Issued: March 8, 2019
Partners March Provider Webinar
Partners will host its next Provider Webinar on Wednesday, March 13 from 1 p.m.-3 p.m. To register for the webinar, click here.
Please contact Roanna Newton at 828-323-8054 or email firstname.lastname@example.org with any questions. To view past webinars, slide decks, and handouts, please visit https://providers.partnersbhm.org/provider-webinars-forums/
DMH/DD/SAS, DHB issue LME-MCO Joint Communication Bulletin #J319: Verification of Education
On March 6, 2019, the Division of Mental Health, Developmental Disabilities and Substance Use Services (DMHDDSUS) and the Division of Health Benefits (DHB) issued communication that clarifies the education verification process, specifically with respect to assessing the validity and/or acceptability of high school diplomas and GEDs. This Joint Communication Bulletin is consistent with Partners’ prior communications on the subject, including information shared in Provider Communication Bulletin #72, dated August 17, 2017.
The content of #J319 Verification of Education is shared below. Providers can also access the official communication by visiting https://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins.
LME-MCO Communication Bulletin #J319
Date: March 06, 2019
To: Local Management Entities/Managed Care Organizations (LME-MCOs)
From: Deb Goda, Behavioral Health Unit Manager, NC Medicaid, Lisa Haire, Assistant Director, Quality Management and Operations, DMH/DD/SAS
Subject: Verification of Education
The purpose of this bulletin is to provide clarifying information to the LME-MCOs and providers regarding the education verification process, specifically with respect to assessing the validity and/or acceptability of high school diplomas and GEDs. Prior communications indicated that education verification referred to the receipt of sufficient evidence that a person received a high school diploma or GED. While this remains true, the prior communication was not intended to eliminate the need for the diploma or GED to be issued by an entity qualified to make such an award. DHHS is aware of concerns raised about “diploma mills” that may be awarding diplomas while not offering an education that is sufficiently rigorous.
Whether a high school diploma constitutes acceptable evidence of education may require an analysis by LME-MCOs and providers of the history of the entity awarding the diploma. DHHS has not established rules that the LME-MCOs and providers must follow in making such an analysis. An example of a potential analysis has been published by the DHHS Division of Child Development and Early Education (DCDEE) within the context of that Division’s scope of work. DCDEE requires that high school diplomas be issued by nationally recognized regional accrediting bodies but makes an exception for high schools listed with the North Carolina Division of Non-Public Education, which is a Division of the North Carolina Department of Administration. The schools listed with the Division of Non-Public Education change over time and, therefore, diplomas issued at different times may not have the same weight in the analysis done by DCDEE.
Ultimately, LME-MCOs and providers that verify the education and training of individuals interacting with Medicaid beneficiaries must be able to reject certain evidence of education when there is sufficient reason to doubt the legitimacy or authenticity of the information and evidence presented. When a diploma is not awarded by an accredited body, or the accrediting body is not widely recognized, LME-MCOs and providers may choose to investigate further or may choose to find that the diploma is insufficient evidence of education. Given the complexity of the variations that are present between public schools, private schools, home schools, and accrediting bodies, as well as the regular change in the schools listed with the Division of Non-Public Education, DHHS believes LME-MCOs and providers are in the best position to make factual determinations about the acceptability and authenticity of high school diplomas.
If you have any questions, please call Kenneth Bausell at 919-527-7643 or e-mail at Kenneth.Bausell@dhhs.nc.gov.
Attention Psychological Testing Providers: Psychological Testing Codes
Partners has had a slower implementation of the Psych Testing codes than was anticipated. We have consulted with the State and NC Tracks and we are still missing a few codes/rates for providers from DHB. In response, DHB stated that they are aware of this and are working to establish rates for these codes.
In addition, some codes were not incorporated into the State Funded Services array, which can be found here: https://www.ncdhhs.gov/
In our implementation of these codes, it also became a barrier for providers to bill add-on codes on a different day than the base code. We sought guidance for this dilemma, and with guidance from DHB, Partners is asking providers to bill all Psychological Testing codes on the last date of service. Providers will still need a service note for each encounter with the consumer.
If you have any additional questions or concerns regarding these codes, please do not hesitate to reach out to your Provider Account Specialist.