                                        providers to obtain CABHA certification on or before December
                                                                        31, 2010.

                                                                            The Centers for Medicare and Medicaid Services (CMS) has
                                      Update on
      #075                                                                  clarified that a CABHA may not subcontract with another agency
                                   Subcontracting         CABHA - sub-
    SPECIAL          6/29/2010                                              for the provision of services to meet CABHA requirements for
                                  between a CABHA          contracting
IMPLEMENTATION    REVISED 6/30/10                                           required services; however, CABHAs may secure the services of
                                     and Provider           prohibited
    UPDATE                                                                  individual practitioners either through employment of the
                                      Agencies
                                                                            individual or as an independent contractor.




                                                               154 OF 366
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 Implementation   Implementation
                                          Title (s)        Subject(s)                                  Summary
   Update #:        Update Date


                                                                     The end date for case management services under Community
                                                                     Support Services has been extended to allow recipients to access
                                                                     case management services under Child and Adult Community
                                                                     Support Services until the Mental Health and Substance Abuse
                                                                     Case Management State Plan Amendment has been approved.
                                                                     Community Support Services may be provided only for case
      #075                                             Community     management functions for up to four hours monthly for adults and
                                   Extension of Case
    SPECIAL          6/29/2010                          Support      children, although services for individuals under 21 are subject to
                                     Management
IMPLEMENTATION    REVISED 6/30/10                    Services - Case Early and Periodic Screening, Diagnostic, and Treatment
                                  Services under CSS
    UPDATE                                            Management (EPDST) provisions. See Implementation Updates #65 and #68
                                                                     for information on providing the case management functions of
                                                                     Community Support. Community Support providers should
                                                                     continue to request authorizations and bill under their current
                                                                     Community Intervention Service Agency (CISA) Medicaid
                                                                     provider number (MPN). Providers should not attempt to request
                                                                     authorization and bill under a CABHA MPN.


                                                                         Within 30 days of hire, the training requirements for Day Tx. , IIH,
                                                                         and CST are outlined in attachment A - C respectivley. The
                                                                         attachments also outline the training requirements which must be
                                                                         obtained within 90 days of hire or by September 30, 2010 (IIH,
                                                                         CST) or by December 31, 2010 (Day Tx., IIH and CST)) for staff
      #075                        Update on CST, IIH
                                                          Training - Day members of existing services per the attached specifications.
    SPECIAL          6/29/2010    and Day Treatment
                                                          Treatment, IIH These mimum training requiremernts will be in effect January
IMPLEMENTATION    REVISED 6/30/10      Training
                                                             and CST     2011 for CST and IIH per Clinical Coverage Policy 8A and
    UPDATE                          Requirements
                                                                         Implementation Update #36. The training requirements for Child
                                                                         and Adolescent Day Treatment are the same as outlined in the
                                                                         04/01/10 Revised Clinical Coverage Policy 8A. The new training
                                                                         requirements for Day Treatment, IIH and CST will go into effect
                                                                         January 2011.




                                                              155 OF 366
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 Implementation   Implementation
                                          Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                           The effective date for the following rate decrease is July 1, 2010.
                                                                           H2015 HT - Community Support Team will decrease from $
      #075
                                       CST Service                         15.60 per 15 minute to $ 14.50 per 15 minute unit. The fee
    SPECIAL          6/29/2010                             Rate Revision -
                                     Revised Rate and                      schedules are available on the Division of Medical Assistance
IMPLEMENTATION    REVISED 6/30/10                               CST
                                      Effective Date                       (DMA) website at
    UPDATE
                                                                           http://www.ncdhhs.gov/dma/fee/. Providers must always bill their
                                                                           usual and customary charges.

                                                                            Effective August 1, 2010, all new authorizations for CST shall be
                                                                            based upon medical necessity as defined by DMA Clinical
      #075                                                                  Coverage Policy 8A and shall not exceed 32 hours (128 units) per
                                       CST Revised
    SPECIAL          6/29/2010                             Authorizations - 60-day period. Effective August 1, 2010, requests received by
                                     Authorization Limit
IMPLEMENTATION    REVISED 6/30/10                               CST         ValueOptions for more than 32 hours per 60-day period shall be
                                     and Effective Date
    UPDATE                                                                  returned as “Unable to Process.” Existing authorizations for CST
                                                                            will remain effective until the end of the current authorization
                                                                            period.

                                                                          The Department of Health and Human Services (DHHS) is
                                                                          pleased to announce that Mecklenburg County Area Mental
                                                                          Health, Developmental Disabilities and Substance Abuse
      #074                          Selection of the Next
                                                                          Authority has been selected to be the next Local Management
    SPECIAL                         LME to Participate in   1915 (b)(c)
                     6/7/2010                                             Entity (LME) to participate in the State’s Medicaid Waiver for
IMPLEMENTATION                         the 1915(b)(c)     Medicaid Waiver
                                                                          mental health, developmental disabilities and substance abuse
    UPDATE                           Medicaid Waiver
                                                                          services. The waiver is commonly known as the 1915 b/c waiver
                                                                          in reference to the sections of the Social Security Act that
                                                                          authorize such waivers.




                                                                156 OF 366
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 Implementation   Implementation
                                     Title (s)      Subject(s)                                 Summary
   Update #:        Update Date

                                                                   The processing of Letters of Attestation from provider agencies
                                                                   pursuing certification as a CABHA continues to progress. The
                                                                   following is a brief summary of the current status as of the fourth
                                                                   week in May: · 110 agencies have met the requirements of the
                                                                   desk review · 55 of those meeting the desk review have been
                                                                   sent to the DMH/DD/SAS Accountability Team to be scheduled
                                                                   for the verification review · 34 agencies have completed the
      #073
                                                                   verification review and of those 26 have been sent to the regional
    SPECIAL                                         CABHA
                     6/3/2010      CABHA Update                    certification team to be scheduled for interviews · 12 agencies
IMPLEMENTATION                                     Certification
                                                                   have completed the interview and have been certified as CABHA
    UPDATE
                                                                   agencies; the remaining are scheduled to be interviewed in the
                                                                   upcoming weeks Resubmissions of Attestation Letters continue
                                                                   to be processed and verification and interviews will be scheduled
                                                                   as they complete the prior phase. A list of those agencies
                                                                   receiving CABHA certification will be available on the
                                                                   DMH/DD/SAS CABHA webpage,
                                                                   http://www.ncdhhs.gov/mhddsas/cabha/index.htm


                                                                 CABHA Certification extends across the state. CABHAs are still
      #073                                                       required to enter into MOAs with the LMEs in the catchment
    SPECIAL                                       CABHA Agency areas where they deliwer services. CABHAs must also enter into
                     6/3/2010      CABHA Update
IMPLEMENTATION                                    Responsibities a standardized contract with those same LMEs for State Funded
    UPDATE                                                       Services. CABHA certiifcation is based upon the agency meeting
                                                                 the established performance standards established by DHHS.




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 Implementation   Implementation
                                        Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                       Each CABHA is required to offer, at a minimum, the following
                                                                       "core" services: clinical assessment, medication management,
                                                                       outpatient therapy and at least two other MH/SA services as
      #073
                                                            CABHA -    defined in DMA Clinical Coverage Policy 8A for Enhanced
    SPECIAL                         CABHA Service
                     6/3/2010                            Reimbursement Behavioral Health Services and DMA Clinical Coverage Policy 8D-
IMPLEMENTATION                        Continuum
                                                           and Billing 2 for Residential Child Care Services. in addition, only CABHAs
    UPDATE
                                                                       will be able to provide MH/SA TCM upon approval by CMS. The
                                                                       allowable CPT and HCPCS codes are provided for the billing of
                                                                       these services.



                                                                          Per IU #70, providers who have achieved certification as a
                                                                          CABHA will need to complete a Medicaid Provider Enrollment
                                                                          application to obtain a Medicaid provider billing number (MPN).
                                                                          CABHA applicants must complete and submit the downloadable
                                                                          paper version of the In-State/Border Organization Provider
      #073                                                                Enrollment Application or the online version of the Provider
                                   CABHA Enrollment,
    SPECIAL                                                 CABHA -       Enrollment Application to enroll as a CABHA. When completing
                     6/3/2010       Authorization, and
IMPLEMENTATION                                             Enrollment     the Affiliated Provider Information section of the application, the
                                         Claims
    UPDATE                                                                CABHA must list the name, MPN, and NPI associated with that
                                                                          number for each independently enrolled behavioral health
                                                                          practitioner and the name, attending MPN (identified by the alpha
                                                                          suffix appended to the core number), and the NPI associated with
                                                                          that number for each community intervention service that will be
                                                                          billed through the CABHA.




                                                             158 OF 366
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 Implementation   Implementation
                                        Title (s)          Subject(s)                                 Summary
   Update #:        Update Date

                                                                       At enrollment, CABHAs will need to identify an NPI associated
                                                                       with the CABHA billing MPN. Providers current NPIs may
                                                                       choose to subpart, or request multiple NPIs for specific entities
                                                                       within the organization. All CABHAs are encouraged to obtain
                                                                       a separate NPI for the CABHA for ease of claims
                                                                       reimbursement. The CABHA NPI must be used as the "billing
      #073                                                             number" for services provided by the directly enrolled individuals
                                   CABHA Enrollment,      CABHA -
    SPECIAL                                                            that are a part of the CABHA. For dates of service July 1, 2010,
                     6/3/2010       Authorization, and Enrollment- NPI
IMPLEMENTATION                                                         forward, if a provider has multiple MPNs but does not elect to
                                         Claims           Number
    UPDATE                                                             subpart their CABHA, the claim will adjudicate through the NPI
                                                                       mapping solution and adjudicate to the CABHA MPN only.
                                                                       Please refer to the NPI section on the DMA website at
                                                                       http://www.ncdhhs.gov/dma/NPI/ for additional information
                                                                       regarding NPI. Special instuctions are given for Therpaeutic
                                                                       Foster care (Level II - Family Type), Residential Levels II-
                                                                       Programs Types, Level III and IV services.

                                                                          CABHAs should submit requests for all enhanced services with
                                                                          the attending MPN. All authorizations will be made to the
                                                                          attending MPN. For outpatient services, independently enrolled
                                                                          providers operating under a CABHA are required to submit a new
                                                                          request for prior approval to ValueOptions for service dates
      #073                                                                effective July 1, 2010, and forward for any recipient that will be
                                   CABHA Enrollment,
    SPECIAL                                                CABHA -        now seen under a CABHA. For dates of service, effective July 1,
                     6/3/2010       Authorization, and
IMPLEMENTATION                                            Authorization   2010, and forward, all authorizations for outpatient services will
                                         Claims
    UPDATE                                                                be made to the attending MPN (the “Attending Provider
                                                                          Name/Medicaid #" on the ORF2 form). This is a change from the
                                                                          prior authorization process published in the June 2009 and July
                                                                          2009 Medicaid bulletins. Prior authorizations for outpatient
                                                                          services will now cover only the attending provider who requested
                                                                          and received the authorization.




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 Implementation   Implementation
                                        Title (s)         Subject(s)                                Summary
   Update #:        Update Date


                                                                      Claims for all CABHA services (with the exception of Levels
                                                                      II–Program Type, III, and IV) will be billed using the professional
                                                                      claim (CMS-1500/837P) format. The CABHA NPI should be listed
                                                                      as the 'billing provider." The “attending provider number" should
                                                                      be the NPI associated with the provider/service for which prior
                                                                      authorization was obtained. Claims for Therapeutic Foster Care
      #073
                                   CABHA Enrollment,                  (Level II–Family Type) must continue to be submitted through the
    SPECIAL
                     6/3/2010       Authorization, and CABHA - Claims LME for processing. Claims for Residential Levels II–Program
IMPLEMENTATION
                                         Claims                       Type, III, and IV (provided by CABHAs) should continue to be
    UPDATE
                                                                      billed using the institutional claim (UB-04/837I) format. In these
                                                                      instances, providers must continue to submit claims with the
                                                                      current billing NPI associated with the Level II–Program Type, III,
                                                                      or IV. CABHA’s performing State funded services will continue to
                                                                      have services approved and billed to the Integrated Payment and
                                                                      Reporting System (IPRS) through the LMEs.




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 Implementation   Implementation
                                         Title (s)            Subject(s)                                 Summary
   Update #:        Update Date




                                                                             Effective July 1, 2010, prior authorizations for all outpatient
                                         New Prior                           services will be created for the "Attending Provider
                                        Authorization                        Name/Medicaid #" on the ORF2 form. Providers must enter the
                                        Guidelines for                       Attending Medicaid Provider Number (MPN) associated with the
                                         Outpatient                          Attending NPI with which they will submit their claims (do not
      #073                          Behavioral Health                        submit NPI on the ORF2). Prior authorization requests will no
                                                             Provisionally
    SPECIAL                         Service Providers                        longer be made for group providers. Effective July 1, 2010, prior
                     6/3/2010                                  Licensed
IMPLEMENTATION                       and Provisionally                       authorizations for all outpatient services will be created for the
                                                             Professionals
    UPDATE                         Licensed Providers                        "Attending Provider Name/Medicaid #" on the ORF2 form.
                                   Billing “Incident to” a                   Providers must enter the Attending Medicaid Provider Number
                                   Physician or through                      (MPN) associated with the Attending NPI with which they will
                                          the Local                          submit their claims (do not submit NPI on the ORF2). Prior
                                   Management Entity                         authorization requests will no longer be made for group providers.
                                                                             "




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 Implementation   Implementation
                                         Title (s)            Subject(s)                                 Summary
   Update #:        Update Date


                                                                             For all providers: Both the "Attending Provider Name/Medicaid
                                         New Prior                           #" and "Billing Provider Name/Medicaid #" fields on the ORF2
                                        Authorization                        must be completed or the request will be returned by
                                        Guidelines for                       ValueOptions as "Unable to Process.                             For
                                         Outpatient                          CABHA only: For outpatient services, independently enrolled
      #073                          Behavioral Health        Provisionally   providers operating under a CABHA are required to submit a new
    SPECIAL                         Service Providers          Licensed      request for prior approval to ValueOptions for service dates
                     6/3/2010
IMPLEMENTATION                       and Provisionally       Professionals   effective July 1, 2010, and forward for any recipient that will be
    UPDATE                         Licensed Providers           (contd)      now seen under a CABHA. Again, these new authorizations will
                                   Billing “Incident to” a                   only be required for “CABHA” clients. In these situations,
                                   Physician or through                      providers must submit a new request on the ORF2 with their
                                          the Local                          "Attending Provider Name/Medicaid #" and the (CABHA) "Billing
                                   Management Entity                         Provider Name/Medicaid #." A new prior authorization will be
                                                                             created for the "Attending Provider Name/Medicaid #.




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 Implementation   Implementation
                                        Title (s)       Subject(s)                                  Summary
   Update #:        Update Date


                                                                        Current Community Intervention Service providers and Critical
                                                                        Access Behavioral Health Agencies will be able to provide the
                                                                        case management component of Community Support service by
                                                                        qualified and licensed professionals during the interim period until
                                                                        the new case management service definition is approved. As a
                                                                        result, consumers currently receiving Community Support and
                                                                        new consumers entering the system on or after July 1, 2010, will
      #073                                                              be able to receive the case management component of
                                   Community Support
    SPECIAL                                             Community       Community Support in order to ease the transition to the new
                     6/3/2010      Case Management
IMPLEMENTATION                                           Support        case management service. Further information will be published
                                      Component
    UPDATE                                                              as it becomes available. Please see Implementation Updates #65
                                                                        and #68
                                                                        (http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdat
                                                                        es/) for additional information. (Note: LMEs may also authorize
                                                                        the case management component of state funded Community
                                                                        Support services for non-Medicaid-eligible consumers under
                                                                        these same criteria, subject to availability of funds and the
                                                                        provisions of the LME’s benefit plan.)

                                                                       Requests for the skill building components of Community Support
      #073
                                   Community Support    Community      services for children must follow the established Early and
    SPECIAL
                     6/3/2010      Case Management     Support - Skill Periodic Screening, Diagnosis, and Treatment (EPSDT)
IMPLEMENTATION
                                      Component          Building      procedures and requirements, which are available at
    UPDATE
                                                                       http://www.ncdhhs.gov/dma/




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 Implementation   Implementation
                                        Title (s)        Subject(s)                                  Summary
   Update #:        Update Date



                                      Revised Staff
                                        Training                        Training requirements for Community Support Team, Intensive
      #073
                                    Requirements for                    In-Home, and Day Treatment Services have been revised in
    SPECIAL
                     6/3/2010      Community Support      Training      relation to Person Centered Thinking;Motivational Interviewing;
IMPLEMENTATION
                                   Team, Intensive In-                  and System of Care. The process to become a certified trainer is
    UPDATE
                                     Home, and Day                      outlined in thsi IU.
                                   Treatment Services


                                                                        The following additional clarifcation of other training requirements
                                                                        is noted; Provider agency staff who have documentation of
                                                                        having received the required training specific to the modality
                                      Revised Staff                     selected by the agency for the provision of services for
                                        Training                        Community Support Team, Intensive In-Home and Day
      #073
                                    Requirements for                    Treatment within the past two years and prior to April 1, 2010
    SPECIAL
                     6/3/2010      Community Support      Training      (Clinical Coverage Policy 8A posting of Community Support
IMPLEMENTATION
                                   Team, Intensive In-                  Team and Intensive In-Home) for the following practices will be
    UPDATE
                                     Home, and Day                      deemed to have met this requirement:
                                   Treatment Services                     Cognitive Behavior Therapy
                                                                          Trauma-Focused Therapy
                                                                          Illness Management and Recovery (SAMHSA Toolkit)
                                                                          Family Therapy

                                      Revised Staff
                                                                        In order to comply with the new chnages in the service definitions
      #073                              Training
                                                          Service       for Community Support Team and Intensive In-Home providers
    SPECIAL                         Requirements for
                     6/3/2010                            Definition     must ensure that all staff delivering these services prior to July 1,
IMPLEMENTATION                     Community Support
                                                         Changes        2010 are informed of and adhere to all service definition changes
    UPDATE                         Team and Intensive
                                                                        per Clinical Coverage Policy 8A effective July 1, 2010.
                                        In-Home




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 Implementation   Implementation
                                        Title (s)       Subject(s)                                   Summary
   Update #:        Update Date


                                      Revised Staff                     The initial number of required training hours for Community
      #073                              Training                        Support Team and Intensive In-Home has decreased. The Day
    SPECIAL                         Requirements for Training - Hours   Treatment training hours have been clarified (refer to training grid
                     6/3/2010
IMPLEMENTATION                     Community Support and Timeframes     attachment A). The time frames for completion of training have
    UPDATE                         Team and Intensive                   been extended (refer to the training grid attachments A, B, and
                                        In-Home                         C).


                                                                         DHHS will begin publishing individual Provider Performance
                                                                        Reports on the DMH/DD/SAS website in SFY 2011. Draft reports
                                                                        will be piloted in the fall of 2010 with a small group of providers
                                                                        and published on the web in 2011. Based on preliminary
                                                                        conversations with the State Consumer and Family Advisory
      #073
                                                                        Committee (CFAC) and representatives of local management
    SPECIAL                              Provider         Provider
                     6/3/2010                                           entities and provider groups, DHHS has developed a tentative
IMPLEMENTATION                     Performance Report   Performance
                                                                        schedule, format and content for these reports. The draft Provider
    UPDATE
                                                                        Performance Report is attached as an example of the proposed
                                                                        structure. The DHHS is seeking input from provider agencies,
                                                                        LMEs, and consumers and family members on the plans for this
                                                                        project. Please submit any comments to
                                                                        ContactDMHQuality@dhhs.nc.gov by June 30, 2010.




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 Implementation   Implementation
                                         Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                          Federal regulations governing Psychiatric Residential Treatment
                                                                          Facilities for children/adolescents (PRTFs) require the programs
                                                                          to have 24/7/365 nursing coverage. In North Carolina,this
                                                                          requirement has been expanded in rule to specify that the nursing
                                       Psychiatric                        coverage must be provided by a registered nurse (RN) (10A
      #073                                                Psychiatric
                                       Residential                        NCAC 27G.1902(e)). After the review of a number of requests e
    SPECIAL                                               Residential
                     6/3/2010      Treatment Facilities                   received a number of waiver requests from PRTF providers to
IMPLEMENTATION                                             Treatment
                                     (PRTF) Nursing                       have a licensed practical nurse (LPN) fulfill the nursing
    UPDATE                                              Facilities (PRTF)
                                        Coverage                          requirement on the third shift. Approval has been granted to
                                                                          permit a Licensed Practical Nurse, (LPN) to fulfill the nursing
                                                                          requirement on third shift. Such waiver requests will continue to
                                                                          be approved when the provider indicates that a RN is available on
                                                                          call to provide assistance to the LPN, if necessary.


                                                                          Effective July 1, 2010 DMA is requiring all targeted case
                                                                          management provider agencies to be directly enrolled to provide
                                      Targeted Case
                                                                          Medicaid reimbursable TCM services for individuals with
                                       Management
                                                                          developmental disabilities. Computer Sciences Corporation
      #073                          Services (TCM) for        TCM -
                                                                          (CSC) will begin accepting enrollment applications effective May
    SPECIAL                          Individuals with       Enrollment
                     6/3/2010                                             1, 2010. The LME will have the ability to continue to bill on behalf
IMPLEMENTATION                        Developmental       process for new
                                                                          of providers until December 31, 2010 to enable adequate time for
    UPDATE                              Disabilities         providers
                                                                          providers to attain notification of direct enrollment. Existing
                                   (Update/ Clarification
                                                                          providers must complete the Medicaid provider enrollment
                                        of IU #71)
                                                                          process to request direct enrollment for their corporate site by
                                                                          June 30, 2010.




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 Implementation   Implementation
                                        Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                          For those providers currently providing TCM and billing Medicaid
                                      Accreditation
                                                             TCM -        for those services through an LME, the endorsement process will
      #073                          Requirements for
                                                         Endorsement      be completed through the use of the signed Letter of
    SPECIAL                          Developmental
                     6/3/2010                             Process for     Attestation
IMPLEMENTATION                     Disability Targeted
                                                            Existing      http://www.dhhs.state.nc.us/MHDDSAS/servicedefinitions/servdef
    UPDATE                         Case Management
                                                           Providers      updates/update71/tcmattestationltr3-
                                       Providers
                                                                          31-10-attach3.doc).




                                      Accreditation                      Existing providers of TCM who have multiple sites are required to
      #073                          Requirements for                    sign the TCM Letter of Attestation indicating compliance to the
    SPECIAL                          Developmental       TCM - Multiple new TCM policy. Providers who have multiple sites and have
                     6/3/2010
IMPLEMENTATION                     Disability Targeted      Sites       already submitted the information for the corporate site will have
    UPDATE                         Case Management                      until December 31, 2010 to submit the necessary information for
                                       Providers                        each additional site.




                                                                          Upon receipt of the provider number, the case management
                                      Accreditation
                                                                          provider will submit a Provider Change Request form found on
      #073                          Requirements for
                                                                          the link below to ValueOptions requesting a change of all current,
    SPECIAL                          Developmental      TCM - Provider
                     6/3/2010                                             valid TCM service authorizations from the LME’s provider number
IMPLEMENTATION                     Disability Targeted Change Request
                                                                          to the TCM agency’s new provider number. ValueOptions will
    UPDATE                         Case Management
                                                                          update the current authorization to include the agency’s provider
                                       Providers
                                                                          number.




                                                             167 OF 366
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 Implementation   Implementation
                                        Title (s)          Subject(s)                                 Summary
   Update #:        Update Date


                                                                        The LME is required to monitor the provider’s compliance to the
                                                                        Medicaid State Plan Amendment for Targeted Case
                                      Accreditation
                                                                        Management Services for Individuals with Developmental
      #073                          Requirements for
                                                                        Disabilities based on the established monitoring and oversight
    SPECIAL                          Developmental       TCM - Provider
                     6/3/2010                                           protocol as defined in the Guide to Standardized Administration
IMPLEMENTATION                     Disability Targeted     Monitoring
                                                                        of the Division of Mental Health, Developmental Disabilities, and
    UPDATE                         Case Management
                                                                        Substance Abuse Services Frequency and Extent of Monitoring
                                       Providers
                                                                        Tool and the Provider Monitoring Tool for Local Management
                                                                        Entities.


                                      Accreditation
      #073                          Requirements for
                                                                          Providers of Targeted Case Management (TCM) services for
    SPECIAL                          Developmental           TCM -
                     6/3/2010                                             individuals with developmental disabilities are required to secure
IMPLEMENTATION                     Disability Targeted    Accreditation
                                                                          national accreditation within one year of enrollment with DMA.
    UPDATE                         Case Management
                                       Providers




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 Implementation   Implementation
                                        Title (s)         Subject(s)                                  Summary
   Update #:        Update Date



                                                                     Clarification is provided for information contained in IU #72 which
                                                                     indicated that when there is a CAP Provider change only, the
                                                                     following documents should be submitted: CAP Provider Change
                                                                     Only · Cost Summary · CTCM to discharge previous provider ·
                                     CAP-MR/DD:
      #073                                                           CTCM to add new provider The following correction has been
                                   Processing Person ValueOptions -
    SPECIAL                                                          made when there is a change in the CAP Provider only, the
                     6/3/2010       Centered Plans   Provider Change
IMPLEMENTATION                                                       following documents are to be submitted Correction: CAP
                                    (PCP) by Value       Request
    UPDATE                                                           Provider Change Only · PCP Update (per the Records
                                        Options
                                                                     Management and Documentation Manual for Providers of
                                                                     Publicly- Funded MH/DD/SA Services CAP-MR/DD Services
                                                                     and Local Management Entities) · Cost Summary · CTCM to
                                                                     discharge previous provider · CTCM to add new provider


                                                                          Effective June 1, 2010, providers must use the following new toll-
                                                                          free fax numbers when faxing requests to Value Options: Mental
                                                                          Health/Substance Abuse 877-339-8753; Developmental
                                    New Value Options
                                                                          Disabilities 877-339-8754; Residential (Program & Family
     #072            5/6/2010          Fax Numbers       ValueOptions
                                                                          Type) and Retro Review 877-339-8757; Health Choice 877-
                                   Effective   June 1
                                                                          339-8758. The Value Options Customer Service Numbers
                                                                          remain unchanged: 888-510-1150 for Medicaid and 800-753-
                                                                          3224 for Health Choice.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                  Summary
  Update #:        Update Date

                                                                         Implementation Update #58 and Implementation Update #62
                                                                        reinforced that all providers, including directly enrolled Medicaid
                                                                        providers, are responsible for maintaining custody of the records
                                                                        and documentation to support service provision and
                                                                        reimbursement for the required retention period for publicly
                                                                        funded mental health, developmental disabilities, and substance
                                   Safeguarding the                     abuse services. This includes the clinical service record,
                                                          Records
    #072            5/6/2010      Privacy and Security                  personnel records and the billing and reimbursement records.
                                                         Management
                                       of Records                       Failure to protect consumer privacy and failure to safeguard
                                                                        records and to ensure the confidentiality of individually identifiable
                                                                        health information is a violation of the Health Insurance Portability
                                                                        and Accountability Act (HIPAA), the Family Educational Rights
                                                                        and Privacy (FERPA) Act, and GS § 108A-80 and GS § 122C-52.
                                                                        If there are additional questions and concerns, please contact
                                                                        Cynthia.Coe@dhhs.nc.gov
                                                                        As stipulated in the DHHS Provider Administrative Participation
                                                                        Agreement and in the provider contract with the LME, a provider’s
                                                                        obligation to maintain the records acquired during the course of
                                                                        service delivery extends beyond the expiration or termination of
                                                                        the agreement or contract. This applies to clinical service records
                                   Maintaining the                      and records to support staff qualifications and credentials
                                     Security and                       (personnel records) as well as billing and reimbursement records.
                                    Accessibility of      Records       Implementation # 62 provides instructions to be followed in the
    #072            5/6/2010
                                   Records after a       Management     event that a provider agency ends services or dissolves for any
                                   Provider Agency                      reason. The provider is required to make arrangements to
                                       Closes                           continue safeguarding both the clinical and reimbursement
                                                                        records in accordance with the record retention guidelines. The
                                                                        abandonment of records or the failure to properly safeguard the
                                                                        security of records is a HIPAA violation which can result in further
                                                                        sanctions and financial penalties as noted above. If there are
                                                                        additional questions and concerns, please contact




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Implementation   Implementation
                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date

                                                                    The MOA between the day treatment provider and the LEA,
                                                                    private or charter school is highly encouraged, but is not a
                                                                    requirement for endorsement as a day treatment provider. It
                                                                    should be noted that the purpose of an MOA is to ensure that all
                                                                    relevant parties (LEA, LME, provider) understand and support the
                                                                    primary purpose of the day treatment service definition which is to
                                                                    serve children who, as a result of their mental health and/or
                                      Child and                     substance abuse treatment needs, are unable to benefit from
                                   Adolescent Day                   participation in academic or vocational services at a
    #072            5/6/2010                          Day Treatment
                                  Treatment Service                 developmentally appropriate level in a traditional school or work
                                       Update                       setting. The provider is to implement therapeutic interventions
                                                                    that are coordinated with the child’s academic or vocational
                                                                    services available through enrollment in an educational setting.
                                                                    The "Elements to Consider" in IU # 70 are suggested elements;
                                                                    not mandated ones. Day treatment services are designed for
                                                                    children who require treatment to address functional problems
                                                                    associated with participation in school. Day treatment should not
                                                                    operate simply as an after-school program.
                                                                    The new web based incident reporting system, NC-IRIS, will be
                                                                    implemented on May 1, 2010. NC-IRIS will be ready to receive
                                                                    and process incident reports on this date. The web site address
                                                                    for connecting to NC-IRIS is: https://iris.dhhs.state.nc.us/
                                     NC Incident                    Providers who have been trained to use NC-IRIS are required to
                                     Response                       begin submitting incident reports through NCIRIS on May 1,
                                                         Incident   2010. Providers who have not been trained to use NC-IRIS are
    #072            5/6/2010        Improvement
                                                        Reporting   requested to contact their LME for training so that they can begin
                                  System (NC-IRIS)
                                   Implementation                   using the new incident reporting system as soon as possible.
                                                                    Effective July 1, 2010, all mental health, developmental disability,
                                                                    and substance abuse service providers who are required to
                                                                    participate in the DHHS incident reporting system shall be
                                                                    required to use NC-IRIS. Providers should contact their LME if
                                                                    they have questions about this new system.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                     Four LMEs responded to the request for applications (RFA) to
                                                                     participate in the State's 1915 (b)/(c) Medicaid Waiver. The four
                                                                     LMEs are: East Carolina Behavioral Health, Mecklenburg County
                                  1915 (b)(c) Waiver   1915 (b)(c)
    #072            5/6/2010                                         Area MH/DD/SAS, Sandhills Center for MH/DD/SAS, and
                                       Update        Medicaid Waiver
                                                                     Western Highlands Network. DHHS will not make additional
                                                                     comment on the review process until the formal announcement is
                                                                     made in July 2010.

                                                                         This serves to provide clarification regarding information provided
                                                                         in the April 8, 2010 Implementation Update #71 regarding case
                                                                         manager qualifications in the Medicaid State Plan Amendment for
                                                                         Targeted Case
                                                                         Management (TCM) Services for Individuals with Developmental
                                                                         Disabilities. Based on staffing qualifications and equivalencies in
                                     Targeted Case                       10A NCAC 27G.0101, a graduate of a college or university with a
                                  Management Services
                                                                         bachelor’s degree in a field other than human services who has
    #072            5/6/2010      (TCM) for Individuals     TCM
                                   with Developmental
                                                                         four years of full-time, post-bachelor’s degree accumulated
                                        Disabilities                     MH/DD/SAS experience with the population served is equivalent
                                                                         to a bachelor’s degree in a human services field with two years of
                                                                         accumulated MH/DD/SAS experience working with the population
                                                                         served. The endorsement check sheet and instructions for
                                                                         Targeted Case Management (TCM) Services for Individuals with
                                                                         Developmental Disabilities will be posted on the DMH/DD/SAS
                                                                         website: http://www.dhhs.state.nc.us/MHDDSAS/




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Implementation   Implementation
                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                         In order to expedite the processing and approval of Initial CAP-
                                                                         MR/DD Plans and Continued Need Reviews (CNR) providers
                                                                         should be sure to submit all the elements listed in Implementation
                                                                         Update #59. In order to remind you of the requirements following
                                                                         are the required documents for DD submissions to Value Options
                                  Processing Initial CAP-                for review to occur: Person Centered Plan (PCP) with signatures
                                    MR/DD Plans and       Continued Need
                                                                         and cost summary · MR2 · CTCMs – all services requested ·
    #072            5/6/2010         Continued Need       Review (CNR):
                                    Reviews by Value
                                                                         NC SNAP (four pages and Summary Report/Supplemental
                                                               CAP
                                         Options                         Information sheet) · For equipment/supplies –
                                                                         justification/assessment, physician order or prescription, price
                                                                         quote (two quotes required for Home Modifications/Augmentative
                                                                         Communication /Vehicle Adaptation) · Proof of insurance for
                                                                         Vehicle Adaptation · Completed Risk Identification Tool · Non
                                                                         CAP Medicaid supplies billed through the LME require
                                                                         PCP with signatures and cost summary · MR2 with prior approval
                                                                         date and number · CTCMs - all services requested · NC SNAP
                                                                         (four pages and Summary Report/Supplemental Information
                                  Processing Initial CAP-                sheet)
                                    MR/DD Plans and
                                                            PCP (Initial · Current psychological · For equipment/supplies –
    #072            5/6/2010         Continued Need
                                    Reviews by Value
                                                               CAP)      justification/assessment, physician order or prescription, price
                                         Options                         quote (two quotes required for Home Modifications/Augmentative
                                                                         Communication/Vehicle Adaptation) · Proof of insurance for
                                                                         Vehicle Adaptation · Completed Risk Identification Tool · Non
                                                                         CAP Medicaid supplies billed through LME require prescriptions

                                  Processing Initial CAP-                PCP update with signatures and cost summary · CTCMs · For
                                    MR/DD Plans and                      equipment/supplies – justification/assessment, physician order or
    #072            5/6/2010         Continued Need       Revision (CAP) prescription, price quote (two quotes required for Home
                                    Reviews by Value                     Modifications/Augmentative Communication/Vehicle Adaptation)
                                         Options                         · Proof of insurance for Vehicle Adaptation




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Implementation   Implementation
                                         Title (s)            Subject(s)                                Summary
  Update #:        Update Date


                                  Processing Initial CAP-
                                    MR/DD Plans and
                                                            CAP Provider     Cost summary · CTCM to discharge previous provider · CTCM
    #072            5/6/2010         Continued Need
                                    Reviews by Value
                                                            Change Only      to add new provider
                                         Options


                                                                             In the PCP Instruction Manual there is an item that needs
                                                                             revision and clarification. On page 35, Section III: Legally
                                                                             Responsible Person includes the CAP choice statement. All
                                                                             individuals who receive CAP funding or their legally responsible
                                  Person Centered Plan
                                                                             person (LRP) must sign to confirm their understanding of their
    #072            5/6/2010       Instructions: CAP-        CAP-MR/DD
                                    MR/DD ONLY!!!
                                                                             choice to participate in the CAP-MR/DD waiver. Therefore, this
                                                                             section III must be signed by either the guardian/LRP or the
                                                                             individual, in the event they are their own guardian and check
                                                                             all three of the boxes since the CAP choice statement is not
                                                                             included in Section II on the signature page.

                                                                          The verification stage of the Critical Access Behavioral Health
                                                                         Agency (CABHA) certification process originally required the
                                                                         provider to demonstrate 60 days of history of implementation of
                                     Critical Access                     the policy (provision of core services and required positions
                                   Behavioral Health                     carrying out defined job responsibilities). This requirement has
    #072            5/6/2010                                CABHA Update
                                    Agency (CABHA)                       now been reduced to 30 days of history. Agencies that have
                                   Verification Update                   received notification of meeting the desk review elements should
                                                                         notify the LME System Performance Team at
                                                                         www.contact.dmh.lme@dhhs.nc.gov when they have the 30 days
                                                                         of history.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                         The Medicaid State Plan Amendment for Targeted Case
                                                                         Management (TCM) Services for Individuals with Developmental
                                                                         Disabilities has been approved by CMS and is scheduled for
                                   Targeted Case                         implementation on July 1, 2010. While the basic case
                                    Management                           management functions as outlined in July 2005 Medicaid Special
                                                         TCM - New
                                  Services (TCM) for                     Bulletin remain the same, specific training requirements have
    #071            4/8/2010                              Training
                                   Individuals with                      been added. Within the first 90 days of hire, each case manager
                                                        Requirements
                                   Developmental                         hired on or after July 1, 2010 must receive 20 hours of training
                                      Disabilities                       including 6 hours in Person-Centered Thinking, 3 hours in Person-
                                                                         Centered Planning Elements (per IU # 36) and 11 hours in the
                                                                         following case management functions: Assessment, Service
                                                                         Plan (PCP) Development, Referral, and Monitoring.
                                                                      Effective July 1, 2010, DMA is requiring all targeted case
                                                                      management provider agencies to be directly enrolled to provide
                                                                      Medicaid reimbursable Targeted Case Management (TCM)
                                   Targeted Case                      Services for Individuals with Developmental Disabilities. Two
                                    Management                        documents related to the required processes are attached to the
                                  Services (TCM) for TCM - Transition update: Transition Requirements: Targeted Case Management
    #071            4/8/2010
                                   Individuals with   Requirements Services for Individuals with Developmental Disabilities and TCM
                                   Developmental                      Letter of Attestation. CSC will begin to accept enrollment
                                      Disabilities                    applications on May 1, 2010. Existing providers must complete
                                                                      the Medicaid enrollment process by June 30, 2010. LMEs will be
                                                                      able to continue to bill on behalf of providers until December 31,
                                                                      2010 to allow time for providers to be notified of their direct
                                                                      enrollment status.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                Summary
  Update #:        Update Date


                                                                      Existing providers of TCM are required to sign the attached TCM
                                                                      Letter of Attestation indicating compliance to the new TCM policy.
                                                                      The original signed TCM Letter of Attestation is sent to the LME
                                   Targeted Case                      where the provider’s corporate office is located and a copy to all
                                                       TCM - Existing
                                    Management                        LMEs where the provider has a signed MOA and/or contract. The
                                                         Providers -
                                  Services (TCM) for                  LME where the provider’s corporate office is located will complete
    #071            4/8/2010                            Endorsement
                                   Individuals with                   a notification of endorsement action (NEA) letter and send to the
                                                       and Enrollment
                                   Developmental                      provider agency. The provider agency will submit the signed TCM
                                                          Process
                                      Disabilities                    Letter of Attestation, the NEA letter and a completed Medicaid
                                                                      Provider Enrollment Application to obtain a Medicaid provider
                                                                      billing number.
                                                                      (http://www.nctracks.nc.gov/provider/providerEnrollment/).




                                   Targeted Case                        When the provider receives a provider number for TCM, the
                                                      TCM- Existing
                                    Management                          provider should submit a Provider Change Request form to Value
                                                        Providers -
                                  Services (TCM) for                    Options to request that all current, valid TCM service
    #071            4/8/2010                         Provider Change
                                   Individuals with                     authorizations be transferred from the LME to the provider's new
                                                        Request to
                                   Developmental                        TCM provider number. Value Options will update the current
                                                      Value Options
                                      Disabilities                      authorizations with the agency's new TCM provider number.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                                                           The LME that serves the catchment area where the provider's
                                                                           corporate office is located is required to monitor the provider's
                                    Targeted Case
                                                                           compliance to the Medicaid State Plan Amendment for Targeted
                                     Management
                                                                           Case Management Services for Individuals with Developmental
                                   Services (TCM) for      TCM - LME
    #071            4/8/2010                                               Disabilities based on the established monitoring and oversight
                                    Individuals with       Monitoring
                                                                           protocol as defined in the Guide to Standardized Administration o
                                    Developmental
                                                                           the DMH/DD/SAS Frequency and Extent of Monitoring (FEM)
                                       Disabilities
                                                                           Tool and the Provider Monitoring (PMT) Tool for Local
                                                                           Management Entities.



                                    Targeted Case                          Beginning May 1, 2010, any agency that has not previously
                                     Management                            delivered TCM services that now wishes to begin delivering that
                                   Services (TCM) for      TCM - New       service may submit an application to the LME. The endorsement
    #071            4/8/2010
                                    Individuals with        Providers      and enrollment process shall be in accordance with the DHHS
                                    Developmental                          Policy and Procedures for Endorsement of Providers of Medicaid
                                       Disabilities                        Reimbursable MH/DD/SA Services.


                                                                          Effective May 1, 2010, all requests for non-waiver, Medicaid-
                                                                          funded targeted case management services for developmental
                                                                          disabilities will be authorized on an annual schedule based on the
                                  Transition to Annual                    recipient’s birth month. The effective date of the annual
                                                          TCM/DD Non- authorization period will be the first day of the month following the
                                  Authorization for Non-
    #071            4/8/2010                             Waiver Medicaid- recipient’s birth month and the end of the authorization period will
                                    Waiver TCM/DD
                                                         Funded Service be the last day of the recipient’s birth month. Requests received
                                        Services
                                                                          by Value Options prior to May 1, 2010 will be authorized for 90
                                                                          days. Prior to the end of the 90-day period, the case manager is
                                                                          to submit a request with an end date of the last day of the
                                                                          recipient's birth month.




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Implementation   Implementation
                                        Title (s)         Subject(s)                               Summary
  Update #:        Update Date




                                                                        State-funded TCM services for individuals with developmental
                                  Transition to Annual
                                                                        disabilities must follow all of the requirements of the Medicaid
                                  Authorization for Non- TCM/DD State-
    #071            4/8/2010                                            definition and must be reimbursed at the Medicaid rate, however,
                                    Waiver TCM/DD        Funded Service
                                                                        the authorization period will be as determined by each LME's
                                        Services
                                                                        benefit plan.




                                                                    The bidders conference announced in Special Implementation
                                                                    Bulletin #69 was held on March 4, 2010. Questions and answers
                                                                    from the bidders conference are now posted on both the
                                                                    DMH/DD/SAS and DMA waiver web pages. The question and
                                     1915 (b)(c)      1915 (b)(c)
    #071            4/8/2010                                        answer period is officially closed. This includes any questions
                                  Waiver/RFA Update Medicaid Waiver
                                                                    from stakeholders (consumers or providers) about potential LME
                                                                    RFA activities or application submissions. However, e-mail
                                                                    addresses can be accessed on the waiver web pages for input
                                                                    and/or comments from stakeholders.



                                                                    LMEs are to submit applications by April 14. The review process
                                                                    will include a desk review and an on-site review by a team
                                                      1915 (b)(c)   consisting of DMH/DD/SAS and DMA staff, consumers and family
                                     1915 (b)(c)
    #071            4/8/2010                        Medicaid Waiver members, and staff from Mercer Human Services Consulting.
                                  Waiver/RFA Update
                                                      - Timelines   These reviews will take place in April - June. The selected LMEs
                                                                    will be announced in July 2010. The tentative start date is set for
                                                                    January 2011.




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                                      Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                                                         Ongoing updates made to the Critical Access Behavioral Health
                                                                         Agency (CABHA) policy are posted on the DMH/DD/SAS CABHA
                                                                         web page. There is a weekly update posted each Monday that
                                   Critical Access
                                                                         identifies the status of those agencies that have submitted a
                                  Behavioral Health    CABHA - New
    #071            4/8/2010                                             Letter of Attestation for CABHA certification. Please note, per
                                  Agency Updates -    Attestation Letter
                                                                         Implementation Update #70, attestation letters received on the
                                       CABHA
                                                                         old form will not be accepted. The current attestation letter can be
                                                                         accessed on the DMH/DD/SAS CABHA webpage.
                                                                         http://www.ncdhhs.gov/mhddsas/cabha/index.htm

                                                                     DHHS has asked CMS for permission to begin implementation of
                                                                     CABHA effective July 1 but to permit existing CST, IIH and Day
                                                                     Rx providers to have until 12/31/10 to achieve CABHA status or
                                   Critical Access
                                                        CABHA -      to transition consumers from the service. There are also
                                  Behavioral Health
    #071            4/8/2010                          Implementation discussions with CMS about whether subcontracting will be
                                  Agency Updates -
                                                           Date      allowed. Any agency providing CST, IIH and Day Rx that has not
                                       CABHA
                                                                     submitted a letter of attestation by 4/1/10 should develop a plan to
                                                                     transition consumers to ensure a successful transition by 6/30/10
                                                                     in case CMS denies the request for an extension.

                                                                       A small provider, defined as a provider that serves 375 or fewer
                                                                       consumers in mental health or substance abuse services, may
                                                                       employ a single physician who meets the credentials outlined in
                                   Critical Access                     the CABHA policy to serve as the agency’s Medical Director for a
                                                      CABHA Medical
                                  Behavioral Health                    minimum of eight (8) hours/week. Those eight (8) hours must be
    #071            4/8/2010                          Director – Small
                                  Agency Updates -                     devoted to Medical Director functions; no portion of the eight (8)
                                                         Providers
                                       CABHA                           hours may be spent in direct, billable service. Providers serving
                                                                       from 376-749 consumers must have at a minimum one half-time
                                                                       Medical Director and agencies service 750 or more consumers
                                                                       must have a full-time medical director.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                                                      There is a detailed exception process that must be followed for
                                                                      physicians that require specific approval from the Secretary of the
                                    Critical Access     CABHA Medical Department of Health and Human Services to be approved as
                                   Behavioral Health       Director   Medical Directors for CABHAs. Agencies wishing to request an
    #071            4/8/2010
                                   Agency Updates -       Exception   exception under this policy should submit the required documents
                                        CAHBA              Process    noted in Implementation Update #70 along with a specific written
                                                                      request stating that the provider is requesting an exception as
                                                                      part of the provider’s attestation letter submission package.


                                                                           In order to ensure that providers, LMEs, and other stakeholders’
                                                                           questions are answered promptly and correctly, all questions
                                                                           regarding CABHA certification, attestation letters, medical director
                                    Critical Access
                                                                           requirements, etc. should be sent via electronic mail to
                                   Behavioral Health        CABHA
    #071            4/8/2010                                               DMH/DD/SAS at the following address:
                                   Agency Updates -        Questions
                                                                           contact.dmh.lme@dhhs.nc.gov.
                                        CAHBA
                                                                           Due to the volume of activity, electronic mail submissions will
                                                                           receive priority and will receive a response more promptly than
                                                                           telephone inquiries.

                                                                        Significant feedback has been received regarding the information
                                                                        outlined in Implementation Update #70 regarding how agency
                                                                        change of ownership, mergers or acquisitions would impact
                                                          Merger,       Medicaid enrollment, national accreditation, and endorsement.
                                  Merger, Acquisitions
                                                       Acquisitions and The language in that section caused concerns among provider
    #071            4/8/2010        and Change of
                                                         Change of      agencies in terms of the liability that the new or acquiring provider
                                      Ownership
                                                         Ownership      might incur. The concerns have been noted and conversations
                                                                        with legal counsel are under way to develop revised language.
                                                                        Revised guidance will be issued as quickly as possible, but no
                                                                        later than the May Implementation Update.




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Implementation   Implementation
                                       Title (s)       Subject(s)                                  Summary
  Update #:        Update Date

                                                                      The revised definitions for Intensive In-Home Services (IIH)
                                                                      posted in Clinical Coverage policy 8A on DMA’s website at
                                                                      http://www.dhhs.state.nc.us/dma/mp/index.htm.http://www.dhhs.s
                                                                      tate.nc.us/dma/mp/index.htm.
                                                                      These policies go into effect on July 1, 2010. Current providers of
                                   Intensive In-Home                  IIH must comply with all changes in the definition by July 1, 2010,
                                        Services/                     with the exception of the training requirements. The training
    #071            4/8/2010                              IIH
                                  Community Support                   timelines for current providers of IIH begin on the effective date of
                                      Team Update                     this policy, July 1, 2010. IIH providers are strongly encouraged to
                                                                      begin training staff as soon as possible. Endorsement check
                                                                      sheets and directions reflecting the new criteria will be posted to
                                                                      the DMH/DD/SAS endorsement web page,
                                                                      http://www.ncdhhs.gov/mhddsas/stateplanimplementation/provide
                                                                      rendorse/index.htm#checksheets, by May 1, 2010 for use July 1,
                                                                      2010.
                                                                      The revised definitions for Community Support Team (CST) have
                                                                      been posted in Clinical Coverage policy 8A on DMA’s website at
                                                                      http://www.dhhs.state.nc.us/dma/mp/index.htm.
                                                                      These policies go into effect on July 1, 2010. Current providers of
                                                                      CST must comply with all changes in the definition by July 1,
                                   Intensive In-Home                  2010, with the exception of the training requirements. The training
                                        Services/                     timelines for current providers of CST begin on the effective date
    #071            4/8/2010                             CST
                                  Community Support                   of this policy, July 1, 2010. CST providers are strongly
                                      Team Update                     encouraged to begin training staff as soon as possible.
                                                                      Endorsement check sheets and directions reflecting the new
                                                                      criteria will be posted to the DMH/DD/SAS endorsement web
                                                                      page,
                                                                      http://www.ncdhhs.gov/mhddsas/stateplanimplementation/provide
                                                                      rendorse/index.htm#checksheets, by May 1, 2010 for use July 1,




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Implementation   Implementation
                                       Title (s)          Subject(s)                                Summary
  Update #:        Update Date



                                                                      The effective date for the following rate decrease is July 1, 2010.
                                    Rate Reduction                    Community Support Team per 15 min unit with a five hour per
                                   Effective Date for Reimbursement - week maximum decreased from 15.60 to the current rate of
    #071            4/8/2010
                                  Community Support       Billing     11.80. Fee schedules are available on DMA’s website at
                                    Team Service                      http://www.ncdhhs.gov/dma/fee/. Providers must always bill their
                                                                      usual and customary charges.




                                                                      Child and Adolescent Day Treatment went into effect on April 1,
                                                                      2010. The following are areas of clarification to the definition. The
                                      Child and          Child and    updated definition can be found in Clinical Coverage Policy 8A on
    #071            4/8/2010        Adolescent Day     Adolescent Day DMA’s website at
                                      Treatment          Treatment    http://www.dhhs.state.nc.us/dma/mp/index.htm and the revised
                                                                      endorsement check sheet can be found on the DMH/DD/SAS
                                                                      website.


                                                                     The day treatment provider agency shall establish a
                                                                     memorandum of agreement (MOA) among the day treatment
                                                                     provider, the local management entity, and the local education
                                                                     agency (or private or charter school as applicable). In the event
                                      Child and        Memorandum of that a provider operates a day treatment program and is also a
    #071            4/8/2010        Adolescent Day       Agreement   private or charter school, the provider only needs to sign an MOA
                                      Treatment            (MOA)     with the LME. If the day treatment program (which is also a
                                                                     private or charter school) serves children from other LEA(s),
                                                                     private, or charter school(s) then appropriate MOA(s) should
                                                                     be signed with the responsible LEA(s), private, or charter
                                                                     school(s).




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Implementation   Implementation
                                     Title (s)       Subject(s)                                  Summary
  Update #:        Update Date

                                                                    This service is delivered by the following staff per licensed site: ·
                                                                    One (1) full time program director who meets the requirements
                                                                    specified for a qualified professional (preferably Master’s level or
                                                                    a licensed professional) and has a minimum of two years
                                                                    experience in child and adolescent mental health/substance
                                                                    abuse treatment services who must be actively involved in
                                                                    program development, implementation, and service delivery. This
                                    Child and
                                                   Day Treatment individual may serve as one of the qualified professionals in the
    #071            4/8/2010      Adolescent Day                    day treatment program staffing ratio; AND · a minimum of one (1)
                                                       Staffing
                                    Treatment                       full time equivalent (FTE) qualified professional (QP), per six
                                                                    children, who has the knowledge, skills, and abilities required by
                                                                    the population and age to be served, who must be actively
                                                                    involved in service delivery, and a program with 19 recipients
                                                                    needs 4 FTE QPs.) AND · a minimum of one (1) additional FTE
                                                                    (qualified professional, associate professional, or
                                                                    paraprofessional) for every 18 enrolled recipients beginning with
                                                                    the 18th enrolled recipient.
                                                                    AND · a minimum of a .5 of a full time dedicated licensed
                                                                    professional for every 18 enrolled recipients. This individual must
                                                                    be actively involved in service delivery. A provisionally licensed
                                                                    professional who fills this position must be fully licensed within 30
                                                                    months from the effective date of this policy. For provisionally
                                                                    licensed professionals hired after the effective date of this policy,
                                    Child and                       the 30-month timeline begins at date of hire. For substance
                                                   Day Treatment
    #071            4/8/2010      Adolescent Day                    abuse focused programs, the licensed professional (LP) must be
                                                   Staffing (contd)
                                    Treatment                       a Licensed Clinical Addictions Specialist (LCAS). A minimum
                                                                    ratio of one qualified professional to every six children is required
                                                                    to be present, with a minimum of two staff present with children at
                                                                    all times. The exception is when only one child is in the program,
                                                                    in which case only one staff member is required to be present.
                                                                    The staffing configuration must be adequate to anticipate and
                                                                    meet the needs of the recipients receiving this service.




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Implementation   Implementation
                                     Title (s)       Subject(s)                                  Summary
  Update #:        Update Date

                                                                     The day treatment program staff collaborates with the school and
                                                                     other service providers prior to admission and throughout service
                                                                     duration. The roles of day treatment staff and
                                                                     educational/academic staff are established through the MOA
                                                                     among the day treatment provider, the LME, and the LEA (or
                                                    Clarification of
                                    Child and                        private or charter school as applicable). Designation of
                                                   Therapeutic and
    #071            4/8/2010      Adolescent Day                     educational instruction and treatment interventions is determined
                                                     Educational
                                    Treatment                        based on staff function, credentials of staff, the child’s person
                                                      Activities
                                                                     centered plan, and the individual education plan (IEP)/504 plan.
                                                                     Source of staff salary does not necessarily determine educational
                                                                     or treatment determination. Educational instruction is not billable
                                                                     as day treatment. The therapeutic milieu should reflect integrated
                                                                     rehabilitative treatment and educational instruction.


                                                                     This is a day/night service that shall be available year round for a
                                                                     minimum of three hours a day during all days of operation. During
                                                                     the school year, the day treatment program must operate each
                                    Child and
                                                      Hours of       day that the schools in the local education agency are in
    #071            4/8/2010      Adolescent Day
                                                      Operation      operation, and the day treatment operating hours shall cover at
                                    Treatment
                                                                     least the range of hours that the LEA’s, private or charter school’s
                                                                     operate (i.e. they must operate during the hours the LEA, private
                                                                     or charter school’s operate but may offer other additional hours)




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                                      Title (s)         Subject(s)                                  Summary
  Update #:        Update Date




                                     Child and                         A facility providing day treatment services shall be licensed under
                                                         Service
    #071            4/8/2010       Adolescent Day                      10A NCAC 27G .1400 or 10A NCAC 27G .3700; 10A NCAC 27G
                                                       Type/Setting
                                     Treatment                         .3700 was inadvertently left out of the policy.




                                                                       The Child and Adolescent Day Treatment and Intensive In-Home
                                                                       service definitions have specific requirements (with specified
                                                                       hours of training required) that pertain to an Introduction to
                                  Day Treatment and                    System of Care and to Child and Family Team Programs and
                                  Intensive In-Home                    Practices. Eight (8) hours of total training covering these topics is
    #071            4/8/2010                             Training      required for day treatment. Eight (8) hours for Introduction to
                                     Training and
                                       Trainers                        System of Care and eight (8) hours for Child and Family Team
                                                                       Programs and Practices are required for intensive in-home for a
                                                                       total of sixteen hours. The System of Care (SOC) Coordinator at
                                                                       each LME can assist providers in identifying qualified trainers in
                                                                       this area.



                                                                     The new Peer Support Services (PSS) definition is still under
                                    Peer Support       Peer Support DHHS review based on public comments. The Centers for
    #071            4/8/2010
                                   Services (PSS)     Services (PSS) Medicare and Medicaid (CMS) are still reviewing this service as
                                                                     an addition to the current approved State Plan.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                    Update on State
                                   Plan Amendments                        The Centers for Medicare and Medicaid Services are currently
                                    for Peer Support                      reviewing NC’s proposed State Plan Amendments (SPA) for Peer
                                   Services, Facility-                    Support Services, Facility-Based Crisis Services for Children and
    #071            4/8/2010          Based Crisis         State Plan     Adolescents, and Therapeutic Family Services. We anticipate
                                  Services for Children                   that CMS will review the proposed SPA for Mental
                                   and Adolescents,                       Health/Substance Abuse Targeted Case Management within the
                                    and Therapeutic                       next 30 days.
                                     Family Services



                                                                          The March 2010 Medicaid Bulletin and Implementation Update
                                       Extension of
                                                                          #70 reported on the extension of coverage of provisionally
                                      Coverage for
                                                                          licensed providers delivering outpatient behavioral health services
                                      Provisionally
                                                                          as a reimbursable service under Medicaid and State funds and
                                   Licensed Providers     Provisionally
                                                                          billed through the LME to June 30, 2011. This bulletin article listed
    #071            4/8/2010        Billing Outpatient      Licensed
                                                                          the HCPCS procedure codes that could be utilized to bill for
                                    Behavioral Health     Professionals
                                                                          services delivered by the provisionally licensed individuals. These
                                  Services through the
                                                                          codes were codes H0001, H0004, and H0005. HCPCS procedure
                                  Local Management
                                                                          code H0031 was inadvertently omitted and should be added to
                                           Entity
                                                                          the above list of procedure codes.




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Implementation   Implementation
                                       Title (s)          Subject(s)                                 Summary
  Update #:        Update Date


                                                                         The LME is not required to complete an onsite review prior to
                                                                         issuing an NEA letter for a three year site/service re-
                                                                         endorsement. Since the LME has completed on-going monitoring
                                                                         activities (monitoring reviews, post payment reviews, follow-up on
                                   Re-Endorsement                        plans of correction, etc.) during the three year endorsement
    #071            4/8/2010                             Endorsement
                                     Clarification                       period, it is expected that the ongoing monitoring activities that
                                                                         were completed by the LME will provide enough information
                                                                         about the provider’s performance to assist the LME in making the
                                                                         re-endorsement decision. Based upon this information, the LME
                                                                         will make the determination as to the need for an onsite review.



                                                                         A new enhancement to the ValueOptions online web portal
                                                                         ProviderConnect will alert providers to requests being returned as
                                                                         Unable to Process. The alert will be a message to a provider’s
                                                                         inbox indicating the reason for the return and will allow the
                                                                         provider to quickly modify the request and resubmit, minimizing
                                                                         the potential loss of authorized days of service. Unable to
                                  Online Correction of
                                                                         Process letters will continue to be mailed but the online
    #071            4/8/2010      Unable to Process      ValueOptions
                                                                         notification will be quicker than the hardcopy letter in the mail.
                                       Requests
                                                                         The new enhancement only applies to authorization requests
                                                                         submitted via ProviderConnect. To learn how to submit
                                                                         authorization requests online via ProviderConnect, please visit
                                                                         http://www.valueoptions.com/providers/Network/North_Carolina_
                                                                         Medicaid.htm and register for an upcoming webinar training
                                                                         located in the section titled Provider Training Opportunities.




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                                       Title (s)         Subject(s)                                  Summary
  Update #:        Update Date


                                                                         DMA’s Program Integrity (PI) section is devoted to carrying out its
                                                                         mission to ensure compliance, efficiency, and accountability
                                                                         within the N.C. Medicaid Program by detecting and preventing
                                                                         fraud, waste, program abuse, and by ensuring that Medicaid
                                   Reporting Fraud,     Fraud, Waste     dollars are paid appropriately. You are encouraged to report
    #071            4/8/2010      Waste, and Program    and Program      matters involving Medicaid fraud and abuse. If you want to report
                                        Abuse              Abuse         fraud or abuse, you can remain anonymous. However,
                                                                         sometimes in order to conduct an effective investigation, staff
                                                                         may need to re-contact you. Your name will not be shared with
                                                                         anyone investigated. (In rare cases involving legal proceedings,
                                                                         we may have to reveal who you are.)

                                                                       The Division of Medical Assistance and the DHHS Controller’s
                                                                       Office are suspending the requirement for mandatory cost
                                                                       reporting of Medicaid costs for cost reports due after December
                                                                       31, 2009 for: CAP MR/DD Providers, Substance Abuse (SA) &
                                                                       Personal Care Service (PCS) Adult Care Home Providers, PCS –
                                                                       Community Based Providers, Enhanced Mental Health Providers
                                    Suspension of                      and Residential Treatment Providers. Any outstanding cost
                                    Mandatory Cost
    #070            3/2/2010                            Cost Reporting reports from previous cost report periods are due and must be
                                   Reporting for Rate                  filed. For all cost reports due prior to 12/31/09, DMA's policies
                                     Adjustments                       and rules for timely submission will continue to be in effect.
                                                                       Outstanding issues resulting from a previously filed cost report
                                                                       must also be resolved. Providers should continue to record their
                                                                       accounting transactions in accordance with the approved chart of
                                                                       accounts and cost allocation principles to ensure that when the
                                                                       suspension is rescinded, providers will be able to complete and
                                                                       file cost reports within the prescribed timeframe.




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Implementation   Implementation
                                    Title (s)      Subject(s)                                 Summary
  Update #:        Update Date

                                                 CMS Approval of    The Centers for Medicare and Medicaid Services (CMS)
                                                  Critical Access   approved the State Plan Amendment (SPA) to allow only Critical
                                                     Behavioral     Access Behavioral Health Agencies (CABHAs) to provide
     #070           3/2/2010      CABHA Update
                                                 Health Agencies    Intensive In-Home Services (IIH), Community Support Team
                                                  in NC Medicaid    (CST), and Child and Adolescent Day Treatment services,
                                                     State Plan     effective July 1, 2010.

                                                                 An updated Letter of Attestation for CABHA certification is on the
                                                                 DMH/DD/SAS webpage:
                                                                 http://www.ncdhhs.gov/mhddsas/cabha/index.htm. The letter has
                                                                 been revised to include the following additional information: · Site
                                                                 addresses and endorsing LME for all Medicaid numbers. ·
                                                                 Clarification regarding the inclusion of the service continuum in
                                                                 the written explanation of the management and clinical structure
                                                                 of the organization.· LME(s) where the continuum of services for
                                                    CABHA -      the CABHA site are located. Services within a continuum to be
     #070           3/2/2010      CABHA Update   Updated Letter within a 35 mile radius of the site where the core services are
                                                  of Attestation provided as referenced in the Centers for Medicare and Medicaid
                                                                 42 CFR Ch. IV (10-1-09 Edition) § 413.65. · Identification of the
                                                                 two additional services to be considered as part of the continuum
                                                                 if more than two services are provided by the agency. Letters of
                                                                 Attestation postmarked after the date of this Implementation
                                                                 Update must utilize the updated letter. It is no longer necessary to
                                                                 submit Letters of Intent; in order to initiate the certification
                                                                 process, providers must submit Letters of Attestation and
                                                                 supporting documentation.




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Implementation   Implementation
                                    Title (s)      Subject(s)                                  Summary
  Update #:        Update Date

                                                                  Critical Access Behavioral Health Care Agencies are required to
                                                                  operate and describe a continuum of care for a selected
                                                                  age/disability group. This description should include the core
                                                                  services (assessment, outpatient treatment and med
                                                                  management) and at least two enhanced services for the
                                                                  age/disability group selected. The description should describe the
                                                   CABHA -        proposed continuum of care indicating the required competencies
     #070           3/2/2010      CABHA Update    Continuum of and professional qualifications for each level of care (the core
                                                      Care        plus enhanced services) for the selected population. The
                                                                  continuum of care must be flexible enough to allow for stepping
                                                                  up or down in intensities of services based on the consumer’s
                                                                  process of recovery. The levels of care in a continuum are
                                                                  designed to treat the individual’s level of clinical severity and to
                                                                  help the individual achieve permanent change in his or her mental
                                                                  functioning and/or alcohol and drug using behavior. Effective
                                                                  continuums also include relapse services and continued care
                                                                  Other physicians (besides psychiatrists) who could be approved
                                                                  as Medical Directors for CABHAs require an approved exception
                                                                  from the Secretary of DHHS. Other physicians are those who are
                                                                  board-certified or board-eligible in general family practice, or
                                                                  internal medicine, or pediatrics and with two or more years of
                                                                  direct service experience diagnosing, treating, and evaluating the
                                                   CABHA -
                                                                  effectiveness of treatment of the population to be served by the
                                                 Medical Director
     #070           3/2/2010      CABHA Update                    CABHA. Consideration will also be given to physicians with these
                                                   Exception
                                                                  credentials who have received additional training or certification
                                                    Process
                                                                  related to treating the population to be served and those who
                                                                  have prior experience as a medical director for a mental health
                                                                  and/or substance abuse provider organization. Agencies
                                                                  requesting an exception should submit the information regarding
                                                                  their particular physician as outlined in this Implementation
                                                                  Update with their attestation packet.·




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                                    Title (s)      Subject(s)                                   Summary
  Update #:        Update Date


                                                                 Provider agencies that are interested in achieving CABHA status
                                                                 by July 1, 2010 in order to provide IIH, CST, and/or Day
                                                                 Treatment services must submit a Letter of Attestation to
                                                                 Contact.dmh.lme@dhhs.nc.gov prior to April 1, 2010. The
                                                                 submission of the attestation letter before this date will ensure
                                                                 that the required reviews/certification will be completed within the
                                                    CABHA -
                                                                 remaining three months. In addition, this schedule will allow LMEs
                                                  Transition for
     #070           3/2/2010      CABHA Update                   to assist in the transition of consumers from those agencies who
                                                 IIH, CST, and
                                                                 are not certified as CABHA prior to the July 1, 2010 deadline.
                                                 Day Treatment
                                                                 Providers of these three services that do not submit letters of
                                                                 attestation for CABHA certification by April 1, 2010 must assist
                                                                 the LME in planning and implementing a transition plan for
                                                                 consumers served by their agency. The April 1 date does not
                                                                 impact providers who are applying for CABHA certification and do
                                                                 not provide IIH, CST, or Day Treatment.

                                                                  New providers can become a Critical Access Behavioral Health
                                                                  Agency (CABHA) after July 1, 2010 by: 1. Creating a company
                                                                  that provides a MH/ SA service(s) not subject to CABHA
                                                                  requirements. 2. Becoming endorsed by the LME, if required, to
                                                   CABHA -        deliver that service(s). 3. Achieving three year national
                                                  Certification   accreditation for that service(s). 4. Hiring, if not already employed
     #070           3/2/2010      CABHA Update
                                                  after July 1,   or contracted, a physician (half-time or full-time), clinical director,
                                                 2010 - (contd)   and quality improvement/training director. Individuals must be
                                                                  employed for 60 days prior to submission of an attestation letter
                                                                  for CABHA application. 5. Submitting a letter of attestation for
                                                                  CABHA application, indicating if endorsement is being sought for
                                                                  CST, Day Treatment or IIH to create the necessary continuum.




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Implementation   Implementation
                                    Title (s)     Subject(s)                                  Summary
  Update #:        Update Date

                                                                   6. If the letter of attestation passes the desk review, LMEs will
                                                                  perform endorsement review for other services requested as part
                                                   CABHA -
                                                                  of LME verification of the CABHA application. 7. If LME review
                                                  Certification
     #070           3/2/2010      CABHA Update                    and endorsement meet requirements, complete CABHA interview
                                                  after July 1,
                                                                  process. 8. Enroll the provider as a CABHA if the provider meets
                                                 2010 - (contd)
                                                                  all criteria. 9. Apply for endorsement for case management and, if
                                                                  desired, peer support.
                                                                  Providers achieving Critical Access Behavioral Health Agency
                                                                  certification need to complete a Medicaid Provider Enrollment
                                                                  Application to obtain a Medicaid provider billing number.
                                                                  (http://www.nctracks.nc.gov/provider/providerEnrollment/) The
                                                                  new billing number will be used to bill for services rendered by
                                                                  both the direct-enrolled individuals and by group service providers
                                                                  certified under the CABHA. The CAHBA number will be the
                                                                  “billing number” for reimbursement for the core services
                                                   CABHA -        (Comprehensive Clinical Assessment, Medication Management,
                                                   Medicaid       and Outpatient Therapy services); as well as, CST, IIH and Day
     #070           3/2/2010      CABHA Update
                                                   Provider       Treatment and/or others designated to be provided by the
                                                  Enrollment      CABHA. After July 1, CST, IIH and Day Treatment will be
                                                                  reimbursed only to the CABHA billing provider number. With CMA
                                                                  approval, Peer Support and Mental Health/Substance Abuse
                                                                  Targeted Case Management may be provided only by the
                                                                  CABHA and reimbursed only through the CABHA billing number.
                                                                  These services will need site specific endorsement and provider
                                                                  numbers that will be the “attending provider number” on the claim
                                                                  for reimbursement.




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Implementation   Implementation
                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date

                                                                      Providers are responsible for notifying CSC when information
                                                                      related to their business or practice changes. Change of
                                                                      ownership/merger/ acquisition is constituted by an exchange of
                                                                      monies or an asset purchase, both of which result in the
                                                                      assignment of a new tax ID #; a stock purchase, which may not
                                                                      result in the assignment of a new tax identification number; a
                                                                      change in a partner's/ shareholder's percentage of interest in
                                  Impact of Merger &
                                    Acquisitions on
                                                                      ownership; a transfer of title and property to another party; or a
    #070            3/2/2010          Enrollment/      Enrollment     merger of the provider corporation into another corporation or the
                                    Accreditation/                    consolidation of two or more corporations resulting in the creation
                                     Endorsement                      of a new corporation. If there is a change in the organization,
                                                                      CSC, DMH/DD/SAS Accountability Team and the endorsing LME
                                                                      must receive notification within 30 days of the change. 1. Submit
                                                                      an online Provider Enrollment Application for the organization
                                                                      http://www.nctracks.nc.gov/provider/providerEnrollment/ 2. Use
                                                                      company letterhead to provide notification of a site change,
                                                                      services change, merger, acquisition, or organizational closure
                                                                      with a Liability Statement.




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Implementation   Implementation
                                      Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                       Providers are required to notify their accrediting body when there
                                                                       are changes in management/ organizational structure:
                                                                       reorganization, mergers, acquisitions, and closures. Accreditation
                                                                       is awarded to a specific provider and is not transferred from the
                                                                       previous agency to the acquiring or absorbing agency. Depending
                                                                       on the facts and circumstances of the merger, an on-site
                                  Impact of Merger &                   supplemental survey may be required when any of the above
                                    Acquisitions on                    changes are made or when the organization wants to add a new
    #070            3/2/2010          Enrollment/      Accreditation   program or service that is not currently accredited, including
                                    Accreditation/                     cases where an accredited provider merges with another provider
                                     endorsement                       that is not accredited by the same accrediting body. An
                                                                       organization loses its accreditation when the organization goes
                                                                       out of business or discontinues providing the services for which it
                                                                       was accredited. An organization that loses its accreditation may
                                                                       reapply to re-establish accreditation. Providers should refer to
                                                                       their accrediting body's policy regarding this matter for more
                                                                       specific details.

                                                                       When two or more corporations merge resulting in the creation of
                                                                       a new corporation (new organization name, new tax ID #)
                                                                       endorsement of the new corporation is required. When a provider
                                                                       is endorsed and there is a change of ownership affecting the
                                                                       provider organization, the provider must notify the endorsing
                                  Impact of Merger &                   agency, DMH/DD/SAS, and DMA of the changes on company
                                    Acquisitions on
                                                                       letterhead. Notification is required when there is a change in a
    #070            3/2/2010          Enrollment/      Endorsement
                                                                       shareholder’s/partner’s percentage of interest in ownership, a
                                    Accreditation/
                                     endorsement                       transfer of title or property to another agency that is already
                                                                       endorsed, a merger of another provider corporation into another
                                                                       corporation that is already endorsed an exchange of monies or an
                                                                       asset purchase, both of which result in the assignment of a new
                                                                       tax ID #, but the services and/or site is already endorsed, or a
                                                                       stock purchase, which may not result in the assignment of a new
                                                                       tax ID #.


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Implementation   Implementation
                                      Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                        When a provider endorsed to provide services at a specific site
                                  Impact of Merger &   Endorsement      moves to a different site location within the same catchment area
                                    Acquisitions on
                                                        (Change of      (providing the same services), the services do not need to be re-
    #070            3/2/2010          Enrollment/
                                    Accreditation/
                                                        Location) -     endorsed. However, if the move is to a new LME catchment area
                                     endorsement          (contd)       and that site location has not been endorsed, the new site must
                                                                        be endorsed for that service.
                                                                        Effective March 1, 2010, Psychosocial Rehabilitation (PSR)
                                                                        services may be documented in the service record on a weekly
                                                                        basis. CMS has granted approval for PSR services to be
                                                                        documented in a full service note, but on a weekly basis instead
                                                                        of per date of service. All the guidance contained in this IU
                                                                        supersedes the section on page 8-8, and on page 10-11, in the
                                                                        DMH/DD/SAS Records Management and Documentation Manual
                                                                        (RM&DM) that requires a service note per date of service for
                                                           PSR          PSR. With this new allowance, PSR providers must be aware
    #070            3/2/2010      PSR Service Notes
                                                       Service Notes    that there will be some additional requirements that must be met
                                                                        in order to properly document progress on a less frequent basis.
                                                                        To assist PSR providers in the move from a daily note to a weekly
                                                                        note, “PSR Guidance for Service Notes” is attached to this
                                                                        Implementation Update to delineate the basic requirements
                                                                        needed. Providers are strongly encouraged to use this
                                                                        attachment to ensure that all the proper documentation
                                                                        requirements are met.
                                                                        http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdate




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Implementation   Implementation
                                     Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                    The endorsement checksheet and instructions for the revised
                                                                    Child and Adolescent Day Treatment service definitions are
                                                                    attached and will be posted to the Endorsement Page of the
                                                                    DMH/DD/SAS website at:
                                  Day Treatment                     http://www.ncdhhs.gov/mhddsas/stateplanimplementation/provide
                                   Endorsement      Day Treatment - rendorse/index.htm. These items are to be used for any
    #070            3/2/2010
                                  Checksheet and     Endorsement endorsement of Day Treatment that occurs on or following April
                                    Instructions                    1, 2010. The checksheet and instructions reflect revisions to the
                                                                    service definition as well as the proposed changes to the
                                                                    Endorsement Policy. As with all service definition changes,
                                                                    currently endorsed providers of this service will be expected to be
                                                                    in compliance with the new service definition on April 1,2010.

                                                                    Effective models of practice require intentional interagency
                                                                    coordination to meet both the therapeutic treatment as well as the
                                                                    educational needs of each child or youth receiving day treatment
                                                                    ervices. Medicaid and state mental health funds do not pay
                                                                    forEffective models of practice require intentional interagency
                                                                    coordination to meet both the therapeutic treatment as well as the
                                                                    educational needs of each child or youth receiving day treatment
                                  MOA for Child &                   ervices. Medicaid and state mental health funds do not pay for
                                                    Day Treatment - educational services for eligible children, so in accordance with
    #070            3/2/2010      Adolescent Day
                                    Treatment
                                                         MOA        the requirements outlined in the Child and Adolescent Day
                                                                    Treatment Services definition posted with an effective date of
                                                                    April 1, 2010 in the DMA Clinical Coverage Policy 8A, a
                                                                    memorandum of agreement (MOA) must be established in order
                                                                    for this service to exist. The MOA must be established between
                                                                    the provider, local educational agency (LEA), and the LME. See
                                                                    the attached document “Elements to Consider Including in the
                                                                    Memorandum of Agreement for the Implementation of Child and
                                                                    Adolescent Day Treatment Services.”




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Implementation   Implementation
                                        Title (s)         Subject(s)                               Summary
  Update #:        Update Date


                                                                     A new CAP/Targeted Case Management (CTCM) request for
                                                                     authorization form has been approved and MUST be used in
                                                                     conjunction with the new person centered plan (PCP) for MR/DD
                                                                     plans of care, Continued Need Reviews (CNR) and nonwaiver
                                                                     DD Case Management. ValueOptions has posted the new CTCM
                                   New CTCM form for   CAP- Targeted on their website for immediate use as of March 1, 2010. Due to
    #070            3/2/2010      MR/DD Submissions to    Case       changes in the PCP, the additional information required on the
                                         VO            Management new CTCM, such as diagnoses and medications, is essential to
                                                                     the review process. The new CTCM form can be accessed at:
                                                                     http://www.valueoptions.com/providers/Network/North_Carolina_
                                                                     Medicaid.htm
                                                                     If a CNR was submitted prior to March 1, it does not need to be
                                                                     re-submitted to ValueOptions.

                                                                         This article is republished to correct the instruction given to
                                                                         providers in Implementation Update # 68 to bill with the new
                                                                         procedure code T1017SC if additional hours (up to six hours/24
                                                                         units) are needed for completing an assessment, a
                                                         Correction in reauthorization or a continued need review, or for a
                                                        Billing Code for crisis/emergency situation. The correct code to bill for these
                                   Policy Changes for
    #070            3/2/2010                            Additional Hours additional hours is the procedure code currently submitted for
                                   Case Management
                                                             of Case     case management services with an informational modifier SC
                                                         Management appended to the code. See the Implementation Update for billing
                                                                         instructions and for additional information on how this policy
                                                                         change affects CAP/DA, CAP/Choice, CAP/C, CAP-MR/DD, Non-
                                                                         Waiver Targeted Case Management for Persons with
                                                                         Developmental Disabilities, and Early Intervention. These
                                                                         changes became effective March 1, 2010.




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Implementation   Implementation
                                      Title (s)         Subject(s)                                  Summary
  Update #:        Update Date

                                                                        The new limit on case management services has been reduced
                                                                        to no more than three hours (12 units) per calendar month and no
                                                                        more than six additional hours (24 units) if needed for completing
                                                                        an assessment, completing a reauthorization or continued need
                                                                        review, or for a crisis/emergency situation, these limits may not
                                                                        apply to children under 21 years of age. Federal law, 42 U.S.C.
                                                                        §1396d(r)(5), requires the State Medicaid agency to provide to
                                  Policy Changes for
                                                                        Medicaid recipients under 21 years of age “necessary health
    #070            3/2/2010                              EPSDT         care, diagnostic services, treatment, and other measures
                                  Case Management
                                                                        described in section 1905(a) of the [Social Security] Act to correct
                                                                        or ameliorate defects and physical and mental illnesses and
                                                                        conditions discovered by the screening services, whether or not
                                                                        such services are covered under the State [Medicaid] Plan.” For
                                                                        more
                                                                        information about EPSDT and provider documentation
                                                                        requirements for EPSDT requests, please visit
                                                                        http://www.ncdhhs.gov/dma/epsdt/.
                                                                        All requests for recipients under the age of 21 that exceed policy
                                                                        limits will be reviewed against the EPSDT criteria prior to taking
                                                                        adverse action, and the recipient or his/her legal guardian will
                                                                        receive a written notice explaining the decision. The notice will
                                                       Recipient Due    state the decision and effective date of the reduction, explain the
                                  Policy Changes for
    #070            3/2/2010                             Process -      reduction is based on Session Law 2009-451, Sections
                                  Case Management
                                                         Children       10.68A.(a)(2)(a) and 10.68A.(a)(10), DMA policy promulgated
                                                                        pursuant to S.L. 2009-451, Section 10.68A.(c), as well as state
                                                                        the EPSDT criteria not met, and an explanation about how to
                                                                        appeal the decision should the recipient or his/her legal guardian
                                                                        so desire.




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Implementation   Implementation
                                      Title (s)          Subject(s)                                  Summary
  Update #:        Update Date

                                                                        Decisions which authorizes case management services to the
                                                                        policy limit (three hours per calendar month and/or six additional
                                                                        hours if needed for completing an assessment, completing a
                                                                        reauthorization or continued need review, or for a
                                                                        crisis/emergency situation within 365 days), the recipient or
                                                       Recipient Due his/her legal guardian will receive a written notice explaining the
                                  Policy Changes for
    #070            3/2/2010                              Process -     decision. The notice will state the decision and effective date of
                                  Case Management
                                                           Adults       the reduction to the policy limit, explain the reduction is based on
                                                                        Session Law 2009-451, Sections 10.68A.(a)(2)(a) and
                                                                        10.68A.(a)(10) as well as DMA policy promulgated pursuant to
                                                                        S.L. 2009-451, Section 10.68A.(c), and that pursuant to 42 CFR
                                                                        §431.210 and §431.220(b), the recipient is not entitled to appeal
                                                                        this decision.
                                                                        Should less than three hours (12 units) per calendar month
                                                                        and/or less than six additional hours if needed for completing an
                                                                        assessment, completing a reauthorization or continued need
                                                                        review, or for a crisis/emergency situation within 365 days be
                                                                        authorized, the recipient or his/her legal guardian will receive a
                                                        Recipient Due written notice explaining the decision, and that he/she disentitled
                                  Policy Changes for
    #070            3/2/2010                              Process -     to appeal the decision to authorize less than the policy limit. The
                                  Case Management
                                                       Adults - (contd) notice will state the decision and effective date of the reduction,
                                                                        explain the reduction is based on Session Law 2009-451,
                                                                        Sections 10.68A.(a)(2)(a) and 10.68A.(a)(10), as
                                                                        well as DMA policy promulgated pursuant to S.L. 2009-451,
                                                                        Section 10.68A.(c), and an explanation about how to appeal the
                                                                        decision should the recipient or his/her legal guardian so desire.
                                                       Recipient Notice
                                                         Regarding      A notice was sent at the end of January to recipients regarding
                                  Policy Changes for    Reductions in these changes in case management. See the DMA website
    #070            3/2/2010
                                  Case Management           Case        (http://www.ncdhhs.gov/dma/pub/consumerlibrary.htm) for a copy
                                                        Management of the notice.
                                                          Services




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Implementation   Implementation
                                        Title (s)           Subject(s)                                 Summary
  Update #:        Update Date

                                                                           The deadline for coverage of provisionally licensed providers
                                                                           delivering outpatient behavioral health services as a reimbursable
                                                                           service under Medicaid and state funds and billed through the
                                                                           LME has been extended to June 30, 2011. DMA and
                                                                           DMH/DD/SAS will continue to pay for services delivered by the
                                                                           provisionallylicensed individuals listed above when billed through
                                                                           LMEs under HCPCS procedure codes H0001, H0004, and H0005
                                                                           until that date. As outlined in IU # 32, the LME may choose to
                                      Extension for        Provisionally
                                                                           provide this billing service on behalf of the provisionally licensed
    #070            3/2/2010      Provisionally Licensed     Licensed
                                          Billing                          professional. If the provisionally licensed professional is
                                                           Professionals
                                                                           employed by an agency, the agency must develop a contract
                                                                           directly with the LME to do this billing for them. If provisionally
                                                                           licensed professionals work independently, they should contact
                                                                           their licensure board prior to developing a contract with the LME
                                                                           to ensure compliance with each profession’s scope of practice.
                                                                           Additional clinical experience can be obtained by working
                                                                           "incident to" a physician, by providing CISA services as the QP or
                                                                           by serving as the licensed professional in the IIH service.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                                                          Effective January 28, 2010 Public Consulting Group (PCG) will
                                                                          assist the NC Division of Medical Assistance’s Program Integrity,
                                                                          Behavioral Health Review Section in eliminating a backlog of
                                                                          cases and maintaining a steady state of case reviews. PCG will
                                                                          absorb the full scale of operations and extrapolating these
                                                                          findings to calculate the recoupment. PCG will initiate contact with
                                                                          the provider, inform the provider of the post payment review
                                                                          process requirements, and work closely with the provider and
                                                        Fraud Detection DMA. PCG will advise the provider where and how to submit
                                  DMA Program Integrity
    #070            3/2/2010                            and Investigation records for the review, and will address provider questions
                                   contract with PCG
                                                            Program       regarding the post payment review process. If out of compliance,
                                                                          a recoupment letter shall be forwarded to the provider in the
                                                                          amount of the overpayment. The provider will have
                                                                          reconsideration and appeal rights should the agency not agree
                                                                          with the findings of the review. Those instructions will be sent out
                                                                          with the recoupment letter. If the preliminary investigation
                                                                          supports the conclusion of possible fraud, the case shall be
                                                                          referred to the appropriate law enforcement agency for a full
                                                                          investigation.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                Summary
  Update #:        Update Date

                                                                     In compliance with the Improper Payments Information Act of
                                                                     2002, the Centers for Medicare and Medicaid Services
                                                                     implemented a national Payment Error Rate Measurement
                                                                     (PERM) program to measure improper payments in the Medicaid
                                                                     program and the State Children’s Health Insurance Program
                                                                     (SCHIP). North Carolina is one of 17 states required to participate
                                                                     in PERM reviews of Medicaid Fee-For-Service and Medicaid
                                                                     Managed Care claims paid in Federal Fiscal Year 2010 (October
                                  Payment Error Rate   Payment Error
    #070            3/2/2010                                         1, 2009-September 30, 2010). The SCHIP review for FY2010 is
                                  Measurement in NC        Rate
                                                                     on hold until a final ruling is made to include or exclude the
                                                                     measurement from this PERM cycle. Providers will be notified of
                                                                     a medical records request by letter from the review contractor.
                                                                     Providers are urged to respond to these requests promptly with
                                                                     timely submission of the requested documentation. Failure to
                                                                     submit records within the designated time frame will result in an
                                                                     error for the state. All indefensible errors will be recouped from
                                                                     the provider according to state and federal regulations.
                                                                     DMA shall immediately suspend payment to all NC Medicaid
                                                                     providers that currently have outstanding (i.e. thirty days or more
                                                                     past due) balances owed as a result of DMA actions to recoup
                                                         Medicaid    assessments, overpayments or improper payments until such
                                   Medicaid Provider
    #070            3/2/2010                             Payment     outstanding balances are either paid in full or the provider enters
                                  Payment Suspension
                                                        Suspension   into an approved payment plan, in accordance with N.C. Session
                                                                     Law 2009-451, Section 10.73A.(a) (b) (c). For additional
                                                                     information on a repayment plan, please contact DMA Budget
                                                                     Management at (919) 855-4140.




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Implementation   Implementation
                                   Title (s)    Subject(s)                                  Summary
  Update #:        Update Date



                                                               The U.S. Census 2010 will begin in a few weeks. It is important
                                                               that all voices be heard and that every individual is encouraged to
                                                               participate. When communicating with consumers, families and
                                                               staff about Census 2010 reference the following facts: It’s easy -
                                                               The census form only has ten questions and should only take a
                                                               short time to complete. The U.S. Census has also published a
                                                               toolkit, “Supporting the 2010 Census: Toolkit for Reaching People
                                                               with Disabilities” at the following link:
                                                               http://2010.census.gov/partners/pdf/toolkit_Disability_Overview.p
    #070            3/2/2010      Census 2010    Census
                                                               df It’s your responsibility and right - it helps to determine
                                                               changes in population. It plays a part in deciding how billions of
                                                               dollars are spent such as funding for people with disabilities. It’s
                                                               safe and confidential - It is important to point out that information
                                                               on the census form is kept confidential and census workers are
                                                               sworn for life to keep information confidential. Some people may
                                                               also be apprehensive about strangers coming to talk to them.
                                                               Remind everyone that census workers carry identification to
                                                               protect confidentiality.




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 Implementation   Implementation
                                        Title (s)          Subject(s)                               Summary
   Update #:        Update Date

                                                                         There is a request for applications (RFA) to solicit responses
                                                                         from Local Management Entities (LMEs) to participate in the
                                                                         State’s 1915 (b)/(c) waiver posted on the DHHS web site. These
                                                                         web sites are:
                                                                         DMH/DD/SAS: http://www.ncdhhs.gov/mhddsas/waiver/index.htm
                                                                         DMA: http://www.ncdhhs.gov/dma/lme/MHWaiver.htm. This is
      #069                                                               the first step to expanding from the current 1915 b/c waiver, a
    SPECIAL                        RFA for 1915 (b)(c)     1915 (b)(c)   pilot project operated by PBH since 2005, to another LME(s), to
                    2/19/2010
IMPLEMENTATION                     Waiver Expansion      Medicaid Waiver begin planning for long term consideration of statewide
    UPDATE                                                               implementation based upon success of the existing 1915 b/c
                                                                         waiver entities at that time. The RFA details the minimum
                                                                         requirements, application process, and contact information for
                                                                         submitting questions. Consumer volunteers participated with
                                                                         State staff in reading and commenting on the RFA and will
                                                                         participate in the desk reviews of LME applications and in the
                                                                         catchment area's planning efforts around waiver implementation.
                                                                         Questions should be directed to




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Implementation   Implementation
                                    Title (s)   Subject(s)                                 Summary
  Update #:        Update Date



                                                               A Records Management webpage has been established on the
                                                               Division of Mental Health, Developmental Disabilities, and
                                                               Substance Abuse Services (DMH/DD/SAS) website. The purpose
                                                               of this webpage is to provide guidance on important areas of
                                                               records retention and disposition and records management that
                                                               apply to the administration and provision of publicly-funded
                                                               MH/DD/SA services. The webpage includes links to resources
                                   Records                     developed by the Department of Cultural Resources Government
                                  Management                   Records Branch and guidance on managing electronic records
    #068            2/2/2010                     Records
                                   Webpage                     and disaster preparedness and recovery. The state statutes
                                                Management
                                  Established                  governing public records, the DHHS policy on record retention,
                                                               the general schedule for state agencies and the DMH/DD/SAS
                                                               records retention and disposition schedules and forms for the
                                                               storage and destruction of records can also be accessed from
                                                               this webpage. The Records Management webpage can be
                                                               accessed from either the State and Local Government or the
                                                               Providers of MH/DD/SA Services portals or directly from this link:
                                                               http://www.ncdhhs.gov/mhddsas/recordsmgmt/index.htm.




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Implementation   Implementation
                                     Title (s)      Subject(s)                                   Summary
  Update #:        Update Date

                                                                 The service definition for Child and Adolescent Day Treatment
                                                                 has been revised, reviewed by the Division of Medical Assistance
                                                                 (DMA) Physician’s Advisory Group (PAG), offered for public
                                                                 comment, and received final approval. This definition will be
                                                                 implemented effective April 1, 2010 and can be found in the DMA
                                                                 Clinical Coverage Policy 8A located at:
                                                                 http://www.dhhs.state.nc.us/dma/mp/8A.pdf. The day treatment
                                    Child and
                                                                 checksheet will be revised to reflect the changes in the service
    #068            2/2/2010      Adolescent Day   Day Treatment
                                                                 definition and posted to the DMH/DD/SAS endorsement webpage
                                    Treatment
                                                                 to be utilized to complete the endorsement process for any on
                                                                 site visit effective April 2, 2010. All providers endorsed for this
                                                                 service are expected to be in compliance with the new service
                                                                 definition requirements effective April 1, 2010. All stakeholders,
                                                                 including local management entities (LME), providers, and
                                                                 consumers are encouraged to carefully read this definition as it
                                                                 has been substantially modified.
                                                                    The DHHS service definition workgroup has reviewed all public
                                                                    comments for the revised Intensive In-Home service definition.
                                                                    Comments were supportive of the move to adopt Evidence-
                                                                    Based Practices. There were concerns raised regarding training
                                                                    and implementation during this time of significant system
                                                                    transition. Due to these concerns, the specific models listed will
    #068            2/2/2010       IIH and CST          IIH
                                                                    be removed from the current drafts. However, a basic foundation
                                                                    in evidence-based clinical practices is essential in the delivery of
                                                                    these rehabilitative services. Because of this, the new draft
                                                                    definition will include requirements for training in several general
                                                                    clinical best practices. The revised definitions will be re-posted for
                                                                    further comment.




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Implementation   Implementation
                                      Title (s)     Subject(s)                                  Summary
  Update #:        Update Date


                                                                   The DHHS service definition workgroup has reviewed all public
                                                                   comments for the revised Community Support Team service
                                                                   definition. Comments were supportive of the move to adopt
                                                                   Evidence-Based Practices. There were concerns raised
                                                                   regarding training and implementation during this time of
                                                                   significant system transition. Due to these concerns, the specific
    #068            2/2/2010        IIH and CST       CST
                                                                   models listed will be removed from the current drafts. However, a
                                                                   basic foundation in evidence-based clinical practices is essential
                                                                   in the delivery of these rehabilitative services. Because of this, the
                                                                   new draft definition will include requirements for training in
                                                                   several general clinical best practices. The revised definitions will
                                                                   be re-posted for further comment.



                                                                   Providers of Substance Abuse Intensive Outpatient Treatment
                                                                   (SAIOP) are required to submit a discharge ITR to ValueOptions
                                                                   at the end of a treatment episode or when a consumer leaves the
                                                                   service prior to the end of a treatment episode. This will allow
    #068            2/2/2010      SAIOP and SACOT    SAIOP         ValueOptions to keep an accurate and up-to-date record of
                                                                   treatment days available to the consumer. In addition, providers
                                                                   delivering evidence-based models (such as the Matrix Model)
                                                                   should submit the specific evidence based practice model name
                                                                   on the ITR when requesting authorization.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                        Providers of Substance Abuse Comprehensive Outpatient
                                                                        Treatment (SACOT) are required to submit a discharge ITR to
                                                                        ValueOptions at the end of a treatment episode or when a
                                                                        consumer leaves the service prior to the end of a treatment
    #068            2/2/2010      SAIOP and SACOT         SACOT         episode. This will allow ValueOptions to keep an accurate and
                                                                        upto-date record of treatment days available to the consumer. In
                                                                        addition, providers delivering evidence based models (such as
                                                                        the Matrix Model) should submit the specific evidence-based
                                                                        practice model name on the ITR when requesting authorization.


                                                                        The following clarification is a correction: For a mid-size ACT
                                    ACTT Mid-size
                                                                        Team, a physician is required to provide 24 hours of time per
    #068            2/2/2010      Team - Correction in     ACTT
                                                                        week -- not 32 hours a week as previously published in
                                    Physician Time
                                                                        Implementation Update # 65.


                                                                        The maximum caseload for the qualified professional has been
                                      CS Case                           removed for consumers who are receiving only the case
                                                         Community
    #068            2/2/2010         Management                         management component of Community Support services. Refer
                                                          Support
                                     Component                          to Implementation Update #65 for further information regarding
                                                                        the case management component of Community Support.




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Implementation   Implementation
                                       Title (s)       Subject(s)                                 Summary
  Update #:        Update Date

                                                                      Since Targeted Case Management (TCM) is authorized to a
                                                                      recipient's LME, no provider change request is required when the
                                                                      two TCM agencies are within the same LME. TCM providers
                                                                      within the same LME do not need to send a discharge CTCM or a
                                  Provider Changes                    new CTCM to ValueOptions when a recipient wishes to change to
    #068            2/2/2010      for Targeted Case       TCM         another provider. However, if a recipient wishes to change to a
                                     Management                       TCM provider that is not in the same LME as the previous TCM
                                                                      provider, a provider change prior approval request is required to
                                                                      be submitted to VO along with the following documents: a CTCM
                                                                      to discharge the previous provider; a CTCM to add the new
                                                                      provider; and a PCP Update.

                                                                      Beginning March 1, 2010, the maximum number of units for case
                                                                      management services will be limited to no more than three hours
                                                                      (12 units) per calendar month for each recipient. These changes
                                                                      apply to Medicaid funded DD case management and to the
                                  Policy Changes for
                                                          Case        following programs: CAP/DA, CAP/Choice, CAP/C, CAP/MR-DD,
    #068            2/2/2010      Case Management
                                                       Management     Targeted Case Management for Persons with Developmental
                                       Services
                                                                      Disabilities, and Early Intervention. Providers should continue to
                                                                      use the current program case management billing codes. State-
                                                                      funded case management services are authorized in accordance
                                                                      with each LME’s benefit plan.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                    Summary
  Update #:        Update Date

                                                                           Effective March 1 2010, any recipient receiving more than three
                                                                           hours (12 units) of case management per calendar month will
                                                                           have his/her hours reduced to the limit of three hours (12 units).
                                                                           Providers may request additional units (additional annual and
                                                                           monthly) by following the EPSDT requirements as outlined on
                                  Policy Changes for                       http://www.ncdhhs.gov/dma/epsdt/. If the request exceeds the
                                                             Early
    #068            2/2/2010      Case Management                          policy limits described above, the request will be reviewed under
                                                       Intervention (EI)
                                       Services                            the EPSDT criteria. If the request meets all of the EPSDT criteria
                                                                           and the requested amount is necessary to meet the child’s
                                                                           needs, the request will be approved. If the request does not meet
                                                                           all of the EPSDT criteria or the request exceeds what is
                                                                           necessary to meet the child’s needs, the request will not be
                                                                           approved at the level requested.
                                                                           Current authorizations with effective dates prior to March 1, 2010,
                                                                           will continue as authorized until the next annual continued need
                                                       Developmental       review (CNR). The three hour/12 unit limit policy will be applied at
                                  Policy Changes for    Disability (DD)    the next annual review. · Effective March 1, 2010, prior
     #68            2/2/2010      Case Management           Case           authorization of Case Management services for adults on the
                                       Services         Management         Supports and Comprehensive Waivers will not be required.
                                                       (Waiver Adults)     These adults will be eligible for up to three hours/12 units monthly
                                                                           as well as the additional 24 units for assessment, planning and
                                                                           crisis management, annually.




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Implementation   Implementation
                                       Title (s)          Subject(s)                                 Summary
  Update #:        Update Date

                                                                        Current authorizations with effective dates prior to March 1, 2010,
                                                                        will continue as authorized until the next annual continued need
                                                                        review (CNR). The three hour/12 unit limit policy will be applied at
                                                                        the next annual review. · Non–waiver adults will continue to
                                                                        require prior authorization and may be authorized for up to three
                                                        Developmental hours/12 units per month and no more than six additional
                                                        Disability (DD) hours/24 units if needed for completing an assessment,
                                  Policy Changes for
                                                            Case        completing a reauthorization or continued need review, or for a
     #68            2/2/2010      Case Management
                                                         Management crisis/emergency situation. If a case manager submits a request
                                       Services
                                                         (Non-Waiver for a non-waiver recipient that exceeds the policy limits, the case
                                                           Adults)      will be reviewed to determine how many hours/units are
                                                                        necessary to meet the recipient's needs (one, two, or three hours
                                                                        per calendar month and/or six or less additional hours if needed
                                                                        for completing an assessment, completing a reauthorization or
                                                                        continued need review, or for a crisis/emergency situation within
                                                                        365 days).
                                                                        Current authorizations with effective dates prior to March 1, 2010,
                                                                        will continue as authorized until the next annual continued need
                                                        Developmental
                                                                        review (CNR). The three hour/12 unit limit policy will be applied at
                                                        Disability (DD)
                                  Policy Changes for                    the next annual review. Effective March 1, 2010, prior
                                                            Case
    #068            2/2/2010      Case Management                       authorization of Case Management services for children on the
                                                         Management
                                       Services                         Supports and Comprehensive Waivers will not be required unless
                                                       (Waiver and Non-
                                                                        the request exceeds the three hour/12 unit monthly limit or 24 unit
                                                       Waiver Children)
                                                                        limit for assessment, planning and crisis situations. Non–waiver
                                                                        children will continue to require prior authorization. ·




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                      Waiver and non-waiver children must be evaluated under the
                                                                      EPSDT requirements prior to reducing their current service level
                                                      Developmental at their next annual review and for authorization requests that
                                                      Disability (DD) exceed the three hour/12 unit limit or the 24 unit limits for
                                  Policy Changes for
                                                          Case        assessment, planning and crisis management. The case
    #068            2/2/2010      Case Management
                                                       Management manager may request the additional six hours/24 units
                                       Services
                                                     (Waiver and Non- (T1017SC) for these current authorizations even if the current
                                                     Waiver Children) monthly authorization is in excess of the three hour/12 units per
                                                                      month. These requests will be reviewed under the EPSDT
                                                                      criteria.

                                                                         While the new limit on case management services has been
                                                                         reduced to no more than three hours (12 units) per calendar
                                                                         month and no more than six additional hours (24 units) if needed
                                                                         for completing an assessment, completing a reauthorization or
                                                                         continued need review, or for a crisis/emergency situation, these
                                                                         limits may not apply to children under 21 years of age. Federal
                                                                         law, 42 U.S.C. §1396d(r)(5), requires the State Medicaid agency
                                  Policy Changes for                     to provide to Medicaid recipients under 21 years of age
    #068            2/2/2010      Case Management          EPSDT         “necessary health care, diagnostic services, treatment, and other
                                       Services                          measures described in section 1905(a) of the [Social Security]
                                                                         Act to correct or ameliorate defects and physical and mental
                                                                         illnesses and conditions discovered by the screening services,
                                                                         whether or not such services are covered under the State
                                                                         [Medicaid] Plan.” For more information about EPSDT and
                                                                         provider documentation requirements for EPSDT requests,
                                                                         please visit
                                                                         http://www.ncdhhs.gov/dma/epsdt/.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date

                                                                        Case management services for individuals receiving services
                                                                        through the waiver programs will continue as currently approved
                                                                        until the next continued need review (CNR), or reauthorization is
                                                                        submitted. Current authorizations with effective dates prior to
                                                                        March 1, 2010 will continue as authorized until the next annual
                                                       CAP Waiver       CNR. All case management units must be documented on the
                                  Policy Changes for    Programs        cost summary. It is important to note that the conditions set forth
    #068            2/2/2010      Case Management       (CAP/DA,        in the CAP waiver concerning the recipient’s budget and
                                       Services        CAP/Choice,      continued participation in the waiver apply. The cost of the
                                                         CAP/C)         recipient’s care, including case management services, must not
                                                                        exceed the waiver cost limits specified in the CAP waiver. ·
                                                                        Children will be evaluated under EPSDT requirements prior to
                                                                        taking any adverse action. Documentation for case management
                                                                        billable units is required per the respective clinical coverage
                                                                        policies. Lack of supporting documentation for billed units will be
                                                                        referred to Program Integrity for possible recoupment.
                                                                        All requests for recipients under the age of 21 that exceed policy
                                                                        limits will be reviewed against the EPSDT criteria prior to taking
                                                                        adverse action, and the recipient or his/her legal guardian will
                                                                        receive a written notice explaining the decision. The notice will
                                  Policy Changes for   Recipient Due    state the decision and effective date of the reduction, explain the
    #068            2/2/2010      Case Management        Process -      reduction is based on Session Law 2009-451, Sections
                                       Services          Children       10.68A.(a)(2)(a) and 10.68A.(a)(10), DMA policy promulgated
                                                                        pursuant to S.L. 2009- 451, Section 10.68A.(c), as well as state
                                                                        the EPSDT criteria not met, and an explanation about how to
                                                                        appeal the decision should the recipient or his/her legal guardian
                                                                        so desire.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                  Summary
  Update #:        Update Date

                                                                        If the decision authorizes case management services to the policy
                                                                        limit (three hours per calendar month and/or six additional hours if
                                                                        needed for completing an assessment, completing a
                                                                        reauthorization or continued need review, or for a
                                                                        crisis/emergency situation within 365 days), the recipient or
                                  Policy Changes for   Recipient Due    his/her legal guardian will receive a written notice explaining the
    #068            2/2/2010      Case Management        Process -      decision. The notice will state the decision and effective date of
                                       Services           Adults        the reduction to the policy limit, explain the reduction is based on
                                                                        Session Law 2009-451, Sections 10.68A.(a)(2)(a) and
                                                                        10.68A.(a)(10) as well as DMA policy promulgated pursuant to
                                                                        S.L. 2009-451, Section 10.68A.(c), and that pursuant to 42 CFR
                                                                        §431.210 and §431.220(b), the recipient is not entitled to appeal
                                                                        this decision.
                                                                        Should less than three hours (12 units) per calendar month
                                                                        and/or less than six additional hours is needed for completing an
                                                                        assessment, completing a reauthorization or continued need
                                                                        review, or for a crisis/emergency situation within 365 days be
                                                                        authorized, the recipient or his/her legal guardian will receive a
                                  Policy Changes for   Recipient Due    written notice explaining the decision, and that he/she is entitled
     #68            2/2/2010      Case Management        Process -      to appeal the decision to authorize less than the policy limit. The
                                       Services        Adults (contd)   notice will state the decision and effective date of the reduction,
                                                                        explain the reduction is based on Session Law 2009-451,
                                                                        Sections 10.68A.(a)(2)(a) and 10.68A.(a)(10) as well as DMA
                                                                        policy promulgated pursuant to S.L. 2009-451, Section
                                                                        10.68A.(c), and an explanation about how to appeal the decision
                                                                        should the recipient or his/her legal guardian so desire.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                      A notice was sent at the end of January to recipients concerning
                                                                      the changes in case management. See the DMA website
                                                                      (http://www.ncdhhs.gov/dma/pub/consumerlibrary.htm) for a copy
                                                                      of the notice.
                                                     Recipient Notice Comments about the reductions in case management services
                                                       Regarding      may be sent to the following address:
                                  Policy Changes for
                                                      Reductions in Division of Medical Assistance
    #068            2/2/2010      Case Management
                                                          Case        Clinical Policy Section
                                       Services
                                                      Management 2501 Mail Service Center
                                                        Services      Raleigh, NC 27699-2501
                                                                      Questions may also be directed to the following areas: · CAP/DA,
                                                                      CAP/Choice, CAP/C – DMA Community Care Section 919-855-
                                                                      4260 · CAP/MR-DD, DD, EI – DMA Behavioral Health Section
                                                                      919-855-4290

                                                                        The person centered plan (PCP) format has been redesigned.
                                                                        Beginning March 1, 2010, for all other services requiring a PCP,
                                                                        the new format MAY be used when the next annual re-write of the
                                                                        PCP is due. Beginning July 1, 2010, the new format MUST be
                                                                        used when the next annual re-write of the PCP is due. the new
                                                                        design is greatly simplified and shortened. The motivation for the
                                     Revised PCP                        redesign was to lessen the burden on service providers by
    #068            2/2/2010      Format & One Page         PCP         reducing both paperwork and duplication of effort, while not
                                        Profile                         forfeiting the philosophical commitment to person-centered
                                                                        planning. The new PCP format and supporting documents may
                                                                        be found here: http://www.ncdhhs.gov/mhddsas/pcp.htm. The
                                                                        new PCP format includes: · One Page Profile · Action Plan ·
                                                                        Crisis Plan · Signature Page All parts of all sections listed above
                                                                        must be complete or PCPs will be returned as “unable to
                                                                        process” by ValueOptions.




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Implementation   Implementation
                                       Title (s)         Subject(s)                               Summary
  Update #:        Update Date

                                                                    Updates and revisions to the PCP are made per the current
                                                                    requirements, and must occur when: · The person’s needs have
                                                                    changed; or · A provider has changed or been added; or · Based
                                                                    on assigned target dates for review of the PCP goals; or ·
                                                                    Submission of a PCP revision is required for reauthorization
                                                                    requests. Additional information on updates/revisions can be
                                                                    found in the Records Management and Documentation Manual
                                                                    (RMDM) found at this link:
                                                                    http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/
                                     Revised PCP        PCP -
                                                                    rmd09/rmdmanual-final.pdf.
     #68            2/2/2010      Format & One Page Updates/Revisio
                                                                    A new Update/Revision Page and Update/Revision Signature
                                        Profile           ns
                                                                    Page are posted along with the new PCP. The changes to both
                                                                    these pages coincide with the revised Action Plan Page and
                                                                    Signature Page found in the new PCP. · An Update/Revision may
                                                                    be made in the body of the Action Plan of the current PCP,
                                                                    accompanied by the Update/Revision Signature Page. · If a new
                                                                    goal is added or a significant revision to a goal is made, or any
                                                                    other lengthy narrative update or revision is needed, then use the
                                                                    Update/Revision Action Plan Page to record this, accompanied
                                                                    by the Update/Revision Signature Page.
                                                                    A revised manual is posted along with the new PCP format and
                                                                    Update/Revision pages. In addition, supplemental pages are
                                                                    posted or will be posted shortly, that include the Person Centered
                                     Revised PCP
                                                    PCP Instruction Thinking Tools and Guidelines for use in preparing the One Page
     #68            2/2/2010      Format & One Page
                                                       Manual       Profile and for use by providers to assist in implementation of the
                                        Profile
                                                                    PCP. This manual will continue to undergo revisions.
                                                                    Consultants will provide guidance on the preparation and
                                                                    implementation of person-centered plans.




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Implementation   Implementation
                                    Title (s)      Subject(s)                               Summary
  Update #:        Update Date



                                                                Beginning March 1, 2010, notices of new authorization approvals,
                                                                and the letters will be available only on the ValueOptions online
                                                                provider portal ProviderConnect. ValueOptions will end the
                                                                mailing of paper authorization approval letters as of March 1,
                                   Important     ValueOptions -
                                                                2010. Adverse determination letters will continue to be mailed to
    #068            2/2/2010      ValueOptions    Authorization
                                                                the recipient with a copy to the provider. Providers who have not
                                    Updates         Approval
                                                                previously used ProviderConnect must register for
                                                                ProviderConnect at
                                                                https://www.valueoptions.com/pc/eProvider/providerRegisterFrom
                                                                Login.do.


                                                                Training webinars will be conducted in February 2010 to educate
                                                                providers about the new online approval letter process. Visit
                                                                www.valueoptions.com/providers/Network/North_Carolina_Medic
                                   Important                    aid.htm and scroll to “Provider Training Opportunities”
                                                 ValueOptions -
     #68            2/2/2010      ValueOptions                  to register for a webinar. Providers who previously completed
                                                    Training
                                    Updates                     webinar training for submitting requests need not attend again -
                                                                the only change to online request submission for outpatient
                                                                requests is selection of “Outpatient” from the Level of Service
                                                                drop-down menu.
                                                                Outpatient requests can be submitted online via ProviderConnect.
                                                                Service orders can be uploaded with the online outpatient request
                                                                in the same manner as one does now for PCPs with online
                                   Important     ValueOptions -
                                                                enhanced service requests. ValueOptions authorizes outpatient
     #68            2/2/2010      ValueOptions     Outpatient
                                                                services to the provider name and Medicaid number listed in the
                                    Updates        Requests
                                                                Billing Provider Name/Number fields. Providers must participate
                                                                in webinar training before using ProviderConnect to submit
                                                                service requests for the first time.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                   Summary
  Update #:        Update Date


                                                                          All required documents must accompany all requests for
                                                          Residential
                                  Residential Services                    residential services, regardless of whether requests are deemed
                                                          Services -
    #068            2/2/2010        Levels III & IV                       as routine or urgent by the submitting provider. Please refer to
                                                         Requests for
                                       Updates                            Implementation Update #60 and #63 for information on all
                                                           Service
                                                                          required documents.


                                                                       Discharge plans must be updated for each concurrent review
                                                                      with updated information related to discharge setting and/or
                                                         Residential
                                  Residential Services                service needs, updated dates and new signatures. However,
                                                          Services -
    #068            2/2/2010        Levels III & IV                   signoffs on the discharge plan signatures for Level III and Level
                                                       Discharge from
                                       Updates                        IV homes may be done by the System of Care (SOC)
                                                           Service
                                                                      coordinators every 90 days, unless a significant change in the
                                                                      subject child's well-being occurs.

                                                         Residential
                                                         Services -       The psychiatric evaluation must be performed by a psychiatrist,
                                                       Clarification of   psychiatric physician’s assistant (PA) who is working under a
                                  Residential Services Provider Types     psychiatrist’s protocol, or a Licensed Nurse Practitioner. Effective
    #068            2/2/2010        Levels III & IV     Approved to       April 15, 2010, the only Licensed Nurse Practitioners who may
                                       Updates            Perform         perform these assessments will be an Advanced Practice
                                                        Independent       Psychiatric Clinical Nurse Specialist or Advanced Practice
                                                         Psychiatric      Psychiatric Nurse Practitioner.
                                                        Assessments




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Implementation   Implementation
                                       Title (s)        Subject(s)                                    Summary
  Update #:        Update Date

                                                                        LMEs are to process endorsement requests from potential
                                                                        providers of Day Treatment, Intensive In-Home and Community
                                                                        Support Team services in accordance with the current DHHS
                                                                        Endorsement Policy. Implementation Update # 63 indicated that
                                  Endorsement of Day
                                                                        endorsement of Day Treatment, Intensive In-Home and
                                      Treatment,
                                                                        Community Support Team services on or after January 1, 2010
    #068            2/2/2010      Community Support    Endorsement
                                                                        would be limited to providers that appeared to meet the criteria to
                                  Team and Intensive
                                                                        be a Critical Access Behavioral Health Agency (CABHA). This
                                       In-Home
                                                                        restriction on endorsement is being temporarily lifted for these
                                                                        three services until CABHAs are established. It is the intent of the
                                                                        State to require CABHA certification for providers to continue to
                                                                        deliver these three services effective July 1, 2010.




                                                                        DHHS has established a process for requesting approval for
                                                                        other categories of physicians to be approved to service as
                                                                        Medical Directors for CABHAs due to concerns regarding the
                                                                        availability of psychiatrists. The Medical Director (halftime or full-
                                                                        time depending upon the caseload size of the agency) of a
                                                                        Critical Access Behavioral Health Agency must be a physician
                                                        CABHA -
                                                                        (MD/DO) licensed in North Carolina and enrolled in the Medicaid
    #068            2/2/2010       CABHA Physician      Physician
                                                                        program. Other credentials and qualifications are outlined in this
                                                       Qualifications
                                                                        Implementation Update. Agencies wishing to request an
                                                                        exception under this policy should e-mail a request explaining
                                                                        why the agency is requesting an exception, a copy of the license
                                                                        of the physician for whom the exception is requested and
                                                                        documentation to verify the physician's experience with the
                                                                        population to be served to Contact.DMH.LME@dhhs.nc.gov




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 Implementation   Implementation
                                       Title (s)       Subject(s)                                 Summary
   Update #:        Update Date

                                                                      This special Implementation Update is applicable only to
                                                                      providers of Psychosocial Rehabilitation (PSR) services. The
                                                                      requirements for using the new Person-Centered Plan (PCP)
                                                                      format for PSR providers who, based on earlier changes in policy,
                                                                      are now required to write and implement PCPs are outlined. The
                                                                      redesigned PCP is accompanied by an interim Instruction
                                     Psychosocial
      #067                                                            Manual. The manual is “interim” because there will be continued
                                    Rehabilitation
    SPECIAL                                                           development throughout the next month to add detail and
                                   Service Providers
IMPLEMENTATION      1/29/2010                            PCP          clarification in some areas. The new PCP format includes:· a One
                                    Only: Revised
    UPDATE                                                            Page Profile, an Action Plan, a Crisis Plan, and a Signature
                                   Person Centered
                                                                      Page . If all sections are not complete, the PCP will be returned
                                     Plan Format
                                                                      as “unable to process” by ValueOptions. With implementation of
                                                                      the new PCP, an Introductory PCP will not be used for
                                                                      consumers new to the system. For PSR providers, submission of
                                                                      a prior authorization request with an Introductory PCP on or after
                                                                      February 1, 2010 will be returned by ValueOptions as Unable to
                                                                      Process.




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 Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
   Update #:        Update Date



                                                                         Beginning February 1, 2010, the new format ffor the PCP --
                                                                         http://www.ncdhhs.gov/mhddsas/pcp.htm -- must be used when
                                                                         the next annual re-write of the PCP is due. · For example, if the
                                     Psychosocial                        date on the current PCP is March 12, 2009, the new PCP using
      #067                          Rehabilitation                       the new format must be in place by March 12, 2010. · If the date
    SPECIAL                        Service Providers     PCP - PSR       on the current PCP is January 31, 2010, the annual rewrite is not
                    1/29/2010
IMPLEMENTATION                      Only: Revised       Services Only    due until January 31, 2011. · Beginning February 1, 2010, the
    UPDATE                         Person Centered                       new format will be used for anyone who is newly admitted for
                                     Plan Format                         PSR services. · The PCP must include all services that the
                                                                         person receives in addition to PSR, such as outpatient treatment,
                                                                         medication management, etc.· Only a qualified professional (or
                                                                         licensed professional) may complete the PCP.



                                                                       Updates and revisions to the PCP must occur when: ·a) The
                                     Psychosocial                      person’s needs have changed; or ·b) A provider has changed or
      #067                          Rehabilitation                     been added; or ·c) Based on assigned target dates for review of
                                                           PCP -
    SPECIAL                        Service Providers                   the PCP goals; or d)· Submission of a PCP revision is required
                    1/29/2010                          Update/Revision
IMPLEMENTATION                      Only: Revised                      for reauthorization requests. A new Update/Revision Page and
                                                              s
    UPDATE                         Person Centered                     Update/Revision Signature Page are posted along with the new
                                     Plan Format                       PCP. Changes to both these pages coincide with the revised
                                                                       Action Plan page and Signature Page found in the new PCP.




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Implementation   Implementation
                                         Title (s)          Subject(s)                                    Summary
  Update #:        Update Date

                                                                            Facilities that serve or that intend to serve individuals under
                                                                            petitions of involuntary commitment must go through a review
                                                                            process in order to be authorized to accept and treat involuntary
                                                                            clients. Facilities currently serving involuntary clients that have not
                                                                            been through a review process for designation must do so in
                                                                            order ot be in compliance with statute and rule. This includes
                                                                            community hospitals that have a contract to provide local
                                                                            inpatient psychiatric beds under Session Law 2008-107, Section
                                                                            10.15(k), non-hospital medical detox facilities, facility-based crisis
                                                                            services. G.S. §122C-252 requires that designation of 24-hour
                                  Application Process for    Involuntary    facilities for the custody and treatment of involuntary clients be
    #066            1/5/2010
                                     IVC Designation        Commitment      made in accordance with rules of the Secretary (10A NCAC
                                                                            26C.0100) that assure protection of the client and the general
                                                                            public. Faciliites requesting designation should complete the
                                                                            attached form with the requested information and return it to the
                                                                            DMH/DD/SAS Accountability Team’s Policy Unit to the attention
                                                                            of Jamie.Maginnes@dhhs.nc.gov.
                                                                            Note: Due to a staffing change, applications for IVC designation
                                                                            and/or questions about the designation process should be
                                                                            submitted to Mary Tripp at Mary.Tripp@dhhs.nc.gov .




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Implementation   Implementation
                                         Title (s)            Subject(s)                                   Summary
  Update #:        Update Date


                                                                              The Introductory Person Centered Plan (PCP) can only be used and
                                                                              submitted to ValueOptions with an initial request if the consumer is
                                                                              brand new to the MH/DD/SA system or if the consumer has been
                                                                              completely discharged from services and has not received any
                                                                              MH/DD/SA services for 60 days or longer. This reminder is especially
                                  Use of the Introductory                     important for providers of services who have recently assumed
    #066            1/5/2010                                     PCP
                                           PCP                                responsibility for the development and implementation of the Person
                                                                              Centered Plan announced in Implementation Update #60:
                                                                              · Child and Adolescent Day Treatment· Psychosocial Rehabilitation·
                                                                              Opioid Treatment · SA Medically-Monitored Community Residential
                                                                              Treatment· SA Non-Medical Community Residential Treatment· Partial
                                                                              Hospitalization· Residential II-IV (including Level II Family Type).

                                                                            Providers can now save partially or fully completed draft requests
                                                                            for up to seven days from the date originally saved. The draft
                                                                            request can be saved and returned to later to complete and then
                                                                            submit. Providers have the option to perform a “second look” of a
                                                                            saved draft by a supervisor prior to online submission. After the
                                                                            service request has been submitted online, a provider can print
                                      ValueOptions                          the request, print confirmation of the submission, and/or
                                                            Enhancements to
    #066            1/5/2010         ProviderConnect                        download the request as a .pdf or .xml file to a computer. In
                                                            ProviderConnect
                                         Updates                            addition, providers can now submit requests for NC Health
                                                                            Choice consumers online via ProviderConnect in addition to
                                                                            Medicaid recipients. Providers must participate in training before
                                                                            using ProviderConnect to submit service requests. Go to
                                                                            http://www.valueoptions.com/providers/Network/North_Carolina_
                                                                            Medicaid.htm and scroll down to “Provider Training Opportunities”
                                                                            to view the webinar schedule and register.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                   Summary
  Update #:        Update Date

                                                                          As noted in Implementation Update # 60, all Medicaid-funded
                                                                          child mental health and substance abuse residential service
                                                                          providers (Level II-program type, III and IV) are required to be
                                                                          nationally accredited within one year of enactment of the S. L.
                                                                          2009-451 for providers enrolled prior to August 7, 2009 or within
                                                                          one year of enrollment with the Division of Medical Assistance
                                                                          (DMA) for providers enrolled after August 7, 2009. That means
                                   Accreditation for    Accreditation -   that all child residential providers of Level II Program Type, Level
    #066            1/5/2010      Residential Service    Residential      III and Level IV services that were enrolled on August 7, 2009
                                      Providers           Providers
                                                                          must achieve national accreditation by August 7, 2010 (one year
                                                                          from date of enactment of the legislation). Accreditation
                                                                          benchmarks outlined in G. S. 122C-81 will apply to residential
                                                                          service providers. Information on how to apply the accreditation
                                                                          benchmarks can be found in
                                                                          Implementation Update #47 at:
                                                                          http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdate
                                                                          s/dmadmh8-4-08update47.pdf.
                                                                          A revised Notification of Endorsement Action (NEA) letter has
                                                                          been developed. Effective January 11, 2010, providers should
                                                                          discontinue using the NEA letter form that is currently on the
                                                                          DMH/DD/SAS Endorsement website (dated 9/08) and use the
                                                                          revised letter which is attached and which will be placed on the
    #066            1/5/2010      Revised NEA Letter     NEA Letter       DMH/DD/SAS website. The revised letter includes more detailed
                                                                          information regarding reconsideration and appeals, national
                                                                          accreditation, and documentation requirements. A sample letter
                                                                          can be found at:
                                                                          http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdate
                                                                          s/update66/final-nea-letter12-18-09.doc




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Implementation   Implementation
                                       Title (s)          Subject(s)                                      Summary
  Update #:        Update Date


                                                                        The North Carolina Department of Health and Human Services (DHHS)
                                                                        announced in the December Medicaid Bulletin and in Communication
                                                                        Bulletin #106 that DHHS is requesting approval from the Centers for
                                                                        Medicare and Medicaid Services (CMS) for a mental health,
                                                                        developmental disabilities and substance abuse service waiver
                                                                        program. The Waiver Technical Amendment was submitted to CMS on
                                                                        December 16, 2009. The model for this waiver amendment is based
                                   Medicaid Waiver
                                                          1915 (b)(c)   upon the current 1915 (b)(c) waiver that has been operating in
    #066            1/5/2010        Amendment
                                                        Medicaid Waiver Cabarrus, Davidson, Rowan, Stanly, and Union counties since April
                                     Submission
                                                                        2005. The existing waiver is currently administered by the State through
                                                                        PBH (formerly known as Piedmont Behavioral Healthcare) LME. PBH
                                                                        has been working in partnership with DMH/DD/SAS and DMA in support
                                                                        of this waiver expansion request to CMS. DHHS is asking to replicate
                                                                        PBH’s model with some additional amendments to the current 1915
                                                                        (b)(c) waiver application and to make the waiver statewide with the
                                                                        ability to phase in new LME waiver entities.



                                                                           To clarify questions related to the qualifications of the physician (MD/DO
                                                           CABHA -         - Doctor of Osteopathy) who can serve as a medical director: The
    #066            1/5/2010      CABHA Clarification      Physician       qualifications of the medical director are a psychiatrist (Board Eligible
                                                          Qualifications   /Board Certified) or a physician with ASAM certification if the CABHA will
                                                                           have substance abuse as a primary focus of treatment.




                                                                        To clarify questions regarding the minimum of two enhanced services
                                                                        that must be provided in addition to the core services: The list of
                                                                        additional services is defined in Implementation Update #63 and #64;
                                                        CABHA - Service however, in order to provide a continuum of service for the population to
    #066            1/5/2010      CABHA Clarification
                                                            Array       be served the services are required to be specific to the same age and
                                                                        disability type. The goal is for the core and additional services to create
                                                                        a continuum of services. The array will vary depending upon the age
                                                                        and needs of the consumers to be served by the agency.




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Implementation   Implementation
                                       Title (s)          Subject(s)                                       Summary
  Update #:        Update Date


                                                                            In an effort to improve the recipient due process procedure, DMA
                                                                            periodically publishes information to clarify or emphasize procedures
                                                                            related to due process. When a request is submitted to DMA or one of
                                    Clarification on
                                                                            its vendors, it is reviewed to determine if it is a proper request. If the
                                    Procedures for
                                                         Prior Approval -   request is found to be improper, it cannot be processed by DMA or the
                                    Reviewing Prior
    #066            1/5/2010                              Due Process       vendor and it is returned to the sender. A proper request must include
                                  Approval Requests &
                                                           Procedures       the information specified below. Additionally, a request may be returned
                                  Obtaining Additional
                                                                            to the provider as unable to process when another provider other than
                                      Information
                                                                            the requesting provider is currently authorized to provide the requested
                                                                            service. There are no written notice or appeal rights when a request is
                                                                            returned due to unable to process.



                                                                            DMA has determined that providers will no longer be able to change or
                                                                            withdraw a request once it has been submitted. This practice will
                                    Clarification on                        discontinue immediately to ensure that the recipient is involved in the
                                    Procedures for         Change or        decision to change or withdraw the request. The request will be
                                    Reviewing Prior        Withdrawal       considered as presented. As a result, it is imoperative that the request
    #066            1/5/2010
                                  Approval Requests &     Requests No       contain all recipient-specific current clinical information that documents
                                  Obtaining Additional   Longer Allowed     events, impairments, symptoms, and patterns that support satisfaction
                                      Information                           of the clnical coverage criteria for the requested service. If DMA or the
                                                                            vender denies, reduces, or terminates, written notice with appeal rights
                                                                            will be issued to the recipient or the legal representative.




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Implementation   Implementation
                                        Title (s)            Subject(s)                                      Summary
  Update #:        Update Date

                                                                             From time to time, a provider may submit a request without sufficient
                                                                             information for DMA or the vendor to make a decision on the request.
                                    Clarification on        Prior Approval - Medicaid's policy is that DMA or the vendor must request the specific
                                    Procedures for            Requesting     information needed in writing. The provider must respond to this request
                                    Reviewing Prior            Additional    by submitting the needed information or requesting a time extension
    #066            1/5/2010
                                  Approval Requests &         Information    within 15 business days of the date of the notice. If the provider does
                                  Obtaining Additional     (Procedures and not submit the information or request a time extension, the request is
                                      Information              Timelines)    denied, and a written notice with appeal rights is generated. Even if the
                                                                             recipient files an appeal, a new request with the needed information
                                                                             may be submitted at any time.


                                                                              From time to time, information may be needed emergently or to clarify
                                     Clarification on      Prior Approval -   the request. It is acceptable for DMA or the vendor to contact the
                                     Procedures for          Requesting       provider or the recipient by telephone to request the needed
    #066            1/5/2010         Reviewing PA             Additional      information. During the course of the conversation, DMA or the vendor
                                  Requests & Obtaining     Information via    will read a prepared statement indicating the purpose of the call and that
                                  Additional Information      Telephone       the intent of the call is not to ask the provider or recipient to change or
                                                                              withdraw the request.



                                                                              Beginning March 1, 2010, there will be a monthly limit on the number of
                                                                              hours allowed for case management service. Providers will be paid for
                                                                              a maximum of three hours of case management each month. These
                                                                              case management limits apply to CAP/C, CAP/DA, CAP/MR-DD,
                                                                              Targeted Case Management for Persons with Developmental
                                  Limits for Medicaid CM       Case           Disabilities, and Early Intervention. Case management limits for the
    #066            1/5/2010
                                          Services          Management        following programs remain unchanged: At Risk, Maternity Child
                                                                              Coordination, Child Service Coordination, Maternity Outreach, and HIV.
                                                                              These limits may not apply to recipients under the age of 21 years as
                                                                              long as all criteria for Early and Periodic Screening, Diagnosis, and
                                                                              Treatment (EPSDT), Medicaid for Children, are met. For further
                                                                              information about EPSDT, visit DMA's EPSDT web page.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                Summary
  Update #:        Update Date

                                                                   In compliance with the Improper Payments Information Act of
                                                                   2002, the Centers for Medicare and Medicaid Services (CMS)
                                                                   implemented a national Payment Error Rate Measurement
                                                                   (PERM) program to measure improper payments in the Medicaid
                                                                   program and the State Children’s Health Insurance Program
                                                                   (SCHIP). North Carolina has been selected as one of 17 states
                                                                   required to participate in PERM reviews of Medicaid Fee-For-
                                  Payment Error Rate Reimbursement
    #065           12/10/2009                                      Service and Medicaid Managed Care claims paid in Federal fiscal
                                  Measurement in NC     & Billing
                                                                   year 2010 (October 1, 2009-September 30, 2010). CMS is using
                                                                   two national contractors to measure improper payments. One of
                                                                   the contractors, Livanta LLC (Livanta), will be communicating
                                                                   directly with providers and requesting medical record
                                                                   documentation associated with the sampled claims. Providers will
                                                                   be required to furnish the records requested by Livanta, within a
                                                                   timeframe indicated by Livanta.

                                                                         Community Intervention Services (CIS) agencies have now
                                                                         received the re-verification packets that must be completed and
                                                                         returned to Computer Sciences Corporation (CSC) immediately
                                  Provider Verification                  to ensure uninterrupted enrollment as a CIS provider. For detailed
                                                           Provider
    #065           12/10/2009      and Credentialing                     information, please review Implementation Update #63
                                                          Enrollment
                                       Activities                        (http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdat
                                                                         es/), the November 2009 Medicaid Bulletin
                                                                         (http://www.ncdhhs.gov/dma/bulletin/) or contact the CSC EVC
                                                                         Call Center at 1-866-844-1113.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                  Summary
  Update #:        Update Date


                                                                      In instances where a child does not have Community Support
                                                                      services or another clinical home service, a qualified professional
                                                     Therapeutic      (QP) on staff with the licensed private child-placing agency
                                  PCP Development    Foster Care      (LCPA) may complete the PCP as required for submission. This
    #065           12/10/2009
                                  by TFC Providers   (TFC) - PCP      policy change was made by DHHS due to concerns from TFC
                                                     Development      placement agnecies reagarding accessing Community Support
                                                                      services for the timely completion of the Person Centered Plan
                                                                      (PCP) for children and adolescents receiving TFC.

                                                                    A revision to section 10A NCAC 70G.0503 PLACEMENT
                                                                    SERVICES for foster parents and therapeutic foster parents
                                                     Administrative
                                                                    requires supervision of therapeutic foster parents by a qualified
                                                     Rule Change -
                                                                    professional as defined in 10A NCAC 27G.0503. Under this
                                  PCP Development    Licensed Child
    #065           12/10/2009                                       requirement, an LCPA must thave on staff indivdiuals qualified to
                                  by TFC Providers     Placement
                                                                    assume the responsibility for completing PCPs for the children in
                                                        Agencies
                                                                    their care. This rule revision, which became effective November
                                                         (LCPA)
                                                                    1, 2009, makes it possible for QPs working in TFC settings to
                                                                    develop PCPs upon completion of the PCP training requirements.
                                                                    In addition to the six hours of “Person-Centered Thinking”
                                                                    training, QPs working in a TFC setting are also required to
                                                                    complete three hours of “PCP Instructional Elements” training
                                                                    prior to developing a PCP. See Implementation Update #10 and
                                                                    the updated PCP manual on the Division of Mental Health,
                                  PCP Development
    #065           12/10/2009                         PCP Training Developmental Disabilities, and Substance Abuse Services’
                                  by TFC Providers
                                                                    (DMH/DD/SAS) website for more information. The PCP
                                                                    Instructional Webcast Training
                                                                    (http://www.ncdhhs.gov/mhddsas/pcp.htm)
                                                                    or other PCP planning/writing training may aid in fulfilling these
                                                                    requirements.




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Implementation   Implementation
                                      Title (s)        Subject(s)                                  Summary
  Update #:        Update Date


                                                                      Effective January 1, 2010, any requests for authorization to
                                                         Service      ValueOptions for these services must include the total units,
                                  Changes in SAIOP,
    #065           12/10/2009                         Authorization - including the unmanaged units and the start date fo the
                                  SACOT, and ACTT
                                                      ValueOptions admission to assure accurate transfer of information to HP/EDS
                                                                      for claims adjudication.

                                                                       Effective January 1, 2010, Medicaid recipients receiving
                                                                       Substance Abuse Intensive Outpatient Program (SAIOP) services
                                                                       may be seen for the initial 30 days of treatment without a prior
                                                                       authorization. Services provided after this initial 30 day “pass-
                                                                       through” period require authorization from the Medicaid approved
    #065           12/10/2009     Changes in SAIOP       SAIOP
                                                                       vendor (ValueOptions). This pass-through is available only once
                                                                       per calendar year. For State-funded SAIOP services, local
                                                                       management entities (LMEs) will establish authorization
                                                                       guidelines in accordance with the local consumer benefit plan to
                                                                       ensure rapid access to needed treatment.
                                                                       Effective January 1, 2010, Medicaid recipients receiving
                                                                       Substance Abuse Comprehensive Outpatient Treatment
                                                                       (SACOT) services may be seen for the initial 60 days of
                                                                       treatment without a prior authorization. Services provided after
                                                                       this initial 60 day “pass-through” period require authorization from
    #065           12/10/2009     Changes in SACOT       SACOT
                                                                       the Medicaid approved vendor (Value Options). This pass-
                                                                       through is available only once per calendar year. For State-
                                                                       funded SACOT services, LMEs will establish authorization
                                                                       guidelines in accordance with the local consumer benefit plan to
                                                                       ensure rapid access to needed treatment.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                  Summary
  Update #:        Update Date

                                                                    Effective January 1, 2010, providers of Assertive Community
                                                                    Treatment Team (ACTT) services have the option of offering a
                                                                    midsize ACT Team consisting of between 51 and 75 recipients.
                                                                    Currently, providers of ACTT services may provide treatment via
                                                                    a small team (up to 50 recipients) or via a large team (51-100
                                                        Assertive   recipients). With the effective date of January 1, 2010, providers
                                                       Community    will have the option of staffing for the midsize team and providing
    #065           12/10/2009     Changes in ACTT
                                                    Treatment Team services for between 51 and 75 recipients. This is a change from
                                                         (ACTT)     the former policy that only allowed for a small or a large team.
                                                                    The staffing criteria for all three levels of ACTT are contained in
                                                                    this Implementation Update. Refer to the service definition for a
                                                                    detailed description of the roles and responsibilities of each staff
                                                                    position. Until the entire service definition for ACTT has been
                                                                    updated to reflect these changes, providers are required to follow
                                                                    Serving 76-100 this Implementation 10-12 staff (in addition to
                                                                    the guidelines inrecipients consists of Update.
                                                                    the psychiatrist and program assistant). Team composition is as
                                                                    follows: o 1 full-time master’s-level qualified professional team
                                                                    leader o 2 FTE registered nurses (RNs) o 1 FTE substance
                                                                    abuse specialist (LCAS, CCS, or CSAC) o 1 FTE qualified
                                                        Assertive   professional in mental health (preferably with a master’s degree
                                                       Community    in rehabilitation counseling) with responsibility for role as
    #065           12/10/2009     Changes in ACTT   Treatment Team vocational specialist o 2 FTE master’s-level qualified
                                                     (ACTT) - Large professionals in mental health or substance abuse o 1 FTE
                                                       ACT Team:    certified peer support specialist (may be filled by no more than
                                                                    two individuals) o 2 FTE qualified professionals or associate
                                                                    professionals in mental health or substance abuse o 32 hrs per
                                                                    week psychiatrist o 1 full-time program assistant o Additional
                                                                    positions are based on the needs of the individuals served;
                                                                    additional staff members shall meet at least qualified
                                                                    professional, associate professional or paraprofessional status.




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Implementation   Implementation
                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date

                                                                   Serving 51-75 recipients consists of 8-10 staff (in addition to the
                                                                   psychiatrist and program assistant). Team composition is as
                                                                   follows: o 1 full-time master’s-level qualified professional team
                                                                   leader o 2 FTE registered nurses (RNs) o 1 FTE substance
                                                                   abuse specialist (LCAS, CCS, or CSAC) o 1 FTE qualified
                                                        Assertive  professional in mental health (preferably with a master’s degree
                                                       Community   in rehabilitation counseling) with responsibility for role as
    #065           12/10/2009     Changes in ACTT   Treatment Team vocational specialist o 2 FTE master’s-level qualified
                                                     (ACTT) - Mid- professionals in mental health or substance abuse o 1 FTE
                                                    size ACT Team: certified peer support specialist (may be filled by no more than
                                                                   two individuals) o 32 hrs per week psychiatrist o 1 full-time
                                                                   program assistant o Additional positions are based on the needs
                                                                   of the individuals served; additional staff members shall meet at
                                                                   least qualified professional, associate professional or
                                                                   paraprofessional status.
                                                                    Serving at least 50 recipients consists of 6-8 staff (in addition to
                                                                    the psychiatrist and program assistant). Team composition is as
                                                                    follows: o 1 full-time master’s-level qualified professional team
                                                                    leader o 1 FTE registered nurse (RN) o 1 FTE substance abuse
                                                                    specialist (LCAS, CCS, or CSAC) o 1 FTE qualified professional
                                                        Assertive
                                                                    in mental health (preferably with a master’s degree in
                                                       Community
                                                                    rehabilitation counseling) with responsibility for role as vocational
    #065           12/10/2009     Changes in ACTT   Treatment Team
                                                                    specialist o 1 FTE master’s-level qualified professional in mental
                                                     (ACTT) - Small
                                                                    health or substance abuse o 1 FTE certified peer support
                                                       ACT Team:
                                                                    specialist (may be filled by no more than two individuals) o 16 hrs
                                                                    per week psychiatrist o 1 full-time program assistant o Additional
                                                                    positions are based on the needs of the individuals served;
                                                                    additional staff members shall meet at least qualified
                                                                    professional, associate professional or paraprofessional status.




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                   TOPICAL INDEX AND ABSTRACTS OF DMH/DD/SAS AND DMA IMPLEMENTATION UPDATES



Implementation   Implementation
                                      Title (s)       Subject(s)                                  Summary
  Update #:        Update Date

                                                                      The Centers for Medicare and Medicaid Services approved the
                                                                      request to continue the case management component of
                                                                      Community Support service by qualified and licensed
                                                                      professionals during the interim period until the new case
                                                                      management service definition is approved. As a result,
                                                                      consumers currently receiving Community Support and new
                                                                      consumers entering the system on or after January 1, 2010 will
                                     CS Case                          be able to receive the case management component of
                                                      Community
    #065           12/10/2009       Management                        Community Support in order to ease the transition to the new
                                                       Support
                                    Component                         case management service. [Note: LMEs may also authorize the
                                                                      case management component of CSS for non-Medicaid eligible
                                                                      consumers under these same criteria, subject to availability of
                                                                      funds and the provisions of the LME’s benefit plan.] Requests for
                                                                      Community Support services for children must follow the
                                                                      established Early and Periodic Screening, Diagnosis, and
                                                                      Treatment (EPSDT) procedures and requirements, which are
                                                                      available at http://www.dhhs.state.nc.us/dma/epsdt
                                     CS Case            Service      The specific requirements for making initial and concurrent
    #065           12/10/2009       Management       Authorization - authorization requests for case management services are
                                    Component        ValueOptions outlined.

                                                                     IU #60 provided a list of enhanced services that could not be
                                                                     authorized in conjunction with CSS. Those treatment providers
                                  Enhanced Service                   are responsible for the development of the PCP, including the
                                                        Service
                                    Providers and                    Crisis Plan, submission of the consumer admission form to the
    #065           12/10/2009                        Authorization -
                                     Requests to                     LME, and submission of the applicable request for authorization
                                                     ValueOptions
                                    ValueOptions                     form and supporting documentation to ValueOptions. These
                                                                     providers are also responsible for referring the recipient to other
                                                                     appropriate services if a request for authorization is denied.




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Implementation   Implementation
                                       Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                    In Implementation Update #62, the CAP-MR/DD Re-
                                                                    Endorsement Letter of Attestation inadvertently included Day
                                                   CAP-MR/DD Re-
                                                                    Services as a CAP-MR/DD service requiring re-endorsement.
                                                     Endorsement
                                                                    Day Services should not have been included in the list of CAP-
                                                       Letter of
    #065           12/10/2009                                       MR/DD services requiring CAP-MR/DD re-endorsement since it is
                                  CAP-MR/DD Update   Attestation -
                                                                    not a CAP-MR/DD service. The Day Services block should not be
                                                    Deletion of Day
                                                                    checked when completing the form. Day Services will be
                                                       Services
                                                                    removed from the form letter if/when the CAP-MR/DD Re-
                                                                    Endorsement Letter of Attestation is revised.


                                                                        This serves as a reminder of the requirement for national
                                                                        accreditation for providers of CAP-MR/DD waiver services. As
                                                                        required by General Statue 122C-81, providers of waiver services
                                                                        (with the exception of the Adult Day Health service which does
                                                                        not require national accreditation) shall have achieved national
                                                                        accreditation by November 1, 2009. The law establishes specific
                                                                        benchmarks by which specific activities related to accreditation
                                                                        must be completed by providers. The LMEs are responsible for
                                  CAP-MR/DD Update                      monitoring providers to ensure providers are meeting the
    #065           12/10/2009                          Accreditation
                                     (continued)                        benchmarks and have secured accreditation by the November 1,
                                                                        2009 deadline. If providers do not meet all established
                                                                        benchmarks including the November 1, 2009 deadline the LME
                                                                        must remove the provider’s endorsement and notify the Division
                                                                        of Medical Assistance. The law requires DHHS to terminate the
                                                                        provider’s enrollment in the Medicaid program within 60 days of
                                                                        the provider’s failure to meet the required benchmarks. There are
                                                                        no allowable exceptions to this law. For further information see
                                                                        Implementation Update # 47.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                    Summary
  Update #:        Update Date




                                                                   The Division of Mental Health, Developmental Disabilities and
                                                                   Substance Abuse Services provided formal notification to the
                                                    Allocation of
                                  CAP-MR/DD Update                 LMEs on November 19, 2009 regarding the release of CAP-
    #065           12/10/2009                      Additional CAP-
                                     (continued)                   MR/DD slots. This notification can be found at the following link:
                                                    MR/DD Slots
                                                                   http://www.ncdhhs.gov/mhddsas/announce/additionalcap-
                                                                   mrddslots11- 09.pdf



                                                                         Implementation Updates #63 and #64 define the service array as
                                                                         part of the core requirements to be eligible for certification as a
                                                                         Critical Access Behavioral Health Care Agency (CABHA). In the
                                                                         list of additional services Child Residential Level II, III, and IV are
                                                                         identified. Level II refers to both Program type and Family type
                                                                         (Therapeutic Foster Care). Providing multiple residential services
                                                                         (i.e. Level II and Level III) will only count toward one of the
                                                                         additional services. If an agency provides Level II and Level III,
                                                          CABHA
    #065           12/10/2009       CABHA Service                        they would still need to provide an additional non-residential
                                                         Description
                                   Array Clarification                   service, such as Intensive In-Home in order to meet the
                                                                         requirement of two additional services that create a continuum of
                                                                         care for the age/disability served. Providers who wish to pursue
                                                                         the CABHA certification but do not yet meet the minimum
                                                                         requirements may electronically submit a letter of intent signed by
                                                                         the CEO of the agency to the LME Systems Performance Team
                                                                         at Contact.DMH.LME@dhhs.nc.gov. Letters of attestation will be
                                                                         accepted beginning December 1, 2009.




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 Implementation   Implementation
                                        Title (s)         Subject(s)                                   Summary
   Update #:        Update Date


                                                                          The qualified and licensed professional component of Community
                                       Continued                          Support will continue until the new case management service
      #064                            Availability of                     definition is approved in order to provide case management
    SPECIAL                        Community Support      Community       services. Consumers currently receiving Community Support and
                    11/23/2009
IMPLEMENTATION                      Services for Case      Support        new consumers entering the system on or after January 1, 2010
    UPDATE                            Management                          will be able to receive the case management component of
                                       Functions                          Community Support in order to ease the transition to the new
                                                                          case management service.

                                                                      This flow chart identifies the process for certifying agencies and
      #064                           Critical Access    CABHA - Flow will include staff from the Division of Mental Health,
    SPECIAL                         Behavioral Health   Chart (page 1 Developmental Disabilities, and Substance Abuse Services
                    11/23/2009
IMPLEMENTATION                       Care Agencies       and page 2) (DMH/DD/SAS), the Division of Medical Assistance (DMA), and
    UPDATE                              (CABHA)
                                                                      the local management entities (LME).

      #064                           Critical Access
                                                                        This letter may be submitted to indicate the intent to pursue
    SPECIAL                         Behavioral Health   CABHA Letter of
                    11/23/2009                                          CABHA certification if the provider is not yet ready to submit the
IMPLEMENTATION                       Care Agencies          Intent
                                                                        letter of attestation.
    UPDATE                              (CABHA)


      #064                           Critical Access
                                                           CABHA          This letter, which is sent to the provider after completion of the
    SPECIAL                         Behavioral Health
                    11/23/2009                           Standardized     desk review, informs the provider if the provider meets the
IMPLEMENTATION                       Care Agencies
                                                            Letter        qualifications of a CABHA.
    UPDATE                              (CABHA)


      #064                           Critical Access
    SPECIAL                         Behavioral Health   CABHA Letter of This standardized letter that informs the provider of the
                    11/23/2009
IMPLEMENTATION                       Care Agencies        Notification  certification decision.
    UPDATE                              (CABHA)




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 Implementation   Implementation
                                       Title (s)          Subject(s)                                  Summary
   Update #:        Update Date

                                                                          This letter is the primary document the provider will submit if
                                                                          seeking certification as a CABHA. Additional documentation that
                                                                          must be submitted for the desk review is identified. The letter of
      #064                          Critical Access
                                                                          attestation shall be submitted electronically and shall be signed
    SPECIAL                        Behavioral Health        CABHA
                    11/23/2009                                            by the CEO of the provider agency along with all supporting
IMPLEMENTATION                      Care Agencies      Attestation Letter
                                                                          documentation which should be sent to the LME Systems
    UPDATE                             (CABHA)
                                                                          Performance Team at Contact.DMH.LME@dhhs.nc.gov.
                                                                          Letters of attestation will be accepted beginning December 1,
                                                                          2009.

      #064                          Critical Access                       This document provides an update on the information found in
    SPECIAL                        Behavioral Health      CABHA           implementation Update #63 that defines the goals and key
                    11/23/2009
IMPLEMENTATION                      Care Agencies        Description      requirements of a CABHA agency. The services an agency may
    UPDATE                             (CABHA)                            provide have been updated.


      #064                          Critical Access
    SPECIAL                        Behavioral Health   CABHA Review This document outlines the elements of the review process that
                    11/23/2009
IMPLEMENTATION                      Care Agencies        Process    includes two steps: desk and onsite review.
    UPDATE                             (CABHA)


      #064                          Critical Access
    SPECIAL                        Behavioral Health   CABHA On Site This tool will be used to guide the staff interviews and onsite
                    11/23/2009
IMPLEMENTATION                      Care Agencies       Review Tool review.
    UPDATE                             (CABHA)




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 Implementation   Implementation
                                       Title (s)         Subject(s)                                    Summary
   Update #:        Update Date



      #064                          Critical Access
    SPECIAL                        Behavioral Health    CABHA Desk       This tool will be used to guide the desk review of the attestation
                    11/23/2009
IMPLEMENTATION                      Care Agencies       Review Tool      letter and supporting documentation submitted.
    UPDATE                             (CABHA)


                                                                         Agencies that do not meet the minimum staffing requirements
                                                                         (Medical Director, Clinical Director, and Quality
      #064                          Critical Access                      Improvement/Training Director) must have those positions
                                                         Minimum
    SPECIAL                        Behavioral Health                     actively in place for a minimum of two months before the onsite
                    11/23/2009                           Staffing
IMPLEMENTATION                      Care Agencies                        review can be conducted. The goal of onsite review is to verify
                                                       Requirements
    UPDATE                             (CABHA)                           the integration of these key positions into the agency
                                                                         infrastructure as it relates to their roles and responsibilities for
                                                                         clinical oversight and quality assurance.


      #064                          Critical Access                   Because of the time restrictions on agencies providing
    SPECIAL                        Behavioral Health      CABHA -     Community Support Team, Intensive In-Home, and Day
                    11/23/2009
IMPLEMENTATION                      Care Agencies      Review Process Treatment, submissions from provider agencies currently
    UPDATE                             (CABHA)                        delivering those services will be processed first.




      #064                          Critical Access
    SPECIAL                        Behavioral Health    Certification    The certification team will include staff from DMH/DD/SAS, DMA,
                    11/23/2009
IMPLEMENTATION                      Care Agencies         Team           and the LME.
    UPDATE                             (CABHA)




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 Implementation   Implementation
                                       Title (s)         Subject(s)                                  Summary
   Update #:        Update Date

                                                                        This Special Implementation Update further defines the
                                                                        requirements and process to become a CABHA. The
                                                                        requirements of the Medical Director have been revised to clarify
      #064                          Critical Access                     that a provider serving more than 750 consumers must have a full-
    SPECIAL                        Behavioral Health                    time Medical Director, while providers serving fewer than 750
                    11/23/2009                         Medical Director
IMPLEMENTATION                      Care Agencies                       consumers may achieve certification as a CABHA with a half-time
    UPDATE                             (CABHA)                          Medical Director. The Medical Director, either full-time or half-
                                                                        time, may spend up to 60% of their time with the CABHA
                                                                        engaged in the delivery of billable services, as long as all
                                                                        functions required of the Medical Director are completed.
                                                                        DHHS has approved a definition and description for a new
                                                                        category of provider agency, a Critical Access Behavioral Health
                                                                        Agency (CABHA) for mental health and substance abuse
                                                                        services. Effective January 1, 2010, case management services
                                                                        not included within a “clinical home” service definition will only be
                                                                        delivered through Critical Access Behavioral Health agencies.
                                    Critical Access
                                                         CABHA -        Also effective January 1, 2010, any provider seeking
                                   Behavioral Health
     #063           11/2/2009                            Important      endorsement to provide Intensive In-Home, Day Treatment, or
                                    Care Agencies
                                                         Timelines      Community Support Team must meet the criteria for designation
                                       (CABHA)
                                                                        as a Critical Access Behavioral Health agency. This includes
                                                                        providers who may have started, but not completed, the
                                                                        endorsement process, prior to January 1, 2010. If current
                                                                        providers of these services have not become a CABHA by July 1,
                                                                        2010, their endorsement will be involuntarily withdrawn and they
                                                                        will be terminated from the Medicaid program.




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Implementation   Implementation
                                      Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                       The certification team will consist of State staff and endorsement
                                                                       staff from the LMEs in the region in which the CABHA is located.
                                                                       CABHAs will be certified once for the entire state. The
                                                                       certification process will require a demonstration by the agency of
                                                                       its ability to meet the terms of a standardized performance
                                                                       contract developed by DHHS. The contract will include
                                   Critical Access
                                                        CABHA -        requirements related to the geographic area to be served and
                                  Behavioral Health
    #063           11/2/2009                           Certification   requirements prohibiting rejection or premature discharge of
                                   Care Agencies
                                                        Process        consumers served (no eject/reject provisions). The provider will
                                      (CABHA)
                                                                       still be required to enter into standardized memoranda of
                                                                       agreement (MOAs) with LMEs in the catchment area in which
                                                                       they deliver services and a standardized contract with those
                                                                       same LMEs for State-funded services. Continued certification as
                                                                       a CABHA will be based upon the agency meeting or exceeding
                                                                       the required performance standards established by DHHS.

                                   Critical Access                    The requirements for designation as a CABHA can be found in
                                                          CABHA -
                                  Behavioral Health                   the attachment which provides details on accreditation, the
    #063           11/2/2009                           Requirements
                                   Care Agencies                      service array, collaboration with physical health, minimal required
                                                      for Designation
                                      (CABHA)                         staffing and the requirement to secure alternative funding.




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Implementation   Implementation
                                      Title (s)        Subject(s)                                 Summary
  Update #:        Update Date

                                                                       Effective January 1, 2010, Case Management services not
                                                                       included within a "clinical home" service definition will only be
                                                                       delivered through CABHAs. Once the service definition for Peer
                                                                       Support is approved by CMS, the only agencies allowed to
                                                       CABHA -         provide Peer Support will be CABHAs. Services other than Case
                                   Critical Access
                                                         Case          Management and Peer Support that require endorsement will
                                  Behavioral Health
    #063           11/2/2009                          Management       continue to be endorsed for CABHAs on a site/service-specific
                                   Care Agencies
                                                       and Peer        basis. CABHAs are not required to meet the certification criteria
                                      (CABHA)
                                                        Support        in every location in which they deliver Case Management and
                                                                       Peer Support services. If a CABHA chooses to offer Peer
                                                                       Support in a location in which they do not meet certification
                                                                       requirements, they must also deliver Case Management services
                                                                       in that location.
                                                                     ValueOptions is conducting multiple webinars to clarify the
                                                                     documents required for the authorization of behavioral health
                                                                     services covered by NC Medicaid, to identify helpful websites and
                                                                     information resources related to the authorization process, and to
                                                                     respond to provider questions. The intended audience is
                                                                     providers who are new to performing clinical home functions such
                                                                     as completing documentation and submitting requests to VO for
                                                                     review. A specific focus will be on the documentation
                                    ValueOptions      ValueOptions - requirements for Community Support and Level III and IV
    #063           11/2/2009
                                     Webinars            Training    requests as discussed in Implementation Updates # 60, #61, and
                                                                     #62. Providers may register for an upcoming webinar by going to
                                                                     http://www.valueoptions.com/providers/Network/North_Carolina_
                                                                     Medicaid.htm and “Provider Training Opportunities.” In addition,
                                                                     providers are encouraged to also register for a webinar to learn
                                                                     how to submit Enhanced Service and Residential requests to VO
                                                                     electronically via ProviderConnect. Instructions for completing the
                                                                     ITR, the ITR template, a link to PCP training and a provider
                                                                     training presentation can also be found on the VO website.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                   Summary
  Update #:        Update Date

                                                                          The process is outlined for requests for reauthorizations of PSR
                                                                          for individuals that are also receiving Community Support (CS)
                                                                          services whose period of authorization expires on or before
                                                                          December 31, 2009. All PSR service authorizations for recipients
                                                                          currently receiving PSR and CS services, which are end dated
                                                                          December 31, 2009 or earlier, will follow the process for
                                                                          reauthorization in this update which must occur prior to the date
                                   PSR Transition for       PSR -         that the current PSR authorization expires. The PSR provider
    #063           11/2/2009      Recipients Receiving     Service        must work with the CS provider to obtain the current PCP. · In
                                        PSR/CS           Authorization    the event that the PSR provider is unable to obtain the PCP after
                                                                          reasonable efforts, the LME may be contacted to assist in the
                                                                          process. PSR providers must submit the ITR and a PCP Update/
                                                                          Revision with appropriate signatures to ValueOptions for the
                                                                          reauthorization request. A service order signature (for medical
                                                                          necessity by an MD/DO, PA, APN, LP) is only required if a new
                                                                          service is added to the PCP. The maximum authorization may be
                                                                          up to 180 days.

                                                                          The PSR qualified professional, in addition to 6 hours of “PCP
                                                              PSR -       Thinking,” must complete the required 3 hours of “PCP
                                   PSR Transition for
                                                            Training      Instructional Elements” training. The PCP Instructional Webcast
                                  Recipients Receiving
    #063           11/2/2009                             Requirements     Training (http://www.ncdhhs.gov/mhddsas/pcp.htm) or other PCP
                                        PSR/CS
                                                          for Qualified   planning/writing training may fulfill this requirement. The qualified
                                      (continued)
                                                         Professionals    professional must be complete this training within sixty (60) days
                                                                          of this IU #63 or within 30 days of hire, whichever comes first.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                          When the annual re-write of the PCP is prior to December 31,
                                                                          2009, a rewritten PCP must be developed with a new service
                                   PSR Transition for
                                                           PSR -          order for medical necessity. The Date of Plan on the Complete
                                  Recipients Receiving
    #063           11/2/2009                             PCP Annual       PCP is the date on which the annual re-write of the PCP is due.
                                        PSR/CS
                                                          Re-write        All subsequent requests must follow the established authorization
                                      (continued)
                                                                          procedure outlined in the PCP manual and Implementation
                                                                          Update # 39.

                                                                       PSR providers will be responsible for developing a crisis plan
                                                                       which is a part of PCP development; however, PCP providers are
                                                                       not required to be the "first responder." As a part of the crisis
                                   PSR Transition for
                                                                       plan, the PSR provider must coordinate with the LME and the
                                  Recipients Receiving       PSR -
    #063           11/2/2009                                           recipient to identify local crisis services that can be accessed. It
                                        PSR/CS         First Responder
                                                                       has always been the expectation that PSR providers would
                                      (continued)
                                                                       arrange psychiatric services and provider interventions to help
                                                                       recipients acquire the skills needed to identify and access
                                                                       transportation options in their community.
                                                                       As clarification to Implementation Update #60, authorizations for
                                                                       Medicaid and State-funded Community Support services in effect
                                                                       as of the date of this memo will remain valid until the current
                                                                       authorization expires. Individuals who receive Community
                                                                       Support services with other enhanced services can continue to
                                                                       receive Community Support services, until the current Community
                                     CS with Other        Community
    #063           11/2/2009                                           Support authorization expires. The Enhanced Services are listed
                                   Enhanced Services       Support
                                                                       for which no new or concurrent requests for Community Support
                                                                       services can be authorized effective October 12, 2009. Requests
                                                                       for Community Support and another enhanced service for
                                                                       children must follow the established Early and Periodic
                                                                       Screening, Diagnosis, and Treatment (EPSDT) procedures and
                                                                       requirements, which are available at




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Implementation   Implementation
                                       Title (s)          Subject(s)                                 Summary
  Update #:        Update Date

                                                                        Children currently in Level III and Level IV residential treatment
                                                                        must have an independent (meaning independent of the
                                                                        residential provider and its provider organization) psychiatric
                                                                        evaluation as one of the requirements for concurrent
                                                                        (reauthorization) requests. The psychiatric evaluation must be
                                     Independent                        performed by a psychiatrist, psychiatric physician’s assistant (PA)
                                                           Service
                                      Psychiatric                       who is working under a psychiatrist’s protocol or an Advanced
    #063           11/2/2009                           Authorization -
                                  Evaluation for Level                  Practice Nurse Practitioner (APN) only. The psychiatric evaluation
                                                        ValueOptions
                                        III & IV                        shall determine the clinical needs of the child and make
                                                                        recommendations for the appropriate level of treatment such as
                                                                        residential, Psychiatric Residential Treatment Facilities (PRTF),
                                                                        or other level of care. The required components of the
                                                                        comprehensive clinical assessment can be found in IU #36. The
                                                                        requirements for reauthorization requests in IU #60 must be
                                                                        followed.
                                                                        Up until December 31, 2009, an interim 30-day authorization may
                                                                        be granted by ValueOptions for situations in which the
                                                                        assessment cannot be completed in time for the reauthorization
                                                                        request. The System of Care (SOC) Coordinator must indicate
                                     Independent                        on the discharge plan under his or her signature the date/time of
                                      Psychiatric          Interim      the evaluation as well as the psychiatrist's, PA's, or APN's name.
    #063           11/2/2009      Evaluation for Level Authorizations - These appointments are subject to verification and the
                                        III & IV        ValueOptions evaluation must be completed within the one month period. This
                                      (continued)                       grace period will end on December 31, 2009 and all concurrent
                                                                        requests that are not accompanied by the psychiatric assessment
                                                                        will be returned as "Unable to Process." Level III and IV providers
                                                                        should be coordinating with the LME and Systems of Care
                                                                        Coordinator throughout this process.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                Summary
  Update #:        Update Date

                                                                       Providers my resubmit requests that were previously returned by
                                                                       ValueOptions as "Unable to Process" if the independent
                                     Independent                       psychiatric evaluation was completed within 30 days of the
                                                       Resubmission of
                                      Psychiatric                      authorization request. In these situations providers may resubmit
                                                        Authorization
    #063           11/2/2009      Evaluation for Level                 the original request for reauthorization to ValueOptions and must
                                                         Requests -
                                        III & IV                       attach the completed independent psychiatric evaluation.
                                                        ValueOptions
                                      (continued)                      Providers should indicate on the fax cover sheet of the
                                                                       authorization request "Resubmitted with psychiatric evaluation for
                                                                       originally requested Effective Date of <date>."

                                                                         Children admitted to Residential Level III and IV services after
                                                                         September 28, 2009 must follow authorization procedures for
                                                                         new requests as outlined in Implementation Update #60. For
                                                                         these new admissions to child residential services, length of stay
                                                                         is limited to no more than 120 days. An independent psychiatric
                                  New Authorizations        Service      evaluation does not need to accompany requests for the first 120
    #063           11/2/2009       for Level III and     Authorization - days of service, unless clinically indicated. If providers are
                                       Level IV          ValueOptions submitting concurrent (reauthorization) requests for additional
                                                                         treatment after these 120 days, the provider must follow the
                                                                         authorization guidelines for concurrent (reauthorization) requests
                                                                         as outlined in Implementation Update #60 which includes an
                                                                         independent psychiatric evaluation, updated Child and Family
                                                                         Team meeting, and updated Discharge/Transition Plan.

                                                                        Discharge/Transition Plans for children in Level III and Level IV
                                                                        Residential services must accompany all requests submitted to
                                       Discharge/          Service
                                                                        ValueOptions. All signatures and dates on the
    #063           11/2/2009       Transition Plans for Authorization -
                                                                        Discharge/Transition Plan must be hand written. The
                                  Level III and Level IV ValueOptions
                                                                        Discharge/Transition plan may be faxed or scanned for
                                                                        submission to ValueOptions.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                  Summary
  Update #:        Update Date

                                                                        Some issues related to rules interpretation for PRTFs have been
                                                                        clarified in order to bring licensure rules in sync with federal
                                                                        requirements. The following modifications to current policy have
                                                                        been agree upon: 1. Orders for seclusion and restraint: Only a
                                      Psychiatric                       physician (M.D., D.O.), nurse practitioner, physician’s assistant or
                                      Residential                       licensed psychologist may order seclusion and restraint. A RN
                                                         Residential
    #063           11/2/2009      Treatment Facilities                  may issue the written order based upon a verbal authorization
                                                          Services
                                       (PRTF)                           from one of the authorized individuals. 2. The required one hour
                                     Requirements                       assessment following restraint may be conducted by a physician,
                                                                        nurse practitioner, physician’s assistant or RN. Since one
                                                                        purpose of this assessment is to address potential medical issues
                                                                        arising from the restraint, the assessment may not be conducted
                                                                        by a licensed psychologist.
                                                                        Residential Level II Program – IV providers will be responsible for
                                                                        the development and implementation of the Person-Centered
                                                                        Plan (PCP) when a child does not have Community Support
                                                                        services or another clinical home service. Only a qualified
                                  PCP Development
                                                         Residential    professional delivering the residential service may develop the
    #063           11/2/2009        and Level II
                                                          Services      PCP. Level II Program – IV providers may submit authorization
                                    Program - IV
                                                                        requests to ValueOptions if Community Support services are not
                                                                        available. If a child is receiving more than one non-clinical home
                                                                        service, it is expected that the providers will work together during
                                                                        the Child and Family Team meetings to coordinate the PCP.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                Summary
  Update #:        Update Date

                                                                  As stated in Implementation Update # 60, Day Treatment
                                                                  providers may be responsible for the development and
                                                                  implementation of the Person-Centered Plan (PCP), including the
                                                                  crisis plan when a child does not have Community Support
                                                                  services or another clinical home service. Only a qualified
                                  PCP Development &
                                                                  professional delivering the Day Treatment service may develop
    #063           11/2/2009        Day Treatment   Day Treatment
                                                                  the PCP. As a part of the crisis plan in the PCP, the Day
                                      Providers
                                                                  Treatment provider must coordinate with the LME and the
                                                                  recipient to identify local crisis services that can be accessed. If a
                                                                  child is receiving more than one non-clinical home service, it is
                                                                  expected that the providers will work together during the Child
                                                                  and Family Team meetings to coordinate the PCP.
                                                                         In keeping with the intent of Communication Bulletin # 55,
                                   Service Provision
                                                                         providers are expected to be serving consumers within 60 days of
                                     Timelines for
    #063           11/2/2009                            Endorsement      enrollment. If a provider has not accepted consumers and begun
                                  Endorsed Providers
                                                                         services to consumers within 60 days of DMA direct enrollment,
                                                                         endorsement will be involuntarily withdrawn.

                                                                     There are certain services for which providers cannot currently
                                                                     directly enroll with the Medicaid program. These include Level II
                                                                     Family Type (therapeutic foster care), Targeted Case
                                                                     Management for DD, and provisionally licensed therapists
                                                                     performing outpatient therapy. LMEs have been requested to bill
                                    LMEs Billing                     these services for providers until such time as the providers can
                                                       Reimbursement
    #063           11/2/2009      Medicaid on Behalf                 directly enroll. Through June 2008, LMEs were reimbursed for
                                                          & Billing
                                    of Providers                     performing this billing function on behalf of providers using Mental
                                                                     Health Trust Funds. That funding source has not been available
                                                                     for this purpose for more than a year. Until providers can directly
                                                                     enroll with DMA and to ensure consistency through the system, a
                                                                     15¢ per claim fee has been established as the allowable billing
                                                                     rate for LMEs to charge for this service.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date

                                                                           As noted in the July 2009 Medicaid Bulletin, the process to re-
                                                                           verify information and credential enrolled Medicaid Community
                                                                           Intervention Services providers is scheduled to begin
                                                                           immediately. Computer Sciences Corporation (CSC) will be
                                                                           notifying providers by mail and sending the notification packet to
                                                                           the provider's billing/accounting address. This will include a pre-
                                                                           printed NC MMIS Verification Form which includes demographic
                                  Provider Verification                    data and NPI information currently on file with N.C. Medicaid in
                                                            Provider
    #063           11/2/2009       and Credentialing                       addition to a checklist of credentialing-related documents that
                                                           Enrollment
                                       Activities                          must be returned to CSC. (Providers may verify their
                                                                           billing/accounting address via the DMA Provider Services NPI
                                                                           and Address Database at
                                                                           http://www.ncdhhs.gov/dma/WebNPI/default.htm or by calling the
                                                                           EVC Call Center at 1-866-844-1113.) Providers must complete
                                                                           the verification packet and return it to CSC within 30 days of the
                                                                           date of receipt. Lack of compliance with these procedures could
                                                                           result in suspension of enrollment and eventual termination.
                                                                       Community Support Team providers are required to submit the
                                                                       verification packet with appropriate credentials including all
                                  Provider Verification                current Notifications of Endorsement Actions (NEAs) to qualify for
                                                           Community
    #063           11/2/2009       and Credentialing                   enrollment as a provider of Community Support Team services in
                                                          Support Team
                                       Activities                      order to separate Community Support Child (H0036 HA),
                                                                       Community Support Adult (H0036 HB), and Community Support
                                                                       Group (H0036 HQ) from Community Support Team services.




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Implementation   Implementation
                                       Title (s)       Subject(s)                                 Summary
  Update #:        Update Date

                                                                      The NC-TOPPS policy for Community Support transitional
                                                                      planning remains consistent with the current SFY 09-10 NC-
                                                                      TOPPS Implementation Guidelines regarding consumer
                                                                      participation requirements in NC-TOPPS for consumers receiving
                                                                      certain designated services. The listing of mental heath and
                                                                      substance abuse services that require NC-TOPPS is provided on
                                                                      page 14 of the Implementation Guidelines. These guidelines
                                  CSS Transition and                  which became effective July 1, 2009 are published on the
                                     NC-TOPPS          Community      DMH/DD/SAS web page:
    #062           10/8/2009                                          http://www.ncdhhs.gov/mhddsas/announce/commbulletins/comm
                                                        Support
                                                                      bulletin104/nc-toppsguidelinesjuly09.pdf
                                                                      Participation in NC-TOPPS for the consumer will be based
                                                                      exclusively on the type(s) of service(s) that the consumer is
                                                                      transitioning to -- not on the type(s) of service(s) that the
                                                                      consumer is transferring from.
                                                                      The local management entities (LME) should work with their
                                                                      provider agencies to facilitate the transfer of active cases within
                                                                      NC-TOPPS to the new provider agencies serving these
                                                                      consumers.




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Implementation   Implementation
                                       Title (s)          Subject(s)                                  Summary
  Update #:        Update Date

                                                                         As a follow-up to Implementation Update # 60, the
                                                                         Child/Adolescent and the Adult Discharge/Transition Plans for
                                                                         Community Support Services have been revised. This new plan
                                                                         format will be required as of November 2, 2009 and must be
                                                                         submitted with the completed ITR, the required PCP (i.e.,
                                                                         introductory, complete or update) along with any other supporting
                                                           Initial       documentation justifying the request ofr authorization and
                                  Revised Discharge/    Authorization reauthorization. The consumer name and provider service record
                                  Transition Plans for      and          number are required in the header along with the date the Child
    #062           10/8/2009
                                      CSS/Level        Reauthorization - and Family Team met to develop the discharge/transition plan for
                                        III & IV         Community       children and the date the PCP planning participants met to
                                                          Support        develop the discharge/transition plan for adults. In all cases, the
                                                                         discharge date refers to the "expected" discharge date. The date
                                                                         the discharging provider had a discussion with the natural
                                                                         supports resource regarding the supports to be made available
                                                                         must also be documented. The signatures of the recipient and/or
                                                                         legally responsible person are also required as evidence of
                                                                         participation in the discharge /transition process.




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Implementation   Implementation
                                       Title (s)           Subject(s)                                  Summary
  Update #:        Update Date

                                                                         As a follow-up to Implementation Update # 60, the
                                                                         Child/Adolescent and the Adult Discharge/Transition Plans for
                                                                         Child Residential Level III and IV have been revised. This new
                                                                         plan format will be required as of November 2, 2009 and must be
                                                                         submitted with the completed ITR, the required PCP (i.e.,
                                                             Initial     introductory, complete or update) along with any other supporting
                                                         Authorization documentation justifying the request ofr authorization and
                                  Revised Discharge/                     reauthorization. The consumer name and provider service record
                                                              and
                                  Transition Plans for
    #062           10/8/2009                           Reauthorization - number are required in the header along with the date the Child
                                      CSS/Level                          and Family Team met to develop the discharge/transition plan for
                                                          Residential
                                        III & IV
                                                        Service Levels children and the date the PCP planning participants met to
                                                            III & IV     develop the discharge/transition plan for adults. In all cases, the
                                                                         discharge date refers to the "expected" discharge date. The date
                                                                         the discharging provider had a discussion with the natural
                                                                         supports resource regarding the supports to be made available
                                                                         must also be documented. The signatures of the recipient and/or
                                                                         legally responsible person are also required as evidence of
                                                             Initial     participation in the discharge /transition process. be submitted in
                                                                         A new comprehensive clinical assessment must
                                                         Authorization requests for reauthorizations of Child Residential Level III and IV.
                                  Revised Discharge/
                                                              and        This assessment must be completed by a psychiatrist
                                  Transition Plans for
    #062           10/8/2009                           Reauthorization - (independent of the residential provider and its provider
                                       CSS/Level
                                                          Residential    organization) and should include clinical justification for continued
                                  III & IV (continued)
                                                        Service Levels stay at that level of care as referenced in Implementation Update
                                                            III & IV     #60.
                                                                         Medicaid recipients ages 18-20 are able to receive mental health
                                   Medicaid-Funded                       and substance abuse services that are otherwise limited to adults
                                       Services for    Adult Enhanced if they meet medical necessity criteria for the service. With the
    #062           10/8/2009
                                       Recipients      Benefit Services exception of requests for Adult Facility Based Crisis for this age
                                       Ages 18-20                        group, requests for other adults-only services do not require an
                                                                         Early and Periodic Screening, Diagnosis, and Treatment
                                                                         (EPSDT) exception.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                   Summary
  Update #:        Update Date


                                   Medicaid-Funded        EPSDT
                                                                          Requests for the admission of recipients between the ages of 18-
                                     Services for       Exception for
                                                                          20 into Adult Facility-Based Crisis Services require an Early and
    #062           10/8/2009          Recipients        Adult Facility-
                                                                          Periodic Screening, Diagnosis and Treatment (EPSDT)
                                     Ages 18-20         Based Crisis
                                                                          exception.
                                     (continued)          Services

                                                                          All directly enrolled Medicaid providers are responsible for
                                                                          maintaining custody of the records and documentation to support
                                                                          service provision and reimbursement for the required retention
                                                                          period for publicly- funded MH/DD/SA services. In the event that
                                                                          a provider agency ends services, or dissolves for any reason, the
                                                                          provider is required to make arrangements to continue
                                                                          safeguarding both the clinical and reimbursement records in
                                      Provider                            accordance with the record retention guidelines. Termination of
                                   Responsibility for      Record         enrollment, dissolution of a business, or merger with another
    #062           10/8/2009
                                     Retention of         Retention       agency does not relieve the provider of responsibility for the
                                      Records                             records generated during the time the provider was in business.
                                                                          The two schedules that address the retention and disposition
                                                                          requirements for publicly-funded MH/DD/SA services are the
                                                                          DHHS Records Retention and Disposition Schedule for Grants
                                                                          and the Records Retention and Disposition Schedule for State
                                                                          and Area Facilities, Division Publication, APSM 10-3. Providers
                                                                          are subject to the applicable standards outlined in both
                                                                          schedules.
                                                                          Per the Records Retention and Disposition Schedule for State
                                                                          and Area Facilities (APSM 10-3), the clinical records of children
                                       Provider
                                                          Record          must be maintained for twelve (12) years after the age of majority
                                   Responsibility for
    #062           10/8/2009                             Retention        (I.e., until the person reaches age 30). The clinical records of
                                     Retention of
                                                        Timeframes        adults must be kept for 11 years after the last encounter. When
                                  Records (continued)
                                                                          more than one retention schedule applies to certain records, the
                                                                          stricter of the retention schedules must be applied.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                 Summary
  Update #:        Update Date

                                                                     Each provider must develop a retention and disposition plan
                                       Provider
                                                                     outlining how records are stored, who will be the designated
                                   Responsibility for Record Storage
    #062           10/8/2009                                         records custodian and how the records custodian is going to
                                     Retention of          Plan
                                                                     inform the respective LMEs of their process and where the
                                  Records (continued)
                                                                     records are located.

                                                                     The provider should send the responsible LME a copy of their
                                                                     record storage logs identifying each individual within the LME's
                                       Provider
                                                                     catchment area, the dates of service and into which box a
                                   Responsibility for Record Storage
    #062           10/8/2009                                         records is stored. The storage log can be used for all record
                                     Retention of          Log
                                                                     types including service records, reimbursement records,
                                  Records (continued)
                                                                     personnel records, etc. A sample record storage log with the
                                                                     required identifying information is attached.
                                                                         Per the endorsement policy timelines, the LME will endorse a
                                                                         provider within approximately 50 days or less if the original
                                                                         application packet and on-site review meet all requirements;
                                                                         however, effective September 18, 2009, LMEs were authorized to
                                                                         triple the endorsement timeframes to up to 150 days as
                                                                         consumers are transitioned from Community Support to other
                                     Endorsement                         appropriate services to ensure adequate time for the
                                       Update           Extension of     endorsement process to be completed. If the original application
    #062           10/8/2009                            Endorsement      packet and on-site review meet all requirements, the
                                                         Timelines       endorsement process may take up to 150 days. LMEs are
                                                                         expected to prioritize endorsement for evidence-based services
                                                                         or services that are critically needed within its catchment area.
                                                                         This authorization to triple the endorsement timelines went into
                                                                         effect on September 18, 2009 and applies to all timelines related
                                                                         to endorsement except the three year re-endorsement
                                                                         requirement. Providers are still expected to be re-endorsed every
                                                                         three years under the current policy guidelines. In addition, the




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Implementation   Implementation
                                       Title (s)          Subject(s)                                  Summary
  Update #:        Update Date

                                                                    There has been no change in the timelines related to re-
                                    Endorsement                     endorsement. Providers are still expected to be re-endorsed
    #062           10/8/2009      Update (continued) Re-endorsement every three years under the current policy guidelines of 50 days
                                                                    or less.
                                                         Elimination of
                                    Endorsement             Plan of       The Plan of Correction process for initial endorsement has been
                                  Update (continued)      Correction      eliminated. Providers must be able to demonstrate compliance
    #062           10/8/2009
                                                          Process for     with the service definition checksheets and business verification
                                                             Initial      during the initial endorsement review.
                                                         Endorsement
                                    Endorsement                           Endorsement will be denied if the provider fails to meet the
                                                           Denial of
    #062           10/8/2009      Update (continued)                      requirements of endorsement for the initial business verification
                                                         Endorsement
                                                                          or the on-site endorsement review.


                                                                          Effective immediately, the Division of Medical Assistance will no
                                  Medicaid Enrollment      Provider
    #062           10/8/2009                                              longer amend the effective date of enrollment after the Medicaid
                                    Effective Date        Enrollment
                                                                          provider number has been issued.


                                                                        In Implementation Update #59, there were errors related to the
                                                                        required documentation for DD submission to ValueOptions
                                                                        specific to two items -- TCM Requests and CAP Provider Change
                                                                        Only Requests.             Correction: TCM Requests: Initial TCM
                                                            Required    request requires that the NC-SNAP and comprehensive clinical
                                     CAP- MR/DD          Documents for assessment (current psychological) be submitted with the Intro
    #062           10/8/2009
                                       Update           DD Submissions (Non-CAP-MR/DD PCP) or Complete PCP and CTCM.
                                                        to ValueOptions Correction: CAP Provider Change Only Requests: PCP Update
                                                                        (per the Records Management and Documentation Manual for
                                                                        Providers of Publicly-Funded MH/DD/SA Services CAP-MR/DD
                                                                        Services and Local Management Entities), Cost Summary, CTCM
                                                                        to discharge previous provider, and CTCM to add a new provider.



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Implementation   Implementation
                                       Title (s)         Subject(s)                              Summary
  Update #:        Update Date

                                                                  The following notification process becomes effective immediately.
                                                                  Within 30 days prior to the expiration of the previous
                                                                  endorsement notification, the standardized Letter of Attestation
                                                                  certifying that the provider continues to meet CAP-MR/DD service
                                                                  requirements shall be submitted by providers along with
                                                                  supporting documentation to the LME located in the catchment
                                                                  area where the provider’s corporate office is located. If the
                                  CAP-MR/DD Update
    #062           10/8/2009                       Re-endorsement provider does not deliver services where the corporate office is
                                     (continued)
                                                                  located and was endorsed by another LME, the provider shall
                                                                  submit the Letter of Attestation to the LME which endorsed the
                                                                  service. The LME reviews and approves the Letter of Attestation
                                                                  and completes a NEA letter indicating the new effective dates of
                                                                  endorsement for a period of up to three years. In the event the
                                                                  LME and provider completed the re-endorsement process prior to
                                                                  this notification, the above process is not required.
                                                                    CAP-MR/DD provider endorsement and enrollment are statewide.
                                                                    If a CAP-MR/DD provider does not submit a Letter of Attestation
                                                                    to the LME, the LME shall notify DMA by completing the NEA
                                                                    letter with notation in the comment section indicating the
                                                     Involuntary
                                                                    endorsement has expired and has not been renewed due to
                                                    Withdrawal of
                                                                    failure to submit the Letter of Attestation. The LME shall send a
                                  CAP-MR/DD Update Endorsement
    #062           10/8/2009                                        copy of the NEA to the provider via certified mail noting the
                                     (continued)  Due to Failure to
                                                                    expired endorsement, notify other LMEs statewide, and submit
                                                   Submit Letter of
                                                                    the NEA letter to DMA via electronic submission. This shall be
                                                     Attestation
                                                                    considered involuntary withdrawal and will include all CAP-
                                                                    MR/DD services the provider was endorsed to provide statewide.
                                                                    The provider may not apply to provide for CAP-MR/DD services
                                                                    anywhere in the state for six months.

                                                    Expiration of When an MOA with a CAP-MR/DD provider expires and the
                                  CAP-MR/DD Update
    #062           10/8/2009                       Memorandum of provider has been re-endorsed for CAP-MR/DD services, the
                                     (continued)
                                                     Agreement    LME shall secure a new signed MOA.




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Implementation   Implementation
                                        Title (s)         Subject(s)                                 Summary
  Update #:        Update Date


                                                                   DMH and the DMA are developing the operational details to
                                                                   implement the self- direction option within the Supports Waiver.
                                                    Self-Direction
                                  CAP-MR/DD Update                 "Self-Direction in the Supports Waiver" is attached and provides a
    #062           10/8/2009                          within the
                                     (continued)                   summary of the basic framework for the operational details of the
                                                   Supports Waiver
                                                                   self-direction model. Additional information will be added to the
                                                                   website as new information is compiled.

                                                                       DMH has launched the Supports Intensity Scale webpage found
                                                                       at
                                                                       http://www.ncdhhs.gov/mhddsas/sis/index.htm. This webpage
                                                                       provides helpful information to families, individuals who receive
                                                       Supports
                                  CAP-MR/DD Update                     services, providers and others wanting to learn more information
    #062           10/8/2009                        Intensity Scale
                                     (continued)                       about the Supports Intensity Scale (SIS) in North Carolina. It also
                                                          (SIS)
                                                                       contains a current list of state SIS Examiners. In addition, the
                                                                       webpage provides links to other state’s (outside of NC) specific
                                                                       information about their use of the Supports Intensity Scale. The
                                                                       webpage will be updated periodically introducing new information
                                                      Slot Action      as it becomes available.
                                                                       In this Implementation Update, "The Guidance for
                                                      Guidance:
                                                                       Documents/Procedures Required for CAP-MR/DD Slot Actions"
                                                     Terminations,
                                                                       is attached. This document outlines the procedures and
                                                           De-
                                  CAP-MR/DD Update                     documentation requirements in the case of Terminations,
    #062           10/8/2009                       institutionalizatio
                                     (continued)                       Deinstitutionalization (DI), Money Follows the Person (MFP),
                                                       n, Money
                                                                       Emergency and Reinstatement. The LME is responsible for
                                                      Follows the
                                                                       following these procedures and for submitting the required
                                                         Person,
                                                                       documentation to DMH/DD/SAS with slot requests.
                                                    Emergency and
                                                    Reinstatement




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Implementation   Implementation
                                       Title (s)          Subject(s)                                 Summary
  Update #:        Update Date

                                                                      Rates effective with date of service July 1, 2009 were held at
                                                                      existing rates as of June 30, 2009 with the exception of Medicaid
                                                                      rates which were adjusted downward in accordance with the
                                                                      current year's Medicare fee schedule. Effective October 1, 2009,
                                                                      rate reductions (annualized over nine months) will be applied to
                                                                      all public and private Medicaid providers except for federally
                                                                      qualified health centers, rural health centers, school-based and
                                      Medicaid                        school-linked health centers, State institutions, hospital
                                                        Reimbursement outpatient, pharmacy, hospice and the noninflationary
    #062           10/8/2009       Reimbursement
                                                         Rate Changes components of the case-mix reimbursement system for skilled
                                    Rate Update
                                                                      nursing facilities. Critical Access Hospitals will continue to have
                                                                      their inpatient and outpatient Medicaid costs settled at 100%. The
                                                                      annualized reductions resulted in overall program reduction
                                                                      percentages that differ from the actual rate reduction percent
                                                                      applied. In some programs the rates reduction percentage was
                                                                      not applied uniformly. Updated fee schedules have been
                                                                      published for all current rates on the DMA website at
                                                                      http://www.dhhs.state.nc.us/dma/fee/fee.htm. Program began
                                                                      Effective September 8, 2009, the N.C. Medicaid
                                                                       issuance of one Medicaid identification (MID) card per year to
                                                                       each recipient.
                                                                       http://www.ncdhhs.gov/dma/bulletin/0909bulletin.htm#mid).
                                                                       Because the new card no longer serves as proof of eligibility, it is
                                                                       essential that at each visit providers verify the recipient’s: ·
                                                                       Identity (if an adult); Current eligibility; Medicaid program
                                  Notice of Medicaid                   (including restrictive programs such as Medicaid for Pregnant
    #062           10/8/2009      Identification Card   Medicaid Cards Women (MPW) and Family Planning Waiver (FPW); Special
                                       Changes                         coverage (e.g.: Carolina Alternatives Program (CAP), Program of
                                                                       All Inclusive Care for the Elderly (PACE); CCNC/CA primary care
                                                                       provider information; and Other insurance information. To verify
                                                                       eligibility, a provider can choose to use the North Carolina
                                                                       Electronic Claims Submission/Recipient Eligibility Verification
                                                                       Web Tool (NCECSWeb), the real time or batch Eligibility
                                                                       Verification System (EVS), or the Electronic Data Systems (EDS)
                                                                       Automated Voice Response (AVR) system.


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 Implementation   Implementation
                                       Title (s)       Subject(s)                                 Summary
   Update #:        Update Date

                                                                        DMA has developed a plan for the consolidation of case
                                                                       management services based upon the agreements the
                                                                       workgroup reached regarding the goals and outcomes of the
                                                                       plan, the definitions of case management and care management,
                                                                       and the knowledge, skills and abilities that case managers need
                                                                       to possess. The plan incorporates both short-term and long-term
                                                                       strategies. DMA has asked members of the workgroup to
      #061                                               Case          discuss the plan with the constituencies which each member
    SPECIAL                                           Management       represents (for DMH/DD/SAS that includes providers, LMEs and
                    9/28/2009      Case Management
IMPLEMENTATION                                        Consolidation    consumer organizations) and to provide feedback by 10/5/09.
    UPDATE                                               Plan          Before responding to the plan, it is recommended that the
                                                                       minutes from previous workgroup meetings be reviewed so that
                                                                       the context of the plan is understood. Materials from the 9/24/09
                                                                       meeting, including the PowerPoint presentation used to discuss
                                                                       the plan, are available on the DMA website at
                                                                       http://www.ncdhhs.gov/dma/provider/MedicaidCaseManagement.
                                                                       htm This site can also be accessed through the DMH/DD/SAS
                                                                       The short-term strategies the link labeled "Medicaid Case
                                                                       home page by clicking on of the Case Management Consolidation
                                                                     Plan include: · Limiting the number of units of case management
                                                                     that may be billed in any given month for a recipient. · Allowing
                                                         Case
      #061                                                           only one case management provider to bill for an individual
                                                      Management
   SPECIAL                                                           recipient in any given month. · Implementing further rate
                    9/28/2009      Case Management    Consolidation
 Implementation                                                      reductions (beyond the rate reductions specifically mandated by
                                                      Plan: Short-
     Update                                                          the General Assembly).· Implementing administrative changes to
                                                     Term Strategies
                                                                     reduce the burden on providers, including paperwork reduction
                                                                     and reducing or eliminating requirements around Prior
                                                                     Authorization (PA) (not an exhaustive list).




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 Implementation   Implementation
                                        Title (s)        Subject(s)                                  Summary
   Update #:        Update Date

                                                                       The long-term strategy follows the vision of DHHS for every
                                                                       Medicaid recipient to have a “medical home” through Community
                                                                       Care of North Carolina (CCNC) and for those recipients with
                                                                       mental illness, intellectual/developmental disabilities and/or
                                                           Case
      #061                                                             substance use disorders to also have a “clinical home” through
                                                        Management
    SPECIAL                        Case Management                     the Local Management Entities (LMEs). Case management for
                    9/28/2009                           Consolidation
IMPLEMENTATION                          (contd)                        MH/DD/SA would continue to be coordinated and managed by
                                                        Plan: Long-
    UPDATE                                                             the LMEs through an at-risk, capitated funding model. Case
                                                       Term Strategies
                                                                       management related to physical healthcare issues would be
                                                                       managed and coordinated through CCNC. CCNC and LMEs’
                                                                       activities would be coordinated so that roles, activities and
                                                                       responsibilities would not be duplicative.
                                                                         Implementation Update # 60 announced that effective October
                                                                         12, 2009 no new admissions to Community Support would be
                                                                         allowed. In light of the fact that the Community Support
                                                                         Workgroup is still meeting to develop the full transition plan and
                                                                         the many concerns expressed about that timeframe, a decision
                                                                         has been made to continue to allow new admissions to
                                                        Community        Community Support for the remainder of calendar year 2009.
      #061
                                                          Support -      [Note: this extension applies to Medicaid-eligible individuals only;
    SPECIAL                        Community Support
                    9/28/2009                           Extension of     Local Management Entities (LMEs) may restrict admissions for
IMPLEMENTATION                         Update
                                                         Transition      state-funded consumers at an earlier date subject to availability of
    UPDATE
                                                         Timeframe       funds.] New admissions to Community Support will not be
                                                                         authorized effective January 1, 2010, except as reviewed and
                                                                         approved for children under age 21 through the provisions of the
                                                                         EPSDT requirements. Although the date for admissions to
                                                                         Community Support has been extended, LMEs and providers are
                                                                         encouraged, when possible, to refer consumers to other
                                                                         medically necessary services that will not be discontinued.




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 Implementation   Implementation
                                        Title (s)        Subject(s)                                  Summary
   Update #:        Update Date

                                                                         The mass mailing in September to all Medicaid recipients, in its
                                                                         brevity, omitted important information regarding S.L. 2009-451.
                                                                         Special Implementation Update # 60 (September 14, 2009)
                                                                         contains an accurate explanation of the policy changes occurring
      #061
                                                                         with respect to S.L. 2009-451, specifically changes to Community
    SPECIAL                          Clarification to
                    9/28/2009                           S.L. 2009-451    Support services and
IMPLEMENTATION                      Recipient Mailing
                                                                         Residential Levels III and IV services for children. Please refer to
    UPDATE
                                                                         Special Implementation Update # 60 for information about the
                                                                         transition, including information about services for children under
                                                                         EPSDT. Future implementation updates will contain additional
                                                                         important information regarding these transitions.
                                                                         The following policies become effective September 28, 2009: 1)
                                                                         Community Support services provided by a licensed professional
                                                                         or qualified professional may be provided in a Residential Level III
      #060                                                               or IV setting to assist in discharge planning up to a maximum of
    SPECIAL                        Community Support                     96 units over a 90-day period as authorized by ValueOptions; 2)
                                                         Community       any concurrent (reauthorization) requests or new requests for
  LEGISLATIVE       9/14/2009         and other
                                                          Support        CSS may not exceed 90 days, must be accompanied by a
CHANGES SESSION                      MH/DD/SAS
  LAW 2009-451                                                           discharge plan which must indicate that discharge from the
                                                                         service will occur within that authorization period. The approved
                                                                         forms for new requests for CSS and for reauthorization requests
                                                                         can be found in Attachment A and in Attachment B. [Section
                                                                         10.68.A]




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 Implementation   Implementation
                                        Title (s)      Subject(s)                                 Summary
   Update #:        Update Date

                                                                      The following policies become effective October 12, 2009: The
                                                                      paraprofessional level of Community Support will be eliminated
                                                                      and neither Medicaid funds nor state funds shall be used to pay
                                                                      for this level of service; for Medicaid, Health Choice and State-
                                                                      funded services, no new admissions will be authorized for
                                                                      individual or group Community Support services; CSS cannot be
      #060                                                            provided in conjunction with certain designated enhanced
    SPECIAL                        Community Support                  services; the providers of some enhanced services identified in
                                                       Community      this update that do not include clinical home functions will be
  LEGISLATIVE       9/14/2009         and other
                                                        Support       responsible for the development and implementation of the PCP
CHANGES SESSION                      MH/DD/SAS
  LAW 2009-451                                                        including the crisis plan in coordination with the LME and recipient
                                                                      to identify local crisis services that can be accessed, submission
                                                                      of the Consumer Admission form to the LME and submission of
                                                                      the applicable request for authorization form and supporting
                                                                      documentation to the ValueOptions or the LME. If the recipient
                                                                      receives more than one non-clinical home service (e.g., PSR or
                                                                      Opiod Treatment) it is expected that providers will work together
                                                                      to coordinate services. [Section 10.68.A]
                                                                      Effective June 30, 2010, Community Support Services will not be
                                                                      a covered service under the NC State Medicaid Plan.
      #060                                                            Authorizations for Medicaid and State-funded CSS currently in
    SPECIAL                        Community Support                  effect as of September 14, 2009 will remain valid until the current
                                                       Community
  LEGISLATIVE       9/14/2009         and other                       authorization expires. Requests for Community Support Services
                                                        Support
CHANGES SESSION                      MH/DD/SAS                        for children must follow the established Early and Periodic
  LAW 2009-451                                                        Screening, Diagnosis, and Treatment (EPSDT) procedures and
                                                                      requirements, which are available at
                                                                      http://www.dhhs.state.nc.us/dma/epsdt [Section 10.68.A]

      #060
    SPECIAL                        Community Support
                                                       Community      The current moratorium on CSS provider endorsement remains
  LEGISLATIVE       9/14/2009         and other
                                                        Support       in effect. [Section 10.68.A]
CHANGES SESSION                      MH/DD/SAS
  LAW 2009-451




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 Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
   Update #:        Update Date

                                                                        A provider of CSS whose endorsement has been withdrawn or
                                                                        whose Medicaid participation has been terminated is not entitled
      #060
                                                                        to payment during the period the appeal is pending and DMA
    SPECIAL
                                                         Community      shall make no payment to the provider during that period. If the
  LEGISLATIVE       9/14/2009           Appeals
                                                          Support       final agency decision is in favor of the provider, DMA shall
CHANGES SESSION
                                                                        remove the suspension, commence payment for valid claims and
  LAW 2009-451
                                                                        reimburse the provider for payments withheld during the period of
                                                                        appeal. [Section 10.68.A]
                                                                        Any Community Support provider that ceases to remain in
                                                                        business shall provide written notification to DMA, the LME,
                                                                        recipients, and the prior authorization vendor 30 days prior to
                                                                        closing the business. Medical and financial record retention is the
                                                                        responsiblity of the provider and shall be in compliance with the
      #060                                                              record retention requirements of their Medicaid provider
    SPECIAL                                                             agreement or State-funded services contract. Records shall also
                                                         Community
  LEGISLATIVE       9/14/2009      Closing of Business                  be available to state, federal, and local agencies. Failure to
                                                          Support
CHANGES SESSION                                                         comply with the notification, recipient transition planning, or
  LAW 2009-451                                                          record maintenance shall result in suspension of further payment
                                                                        until such failure is corrected. Failure to comply shall also result
                                                                        in denial of enrollment as a provider for any Medicaid or state-
                                                                        funded service and may be subject to sanctions, including
                                                                        exclusion from further participation in the Medicaid program, as
                                                                        set forth in Title XI. [Section 10.68.A]




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 Implementation   Implementation
                                        Title (s)       Subject(s)                                  Summary
   Update #:        Update Date

                                                                        To prepare for the Community Support transition Local
                                                                        Management Entities will need to: · Provide notice to all
                                                                        Community Support providers regarding the changes in policies
                                                                        affecting Community
      #060                                                              Support services.· Work closely with providers of Community
    SPECIAL                                                             Support services, particularly those that serve high risk
                                    LME Role in CS      Community       consumers. · Collaborate with providers to ensure consumers are
  LEGISLATIVE       9/14/2009
                                   Service Transition    Support        appropriately triaged.
CHANGES SESSION
  LAW 2009-451                                                          · Assess workforce and service development needs. Community
                                                                        Support providers within a given catchment area will need to be
                                                                        aware of alternative services that consumers can transition to
                                                                        including but not limited to: · Provisionally licensed professionals
                                                                        with LME contracts; Licensed professionals; Medicaid-enrolled
                                                                        psychiatrists/psychologists; Primary care providers; Other
                                                                        Effective September 28, 2009, all new authorizations for
                                                                        Community Support Team (CST) shall be based upon medical
      #060                                                              necessity as defined by the DMA Clinical Coverage Policy 8A and
    SPECIAL                                                             shall not exceed 18 hours per week. Requests received by
                                   Community Support     Community      ValueOptions and LMEs for more than 18 hours per week shall
  LEGISLATIVE       9/14/2009
                                       Team             Support Team    be returned as “Unable to Process.” As of the date of this memo,
CHANGES SESSION
  LAW 2009-451                                                          existing authorizations for CST will remain effective until the end
                                                                        of the current authorization period. Effective September 28, 2009,
                                                                        if an adverse decision is appealed, maintenance of services shall
                                                                        not exceed the 18 hour service limit. [Section 10.68.A]




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 Implementation   Implementation
                                         Title (s)         Subject(s)                                 Summary
   Update #:        Update Date

                                                                          All Medicaid funded child mental health, developmental disability
                                                                          and substance abuse residential service providers (Level II-
                                                                          program type, III and IV) are required to be nationally accredited
                                                                          by August 7, 2010 (one year from date of enactment of the
                                                                          legislation). Authorizations currently in effect for Level III and
                                                                          Level IV residential services remain valid. Effective September
      #060                                                                28, 2009, established criteria must be met for new admissions to
    SPECIAL                                                               Level III or Level IV child residential services. In developing the
                                    Child Residential      Residential    Person Centered Plan, the Child and Family Team shall promote
  LEGISLATIVE       9/14/2009
                                        Services            Services      least restrictive services in the home (such as Intensive In- Home
CHANGES SESSION
  LAW 2009-451                                                            or Multisytemic Therapy) prior to residential placement. During
                                                                          treatment there must be inclusion in community activities and
                                                                          parent or legal guardian participation in treatment. In addition to
                                                                          the eligibility criteria documented in DMA Clinical Coverage Policy
                                                                          8D-2, this update provides other conditions that must be met priot
                                                                          to a child being admitted to a Level III or Levell IV placement.
                                                                          Requests for Level III and Level IV residential services for
                                                                          children must follow the established Early and Periodic
                                                                          For all new admissions, length of stay is limited to no more than
                                                                          120 days. All requests for a new admission must include a
                                                                          discharge plan. Effective September 28, 2009, concurrent
      #060                                                                authorizations are limited to a maximum of 90 days after the
    SPECIAL                                                               current authorization expires. Special procedures and
                                   Residential Level III   Residential
  LEGISLATIVE       9/14/2009                                             documentation requirements must be followed as outlined in this
                                   & Level IV Services      Services
CHANGES SESSION                                                           update. Requests for Level III and Level IV residential services
  LAW 2009-451                                                            for children must follow the established Early and Periodic
                                                                          Screening, Diagnosis, and Treatment (EPSDT) procedures and
                                                                          requirements, which are available at
                                                                          http://www.dhhs.state.nc.us/dma/epsdt. [Section 10.68.A]




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 Implementation   Implementation
                                         Title (s)         Subject(s)                                  Summary
   Update #:        Update Date

                                                                           Any residential provider that ceases to operate shall provide
                                                                           written notification to DMA, the LME, recipients, and
                                                                           ValueOptions 30 days prior to closing the business. The provider
      #060
                                                                           is responsible for maintaining records in compliance with record
    SPECIAL
                                   Residential Level III   Residential     retention requirements. Records shall be available to state,
  LEGISLATIVE       9/14/2009
                                   & Level IV Services      Services       federal, and local agencies. Failure to comply with notification,
CHANGES SESSION
                                                                           recipient transition planning, or record maintenance shall be
  LAW 2009-451
                                                                           grounds for withholding payment until such activity is concluded.
                                                                           In addition, failure to comply shall be conditions that prevent
                                                                           enrollment for any Medicaid or State-funded service.


                                                                           To address the reduction in funds for Medicaid Case
                                                                           Management services, DMA has convened a steering committee
                                                                           with representatives from other Department of Health and Human
                                                                           Services (DHHS) divisions, providers, recipients’ family members
      #060
                                                                           and advocates, to identify ways to improve the efficiency and
    SPECIAL
                                   Case Management            Case         effectiveness of case management services. For up-to-date
  LEGISLATIVE       9/14/2009
                                      Workgroup            Management      information on this initiative, please go to the DMA website at
CHANGES SESSION
                                                                           http://www.ncdhhs.gov/dma/provider/MedicaidCaseManagement.
  LAW 2009-451
                                                                           htm. Providers can review meeting agendas, minutes, meeting
                                                                           handouts and working documents as well as data reports and an
                                                                           overview of current Medicaid-funded Case Management services.
                                                                           Please check this site frequently to stay current on developments.


                                                                           Changes related to new annual Medicaid cards for recipients
      #060
                                                                           were discussed in the September 2009 Medicaid Bulletin, which
    SPECIAL
                                     Medicaid Card          Recipient      was published on the DMA website on September 1, 2009.
  LEGISLATIVE       9/14/2009
                                       Changes              Eligibility    Please be sure to review the information in the article carefully.
CHANGES SESSION
                                                                           Medicaid Bulletins may be accessed at
  LAW 2009-451
                                                                           http://www.ncdhhs.gov/dma/bulletin




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 Implementation   Implementation
                                       Title (s)         Subject(s)                                   Summary
   Update #:        Update Date

                                                                     Under Section 10.64A(a)(1)(a)and (b) DHHS is directed to take
      #060                                                           actions to achieve required budget reductions, including the
    SPECIAL                                                          requirement for providers to both receive payment and submit
                                   Electronic Claims   Reimbursement
  LEGISLATIVE       9/14/2009                                        claims electronically. The implementation date and other
                                      Submission          & Billing
CHANGES SESSION                                                      requirements for the Electronic Claims Submission were available
  LAW 2009-451                                                       in the September 2009 Medicaid Bulletin, which may be accessed
                                                                     at the web address above.

                                                                     Effective with the second check write in September (September
      #060
                                                                     15, 2009) the N.C. Medicaid Program will no longer issue paper
    SPECIAL
                                   Electronic Funds    Reimbursement checks for claims payment. All payments will be made
  LEGISLATIVE       9/14/2009
                                       Transfer           & Billing  electronically by automatic deposit to the account specified in the
CHANGES SESSION
                                                                     provider’s Electronic Funds Transfer (EFT) Authorization
  LAW 2009-451
                                                                     Agreement for Automatic Deposits.

                                                                         DHHS may suspend payment to any North Carolina Medicaid
                                                                         provider against whom DMA has instituted a recoupment action,
                                                                         termination of the NC Medicaid Administrative Participation
      #060                                                               Agreement, or referral to the Medicaid Fraud Investigations Unit
    SPECIAL                        Medicaid Provider      Provider       of the North Carolina Attorney General's Office. The suspension
  LEGISLATIVE       9/14/2009         Payment             Payment        of payment shall be in the amount under review and shall
CHANGES SESSION                      Suspension          Suspension      continue during the pendency of any appeal filed at the DHHS,
  LAW 2009-451                                                           the OAH, or State or federal courts. If the provider appeals the
                                                                         final agency decision and the decision is in favor of the provider,
                                                                         the DHHS shall reimburse the provider for payments for all valid
                                                                         claims suspended during the period of appeal. [Section 10.73.A]




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 Implementation   Implementation
                                        Title (s)         Subject(s)                                  Summary
   Update #:        Update Date


                                                                          As a follow-up to Implementation Update #59, the General
                                                                          Assembly imposed restrictions on the use of state funds to
                                                                          supplement the benefits that CAP-MR/DD recipients receive
                                                                          through the waiver. Most waiver recipients may only continue to
                                                                          receive State-funded services when there is not a comparable
      #060                                                                service available in the waiver. Those services are “limited to
    SPECIAL                           State Funds                         guardianship, room and board, and time-limited supplemental
  LEGISLATIVE       9/14/2009      Supplementing CAP-     CAP-MR/DD       staffing to stabilize residential placement.” There is an exception
CHANGES SESSION                      MR/DD Services                       for former Thomas S. consumers. Those individuals may
  LAW 2009-451                                                            continue to receive a broader array of State-funded consumers,
                                                                          based upon the LME’s authorization. In order to come into
                                                                          compliance with this limitation, all LMEs should complete their
                                                                          review of the State-funded services being received by waiver
                                                                          recipients no later than October 1, 2009. As noted in IU # 59,
                                                                          LMEs should not reduce or terminate State-funded services if a
                                                                          revised Person Centered Plan has been submitted to
                                                                          Session Law until the revised into law time to be 26, 2009,
                                                                          ValueOptions2009-526, signedplan has on August processed.
                                                                        made various clarifying changes to the requirements of the
                                                                        Medicaid Fair Hearing and Appeals process. Special attention
      #060                                                              should be directed Section 2 (a) re: changes in the timelines for
                                                         Changes in the when notifications of adverse decisions shall be made, to Section
    SPECIAL
                                                          Medicaid Fair 10.15A.(h2) re: changes in the timeline by which contested cases
  LEGISLATIVE       9/14/2009           Appeals
                                                          Hearing and shall be scheduled and heard by OAH as well as to changes in
CHANGES SESSION
                                                        Appeals Process policy concerning continuances, mediation timeframes and
  LAW 2009-526
                                                                        processes, the presentation of new evidence. Refer to Session
                                                                        Law 2009-526 at
                                                                        http://www.ncleg.net/enactedlegislation/sessionlaws/pdf/2009-
                                                                        2010/sl2009-526.pdf for full details.




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 Implementation   Implementation
                                        Title (s)       Subject(s)                                  Summary
   Update #:        Update Date


      #060
    SPECIAL
                                                        Community       Procedures are outlined in Section 10.15A.(e2) that must be
  LEGISLATIVE       9/14/2009       Provider Appeals
                                                         Support        followed with Community Support provider appeals.
CHANGES SESSION
  LAW 2009-526

                                                                        Proposed Reduction in State Funds for Individuals Receiving
                                                                        CAP-MR/DD Funding per proposed legislation, SB202, SECTION
                                                                        10.21B -- CAP-MR/DD recipients are not eligible for any State-
                                     CAP- MR/DD
     #059            8/4/2009                          IDD Funding      funded services except for those services for which there is not a
                                       Update
                                                                        comparable service in the CAP-MR/DD waiver. The excepted
                                                                        services are limited to guardianship, room and board, and time-
                                                                        limited supplemental staffing to stabilize residential placement.
                                                                       Required Documents for DD Submissions to ValueOptions An
                                                                       incomplete submission for a recipient age 21 and over will be
                                                          Service
                                   CAP-MR/DD Update                    returned to the case manager as Unable to Process and the case
      #59            8/4/2009                          Authorization -
                                      (continued)                      manager must resubmit the entire request. An incomplete
                                                       ValueOptions
                                                                       submission for a recipient under age 21 will be handled under
                                                                       Lack of Information procedures.
                                                                       Person Centered Plan Instructions: CAP-MR/DD ONLY!!! In the
                                                                       PCP Instruction Manual there is an item that needs revision and
                                                                       clarification. On page 35, section III: Legally Responsible Person
                                                                       includes the CAP Choice statement. All individuals who receive
                                   CAP-MR/DD Update                    CAP funding or their legally responsible person (LRP) must sign
     #059            8/4/2009                              PCP
                                      (continued)                      to confirm their understanding of their choice to participate in the
                                                                       CAP-MR/DD waiver. Therefore, this section III must be signed by
                                                                       either the guardian (LRP) or the individual, in the event they are
                                                                       their own guardian and check all three of the boxes since the
                                                                       CAP choice statement is not included in Section II on the
                                                                       signature page.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                 Summary
  Update #:        Update Date


                                                                         Proposed revisions to seven service definitions in Attachment E
                                                                         of Clinical Coverage Policy 8A, Enhanced Mental Health and
                                                                         Substance Abuse Services, have been posted to the Division of
                                                                         Medical Assistance (DMA) web site at
                                                                         http://www.ncdhhs.gov/dma/mpproposed/index.htm. Comments
                                                                         from stakeholders and the public are invited and will be accepted
                                   Proposed Service       Service
    #059            8/4/2009                                             for 45 days (through August 30, 2009). The revised service
                                  Definition Revisions   Definitions
                                                                         definitions include: · Assertive Community Treatment Team
                                                                         (ACTT) · Community Support Team (CST) · Intensive In-Home
                                                                         (IIH) · Mobile Crisis Management (MCM) · Multi-Systemic
                                                                         Therapy (MST) · Substance Abuse Comprehensive Outpatient
                                                                         Program (SACOT) · Substance Abuse Intensive Outpatient
                                                                         Program (SAIOP).

                                                                         As outlined in Implementation Update #56, an agency that
                                                                         provides Community Support services must have at a minimum,
                                  CSS Requires a Full-                   a full-time licensed professional on staff as of January 1, 2009
                                                          Licensed
    #059            8/4/2009        time Licensed                        per Section 6.1, General Information of DMA Clinical Coverage
                                                         Professional
                                     Professional                        Policy 8A, Effective August 1, 2009, licensed professionals shall
                                                                         provide clinical expertise and oversight for the provision of
                                                                         medically necessary services.




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Implementation   Implementation
                                        Title (s)        Subject(s)                                   Summary
  Update #:        Update Date

                                                                         The licensed professional provides or makes provisions for the
                                                                         following: Assure clinically appropriate assessment, person
                                                                         centered planning and therapeutic interventions are delivered
                                                                         within the specific service definition; Assure clinically appropriate
                                                                         services are delivered to eligible recipients within the service
                                                                         definition (right person, right treatment, right intensity, frequency
                                  Role of the Licensed                   and duration); Assure that staff operate within their appropriate
                                                          Licensed
    #059            8/4/2009      Professional in a CS                   scope of practice for services delivered; Coordinate with quality
                                                         Professional
                                        Agency                           assurance and quality improvement functions of the agency;
                                                                         Assure that clinical supervision is provided to staff (qualified
                                                                         professionals, associate professionals, paraprofessionals and
                                                                         Certified Peer Specialist) delivering the specific service; Monitor
                                                                         professional/ethical conduct of direct service staff (includes, but
                                                                         not limited to, confidentiality, client’s rights, appropriate
                                                                         boundaries, etc.).
                                                                         In conjunction with DMA's Case Management Steering
                                                                         Committee, DMH/DD/SAS has formed an internal Case
                                                                         Management Workgroup. This workgroup includes
                                                                         representatives from DMH/DD/SAS, LMEs, providers, advisory
                                   Establishment of                      and advocacy councils, and most importantly, consumers and
                                     DMH/DD/SAS                          family members. The group will meet every other week during the
                                                            Case
    #059            8/4/2009       Stakeholder Case                      case management project and will be responsible for the
                                                         Management
                                     Management                          DMH/DD/SAS vetting of all materials and documents generated
                                      Workgroup                          by the steering committee. DMH/DD/SAS is grateful to those
                                                                         who have agreed to join in this task important to consumers of
                                                                         behavioral healthcare services. The effort will be chaired by
                                                                         Foster Norman (CEO, Southeastern Center LME) and Dave
                                                                         Richard (Executive Director, ARC of NC).




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Implementation   Implementation
                                        Title (s)           Subject(s)                                Summary
  Update #:        Update Date

                                                                           Due to draft legislation that proposes the elimination of the
                                                                           Medicaid service Community Support by June 30, 2010,
                                                                           DMH/DD/SAS and DMA are in the process of developing a
                                                                           Community Support Steering Committee to strategically evaluate,
                                                                           plan and facilitate the transition of adults and
                                  Community Support         Community      children/adolescents utilizing this service. The Committee will
    #059            8/4/2009                                               begin its work within August and will be comprised of Community
                                  Steering Committee         Support
                                                                           Support service recipients/families, providers, LME's, DMA and
                                                                           DMH/DD/SAS representatives and other key stakeholders.
                                                                           Meetings are tentatively scheduled on a weekly basis through the
                                                                           end of September. All information regarding the transitional
                                                                           planning for this service will be posted on the
                                                                           DMH/DD/SAS and DMA websites.
                                                                           The proposed FY 2010 budget reduces funding levels for Child
                                                                           Residential Level III and IV services for both Medicaid and state
                                                                           funded consumers. The leadership of DHHS believes this
                                                                           provision, currently under review by a joint conference committee
                                  Residential Level III     Residential
    #059            8/4/2009                                               of the NC General Assembly, will be included in the final
                                        and IV               Services
                                                                           approved FY 2010 budget. While the timeline has yet to be
                                                                           confirmed, guidance has been given to the LMEs, the local
                                                                           agencies overseeing the proposed reduction, to begin a triage
                                                                           process of all children/youth in these services.

                                                                        Currently, staff of provider agencies and LMEs, at every level of
                                                                        their respective organizations, are contacting many staff in the
                                                                        Department on a wide variety of issues. To address these issues,
                                                                        we have agreed to implement the following communication
                                                                        pattern, effective immediately: LME staff should direct their
    #059            8/4/2009        Communication         Communication questions, through their management channels, to the LME
                                                                        Director or designee. If the LME Director or designee wants
                                                                        information or clarification from DHHS, that individual should
                                                                        contact the assigned DMH/DD/SAS LME liaison. The liaison will
                                                                        be responsible for referring the question to the most appropriate
                                                                        DHHS responder.



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                                      Title (s)         Subject(s)                                Summary
  Update #:        Update Date

                                                                     The LME liaisons will also be responsible for compiling the
                                                                     requests for clarification and information that they receive for
                                                                     review by DHHS leadership to identify trends and instructions,
                                                                     processes, policies and/or procedures that are causing the most
                                                                     concern in the system. This guidance does not apply to specific
                                                                     reporting procedures for which the communication protocol has
                                                                     already been established – such as incident reporting, referral of
                                   Communication                     providers to DHSR, Program Integrity or the DMH/DD/SAS
    #059            8/4/2009                          Communication Accountability Team, etc. LME Finance staff may contact the
                                      (contd)
                                                                     DMH/DD/SAS Budget and Finance Team directly with questions
                                                                     regarding state funds and payments. Provider staff should direct
                                                                     their questions, through their management channels, to the
                                                                     provider agency director or designee. If the provider agency
                                                                     director or designee has questions or seeks clarification, they
                                                                     should contact the appropriate individual in the Local
                                                                     Management Entity in whose catchment area they deliver
                                                                     services.
                                                                     If the provider agency director does not receive a timely
                                                                     response, believes the information they have received is not
                                                                     accurate, or receives different interpretations from different
                                   Communication                     LMEs, they should first contact the LME director. If that contact
    #059            8/4/2009                          Communication does not address the concerns to the agency director’s
                                      (contd)
                                                                     satisfaction, the director or designee may contact Dick Oliver,
                                                                     LME System Performance Liaison Team Leader , (919) 715-
                                                                     1294), or one of the LME liaisons for
                                                                     assistance.mailto:Dick.Oliver@dhhs.nc.gov
                                                                     The deadline for coverage of provisionally licensed providers
                                     Extension for     Provisionally delivering outpatient behavioral health services as a reimbursable
    #058            7/9/2009         Provisionally       Licensed    service under Medicaid and state funds and billed through the
                                  Licensed Services    Professionals Local Management Entity (LME) has been extended to June 30,
                                                                     2010.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                 Summary
  Update #:        Update Date

                                                                        DMA has extended the sunset clause to June 30, 2015 for nurse
                                                                        practitioners who provide outpatient behavioral health services.
                                                                        Nurse practitioners who possess an Advanced Certification in
                                  Extension of Sunset
                                                            Nurse       areas other than psychiatric nursing, and who have two years of
    #058            7/9/2009        Clause for Nurse
                                                        Practitioners mental health experience will be allowed to enroll under this
                                      Practitioners
                                                                        sunset clause. Nurse practitioners must directly enroll with
                                                                        Medicaid to be eligible to provide outpatient behavioral health
                                                                        services.
                                                                        Nurse practitioners must directly enroll with Medicaid to be
                                                                        eligible to provide outpatient behavioral health services. They
                                                            Nurse       may also provide services "incident to" a physician if employed in
                                                        Practitioners - a physician's office or a physician-directed clinic. All behavioral
    #058            7/9/2009      Nurse Practitioners
                                                       Reimbursement health nurse practitioner services billed under "incident to" must
                                                           & Billing    meet the guidelines outlined in the May 2005 Special Bulletin and
                                                                        the October 2008 Medicaid Bulletin available on DMA's website
                                                                        http://www.ncdhhs.gov/dma/bulletin/
                                                                        In order to facilitate best practice and integrated care for clients,
                                                                        CPT procedure codes 99408 and 99409 do not require prior
                                   Prior Authorization  CPT - Service authorization.
    #058            7/9/2009         for CPT Codes     Authorization - These codes are also used by physicians and other medical
                                      99408/99409       ValueOptions professionals for substance abuse assessments and screenings.
                                                                        Value Options will not process prior authorization requests
                                                                        submitted for these CPT codes.
                                                                        This is a reminder of current outpatient prior authorization and
                                                                        billing guidelines for outpatient behavioral health services outlined
                                                                        in the June 2009 Implementation Update/Medicaid Bulletin. Value
                                  Updated Outpatient       Service      Options has revised the current Outpatient Review Form (ORF2).
    #058            7/9/2009       Prior Authorization Authorization - Effective July 1, 2009, providers must use the revised ORF2 for
                                          Form          ValueOptions prior authorization requests. Providers should pay special
                                                                        attention to these two fields on the revised form: · Attending
                                                                        Provider Name/Medicaid # and · Billing Provider Name/Medicaid
                                                                        #.




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Implementation   Implementation
                                        Title (s)          Subject(s)                                  Summary
  Update #:        Update Date


                                                                           DMA has updated edits in the Medicaid Management Information
                                  Facility Based Crisis                    System (MMIS) to by-pass third party commercial insurance and
    #058            7/9/2009                              MMIS - Billing
                                      MMIS Edits                           Medicare for Facility Based Crisis and mobile crisis services
                                                                           since these services are not covered under those plans.


                                                                           DMA has updated edits in the Medicaid Management Information
                                  Mobile Crisis MMIS                       System (MMIS) to by-pass third party commercial insurance and
    #058            7/9/2009                              MMIS - Billing
                                        Edits                              Medicare for Facility Based Crisis and mobile crisis services,
                                                                           since these services are not covered under those plans.

                                                                    DMA will implement a number of changes in response to the
                                                                    budget reductions proposed by the legislature. Providers will be
                                                                    notified of operational changes, and coverage and policy changes
                                       DMA Budget     Reimbursement
    #058            7/9/2009                                        in future Medicaid Bulletins. These changes will also be listed on
                                  Initiative Web Page    & Billing
                                                                    DMA’s website at
                                                                    http://www.ncdhhs.gov/dma/provider/budgetinitiatives.htm.


                                                                           Oral nutritional supplements are covered for children under the
                                                                           age of 21 under Durable Medical Equipment (DME), when
                                                                           justification of medical necessity is provided. Oral nutritional
                                                                           supplements for children can be billed by providers enrolled as a
                                                                           Medicaid DMA provider. All applicable guidelines can be located
                                      Nutritional
    #058            7/9/2009                              CAP-MR/DD        in the DMA Policy 5A located on the DMA website, accessed by
                                     Supplements
                                                                           the provider link. Oral nutritional supplements are not covered for
                                                                           adults (individuals over the age of 21) under DMA. Adults who are
                                                                           receiving CAP-MR/DD services may receive oral nutritional
                                                                           supplements through regular Medicaid which are billed as “B”
                                                                           codes.




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Implementation   Implementation
                                      Title (s)          Subject(s)                                Summary
  Update #:        Update Date

                                                                       The Provider Monitoring Tool (PMT) was implemented on
                                                                       January 1, 2009 and is used by the LMEs for routine monitoring
                                                                       of local providers. Plans were to make revisions to the tool after
                                  Standardization of
                                                         Provider      it had been in use for six months. Posting and implementation of
    #058            7/9/2009        Local Provider
                                                       Monitoring Tool the revised PMT on July 1 has been postponed. In the coming
                                   Monitoring Tool
                                                                       weeks there will be discussions within DMH/DD/SAS and in the
                                                                       PMT Workgroup related to the tool and the monitoring process as
                                                                       it relates to national accreditation.
                                                                    In light of the transformation the MH/DD//SA system has
                                                                    undergone in recent years, including the merger and
                                                                    consolidation of LMEs and a significant expansion of private
                                                                    provider agencies, it is necessary to update all record retention
                                                                    guidelines. Toward this end, several projects are underway.
                                  Record Retention                  Retention schedules are being updated to reflect the records
                                                          Record
    #058            7/9/2009       and Disposition                  management needs of our present system. The retention and
                                                         Retention
                                     Guidelines                     disposition schedules for the central office, state facilities and
                                                                    LMEs will be updated. In addition, a schedule will be developed
                                                                    specifically for provider agencies. These schedules are being
                                                                    developed in collaboration with the Government Records Branch
                                                                    of the Department of Cultural Resources and the DHHS
                                                                    Controller's Office.
                                                                    N.C. Session Law 2008–107, Section 10.15(x), requires DHHS to
                                                                    return the service authorizations, utilization reviews, and
                                                                    utilization management functions to the LMEs. In the March 2009
                                  Implementation of                 General Medicaid Bulletin, providers were notified that four LMEs
    #058            7/9/2009                           UR/UM - LMEs
                                    UM by LMEs                      had been selected to perform this function and that
                                                                    implementation was planned for July 1, 2009. DHHS is
                                                                    continuing to work on transferring the utilization review functions
                                                                    to the LMEs to meet the intent of the legislation.




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Implementation   Implementation
                                      Title (s)       Subject(s)                                   Summary
  Update #:        Update Date

                                                                      A task force was formed to identify the domains, tasks,
                                                                      knowledge, and skills essential to the performance of a
                                                                      competent Peer Support Specialist. The 2009 Peer Support
                                   Peer Support
                                                                      Specialist Training Curriculum Submission and Evaluation
    #057            6/1/2009        Curriculum          Training
                                                                      Guidelines (which is included in this update) will go into effect July
                                    Guidelines
                                                                      1, 2009. Information pertaining to these guidelines and to the
                                                                      Peer Support Specialist Certification Process can be found at
                                                                      http://bhrp.sowo.unc.edu/index.php?q=node/122
                                                                      Clarification is provided regarding LME billing for oral nutritional
                                                                      supplements. The utilization review vendor will no longer
                                                                      authorizes nutritional supplements under the T1999 code. The
                                                                      conditions under which T1999 can be used are discussed. The
                                    Nutritional
    #057            6/1/2009                         CAP-MR/DD        cost summary should identify each supplement needed by the
                                   Supplements
                                                                      individual with the appropriate code and fee. Although prior
                                                                      approval is not required, an order must be provided by a
                                                                      physician, physician's assistant, or nurse practitioner. These
                                                                      changes are effective immediately.
                                                                      The endorsing agency must submit the Notification of
                                                                      Endorsement Action (NEA) withdrawing a provider's endorsement
                                  New Email & Mail
                                                                      to Computer Sciences Corporation (CSC) via certified mail to:
    #057            6/1/2009      Address for NEA    Endorsement
                                                                      N.C. Medicaid Provider Enrollment, CSC, 2610 Wycliff Road,
                                    Withdrawals
                                                                      Suite 102, Raleigh, NC 27607 or electronically to
                                                                      endorsement.dma@lists.ncmail.net.
                                                                  The volume of Community Support Team (CST) requested and
                                                                  approved has tripled over the past year. Much of this trend (also
                                                                  seen with Intensive In-Home and Day Treatment) is a result of
                                  CST: Increasing     Community
    #057            6/1/2009                                      the more appropriate use of CST in lieu of Community Support,
                                  Request Volume     Support Team
                                                                  however, one in five requests for CST since February do not
                                                                  meet medical necessity. Guidelines for determining the
                                                                  appropriateness of the service are provided.




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Implementation   Implementation
                                       Title (s)         Subject(s)                                      Summary
  Update #:        Update Date


                                                                        This is a follow-up to Implementation Update # 51 (December
                                                           Service
                                   Fax Confirmation                     2008) which requires providers to obtain fax confirmation sheets
    #057            6/1/2009                            Authorization -
                                       Update                           as proof of fax submission. Failure to properly set up the
                                                        ValueOptions
                                                                        caller/sender identification (CS ID) continues to be problematic.

                                                                        Effective July 1, 2009, providers must use the revised ORF2 for
                                                                        prior authorization requests. Providers should pay special
                                                                        attention to the Attending Provider Name/Medicaid # and the
                                  Updated Outpatient       Service      Billing Provider Name/Medicaid # fields on the revised form. Both
    #057            6/1/2009      Prior Authorization   Authorization - fields must be completed. Prior authorizations will be created for
                                         Form           ValueOptions the Billing Provider Name/Medicaid #. Instructions are also given
                                                                        for group providers. Effective September 1, 2009, any requests
                                                                        submitted on the old ORF2 form or requests without both of the
                                                                        required fields completed will be returned as "Unable to Process."
                                                                         In Implementation Update # 48 (September 2008), providers
                                                                         were advised of the Medicaid Management Information System
                                                                         (MMIS) upgrade for Adult Enhanced Services, specifically the
                                   MMIS Diagnosis
    #057            6/1/2009                            MMIS - Billing   transition to DSM-IV-TR Diagnostic Coding. This current update
                                    Code Update
                                                                         clarifies some of the problems encountered by providers in
                                                                         managing the transition. Providers are also referred to the July
                                                                         2008 Special Bulletin for information on using the NCECSWeb
                                   Revised Effective                     Tool.
                                                                         The effective date for the rate decrease for ACTT, which was previously
                                                     Reimbursement
    #056            5/6/2009      Date for ACTT Rate               published in Implementation Update # 49, has been changed from
                                                        & Billing  January 1, 2009 to July 1, 2009.
                                      Reduction

                                     Prospective                         Service providers are to check the “prospective” box on the Inpatient
                                                           Service      Treatment Report (ITR) form for initial requests only. Concurrent
                                    Request= Initial
    #056            5/6/2009                            Authorization - requests for which the prospective box is checked will be returned as
                                       Request
                                                        ValueOptions "Unable to Process" which could result in a delayed start date and a
                                                                         gap in authorization periods.




                                                            277 OF 366
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Implementation   Implementation
                                       Title (s)          Subject(s)                                     Summary
  Update #:        Update Date


                                  Update to "Incident                     Providers are required to submit a new request for prior approval to
                                  To" by Provisionally      Service      Value Options using CPT codes for service dates effective May 1, 2009
    #056            5/6/2009           Licensed          Authorization - and forward. Prior approval guidelines pertaining to the SC modifier on
                                   Professionals in a    ValueOptions the service request form outlined in the May 2009 Medicaid Bulletin
                                   Physician's Office                     supersede the guidance provided in the March 2009 Medicaid Bulletin.


                                                                           Computer Sciences Corporation (CSC) assumed Medicaid
                                                                          provider enrollment activities effective April 20, 2009. The
                                  New Email and Mail                      endorsing agency must now submit NEA letters to CSC via
                                   Address for NEA                        certified mail to:
    #056            5/6/2009                             Endorsement
                                       Letters                            N.C. Medicaid Provider Enrollment, CSC
                                                                          2610 Wycliff Road, Suite 102
                                                                          Raleigh, NC 27607 or electronically
                                                                          toendorsement.dma@lists.ncmail.net.

                                                                          Go to http://www.ncdhhs.gov/dma/provider/mmis.htm for updated
                                  CSC Assumes DMA          Provider
    #056            5/6/2009                                              information concerning N.C. Medicaid provider enrollment,
                                  Provider Enrollment     Enrollment
                                                                          credentialing, and verification activities.

                                    CAP-MR/DD
                                      Update:                             As a follow-up to Implementation Update # 55, for Continued Need
                                   Requirement for                        Reviews (CNRs), after the initial plan, the psychological evaluation does
    #056            5/6/2009                             CAP-MR/DD
                                    Psychological                         not have to be completed or updated unless the participant has
                                     Evaluations                          experienced changes that warrant an updated evaluation.




                                                             278 OF 366
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Implementation   Implementation
                                      Title (s)       Subject(s)                                     Summary
  Update #:        Update Date

                                   CAP-MR/DD
                                                                      The April 21, 2009 CAP-MR/DD Update provides the link to Case
                                   Update: Case
                                                                      Management Request for Technical Assistance from
                                   Management
                                                                      ValueOptions, Services Delivered in Staff Member' Homes and
    #056            5/6/2009        Request for       CAP-MR/DD
                                                                      Requirements for Behavior Support Plan:
                                     Technical
                                                                      http://www.ncdhhs.gov/mhddsas/cap-mrdd/cap-update4-21-
                                  Assistance from
                                                                      09.pdf.
                                   ValueOptions


                                                                      Beginning March 1, 2009, the state plan amendment (SPA) requires that
                                                                      Community Support providers meet a 35% qualified professional (QP)
                                    Revision to                       service measure, and then in September 2009, a 50% service measure,
                                                                      up from the 25% benchmark that has been in place. There are two
                                  Guidance on CS      Community
    #056            5/6/2009                                          measurements for LMEs to utilize to determine compliance:
                                  QP% Calculation      Support        1. Monthly reports that indicate the provider meets the 35%/50%
                                                                      benchmarks.
                                                                      2. Three month aggregates to indicate that the average over three
                                                                      months meets the appropriate benchmark.


                                   Clarification of                   The January 1, 2009 revision of the Division of Medical Assistance
                                                                      Clinical Coverage Policy 8A, Section 6.1 General Information, reads
                                     Licensed          Licensed
    #056            5/6/2009                                          “The agency must have a full-time licensed clinical professional on
                                    Professional      Professional    staff.” This statement was included in the policy in error and applies only
                                     Language                         to Community Support agencies at this time.
                                                                      Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the
                                                                      federal law that says Medicaid must provide all medically necessary
                                                                      health care services to Medicaid-eligible children. The services are
    #056            5/6/2009      EPSDT Request         EPSDT
                                                                      required even if the services are not normally covered by children's
                                                                      Medicaid. Providers are responsible for ensuring that staff and
                                                                      recipients are aware of EPSDT.




                                                         279 OF 366
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Implementation   Implementation
                                        Title (s)          Subject(s)                                     Summary
  Update #:        Update Date

                                                                           Medicaid provider enrollment, credentialing, and verification functions
                                                                           will be transferred from DMA Provider Services to Computer Sciences
                                                                           Corporation (CSC). Effective April 20, 2009, providers will mail all
                                                                           Medicaid enrollment forms, including applications, agreements,
                                                                           Medicaid provider change forms, and Carolina ACCESS applications
                                  CSC Assumes DMA           Provider       and agreements, to CSC at the address shown in the chart below.
    #055            4/3/2009
                                  Provider Enrollment      Enrollment      Providers accessing the DMA website for enrollment information after
                                                                           April 20, 2009, will be redirected to the CSC website to obtain provider
                                                                           enrollment forms. CSC will operate a dedicated Medicaid Provider
                                                                           Enrollment, Verification, and Credentialing (EVC) Call Center for
                                                                           providers to inquire on the status of their Medicaid applications or
                                                                           change requests.

                                  Reimbursement of                     Currently licensed behavioral health providers are able to utilize the
                                   Behavioral Health                   following H codes: H0001, H0004, H0004 HQ, H0004 HR, H0004 HS,
                                                                       H0005 and H0031. LMEs are also able to utilize the H codes listed
                                      Services for       Reimbursement
    #055            4/3/2009                                           above to bill for the services of provisionally licensed providers until
                                     Licensed and           & Billing  June 30, 2009. After May 1, 2009, only the appropriate CPT codes (with
                                     Provisionally                     the SC modifier) may be utilized to bill for provisionally licensed
                                  Licensed Providers                   professionals providing services “incident to” the physician.



                                                                     Requests for time limit overrides must be sent to EDS with
                                                                     documentation showing that the original claim was submitted within the
                                                                     initial 365-day time period. Federal guidelines require that all Medicaid
                                                                     claims, except hospital inpatient and nursing facility claims, must be
                                                       Reimbursement received by EDS within 365 days of the first date of service in order to
    #055            4/3/2009      Time Limit Overrides
                                                          & Billing  be accepted for processing and payment. All Medicaid hospital inpatient
                                                                     and nursing facility claims must be received within 365 days of the last
                                                                     date of service on the claim. If a claim was filed within the 365-day time
                                                                     period but not paid for some reason, providers have 18 months from the
                                                                     remittance advice (RA) date to refile a claim.




                                                              280 OF 366
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Implementation   Implementation
                                       Title (s)          Subject(s)                                   Summary
  Update #:        Update Date


                                  Completing Plans of                    Case managers are to submit Continued Need Reviews (CNR)/Plans of
                                                                         Care (POCs) for CAP-MR/DD recipients by the first day of the birth
                                  Care and Continued
    #055            4/3/2009                             CAP-MR/DD       month. If such falls on a weekend or holiday, the CNR is due on or
                                     Need Review                         before the first day of the month (not on the first business day of the
                                       Requests                          month).

                                                                         When consumers change provider agencies due to choice, and the
                                  Authorizations for       Service      previous provider of record has not sent the discharge ITR to the
    #055            4/3/2009      Recipient Transfer    Authorization - utilization review (UR) vendor, or when a provider discontinues a
                                                        ValueOptions site/service, either voluntarily or through withdrawal of endorsement,
                                                                         processes have been approved to minimize barriers.

                                                                         DMA and DMH/DD/SAS continue to work cooperatively with the
                                   Utilization Review
    #055            4/3/2009                            UR/UM - LMEs selected LMEs, ValueOptions and EDS to move toward the July 1, 2009
                                         Update                          implementation date.


                                                                         The most recent Endorsement Policy: “Policy and Procedures for
                                                                         Endorsement of Providers of Medicaid Reimbursable MH/DD/SA
                                  Revised Guidance                       Services”, December 3, 2007, contains guidance regarding the appeal
    #055            4/3/2009       for Endorsement      Endorsement      process on pages 9 and 10, Section 8 “Reconsideration and Appeal
                                        Appeals                          Rights of the Provider.” This guidance is being revised to address
                                                                         Community Support Appeals and Appeals for Services other than
                                                                         Community Support Child and/or Adult Services.



                                                                         Changes to the DHHS Incident Reporting Process - Effective Date: April