State Funded Contract Communication and Changes in Process

Partners is updating the State Funded Process effective July 1, 2022, to align with the new fiscal year. As the need for state funded services grows and there continue to be fewer dollars available, Partners has been working to prioritize these limited dollars.

Partners’ commitment is to serve the most individuals possible throughout our 14-county region. Through this process, we have assessed opportunities to ensure we are maximizing the funding and services available; reducing Medicaid members receiving state funded services where a comparable Medicaid service is available; and maintaining residential utilization for Mental Health/Substance Use (MH/SU) recipients.

Throughout this process, Partners conducted focus groups with providers and members of Consumer and Family Advisor Committees (CFACs) in December 2021. After a review of the feedback obtained and an internal review of systems and processes, Partners has identified the following for implementation with an effective date of July 1, 2022.

State Funded Services Where the Provider is Expected to Manage and Prioritize State-Funded Recipient Access to Services:

For the following categories of services, the State Funded Providers will be able to manage serving those referred to them, provided funds are in their State Funded contract:

Category Services
Crisis Services ·       Mobile Crisis Services

·       Facility Based Crisis Services

Basic Outpatient Services ·       Outpatient Services such as group/individual services available on the State Funded benefit grid

·       Medication Management for those coming out of an inpatient/facility-based crisis service

Substance Use Services ·       Outpatient Substance Use Services

·       Medication Assisted Treatment

·       Services to the Opioid Use Disorder Members

·       SAIOP

·       SACOT

MH/SU Services ·       Psychosocial Rehabilitation (PSR)

·       ACTT (this should be limited)

·       Community Support Team – PSH (this should be limited)

·       Tenancy Management Services

I/DD Day Services for 18–21-year-old ·       Day Activity, Day Supports, Supported Employment Services for 18 to 21-year-old recipients with I/DD or TBI that have graduated from school

o   Exceptional children can go to school until 22.

o   Only if the member has finished school

o   Documentation that school system services are not available any longer

I/DD Respite ·       For the recipients with I/DD not otherwise eligible for or receiving any services who meet one of these three criteria

1)      At imminent risk of institutionalization

2)      Has behavioral complexity resulting in recurrent crisis service usage

3)      At imminent risk of out of home placement from parents/guardians

·       For any new service requests, provider must document how one of these criteria exists

 State Funded Services/Referrals for State Funded Services requiring Partners approval:

 Due to continued restraints on the availability of state funds, Partners will require providers to seek approval for services using a screening process. Recipients who cannot be managed by available funding will be added to Partners’ State-funded Waiting List. Providers should maintain their own waiting lists to share with Partners to add to the network’s waiting list. More information is available below. The state will maintain a statewide waiting list to monitor the need for funding for services.

The following services require Partners’ approval before a recipient can be accepted into services:

Category Services
MH/SUD Residential ·       Group Living Low

·       Group Living Moderate

·       Group Living High

·       Supervised Living Low

·       Supervised Living Moderate

·       Supervised Living High

·       Family Living Low

·       Family Living Moderate

I/DD and TBI Residential ·       Residential Supports

·       Supported Living

 State Funded Referrals for those recipients with an intellectual/developmental disability, mental health or substance use (I/DD/MH/SU) or Traumatic Brain Injury (TBI) diagnosis and requesting one of the aforementioned residential services, will be required to meet at least one of the following criteria to be assessed for State Funded Services:

At imminent risk of entry into institutional settings (e.g., state developmental facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities [ICF-IIDs]), state psychiatric facilities or adult care homes)

Describe:

Has behavioral complexity resulting in recurrent crisis service usage (e.g., emergency department, behavioral health urgent care and facility crisis)

Describe:

At imminent risk for out of home placement from parents or legal guardians
Additional Information:

Effective July 1, 2022

For providers who deliver a residential service that requires approval and have a vacancy, they should:

  • Providers should fill out Partners “State-Funded Service Request & Waiting List Form” for Partners’ review via form found on the Provider Knowledge Base at https://providers.partnersbhm.org/category/provider-tools/
  • Providers should report their members on their agency waiting lists by contacting Partners’ Waiting List Coordinator, Sharon Welling at (704) 884-2539 or email State Funds Wait List statefundswaitlist@partnersbhm.org. Clinical teams meet weekly to review requests for residential services. Providers are notified via email that the member has been added to the waiting list or when the provider may submit a service authorization request.
  • When services end, funding will not remain for a new recipient to fill the opening. However, the services and funding will follow that person if they move to another service provider. For example, if a provider is serving a state funded recipient who ends a service requiring Utilization Management approval, and is seeking services with another State Funded provider, the money designated in the initial provider’s contract for that recipient will be reduced and added to the new providers’ State Funded contract in order to continue to support the recipient in a State Funded service. In these situations, providers should work with the Care Management and assigned Provider Network Specialist to ensure the dollars are following the recipient for service continuity.
  • As part of this transparent process, many stakeholders have asked Partners how to advocate for additional funding so that these cuts can be stopped. It is always helpful to let your member of the House and Senate know you advocate for increased funding for mental health, developmental disabilities, and substance abuse services. You can find out who serves you in the General Assembly here:
  • If you have questions about how the Department of Health and Human Services distributes the money among LME/MCOs, you can direct your comments or questions here: contactdmh@dhhs.nc.gov

Partners Annual Coordination of Care Assessment

Why are we asking you to complete this survey?

Partners is gathering data to identify opportunities to increase sharing of key information for coordination of care across Partners delivery system.

This short survey will assist us in this identification and advance our goals toward consistent coordination of information for our members that are receiving care.

Please respond by June 3, 2022. Partners is updating the State Funded Process effective July 1, 2022, to align with the new fiscal year.

Claims Information

Providers are reminded to contact the Claims Department at claimsdepartment@partnersbhm.org for all claims related questions. To avoid delays in receiving a response please do not contact individual claims staff directly.

AlphaMCS Portal University is an available resource and guide for navigating AlphaMCS. If you need additional claims training, email claimsdepartment@partnersbhm.org to schedule a time for training.

 Explanation of Benefits Requests for Coordination of Benefits Claims

As a reminder, Partners does request copies of the Explanation of Benefits for members/claims submitted indicating Coordination of Benefits. The request will originate via email from Partners’ Claims staff. Once requested, please submit the information, via secured email, prior to the date indicated in the emailed request. If a response is not received, the original claim payment will be recouped.

Reminder: Taxonomy Code 193200000X and 193400000X

Taxonomy Code 193200000X and 193400000X should not be submitted on claims as the rendering taxonomy code. All claims submitted with this taxonomy code as the rendering code will be reverted.

Provider Payments

At Partners Health Management, we are committed to pay claims in a timely manner and adhere to Prompt Pay Guideline Compliance as set forth by the State of North Carolina. In order to ensure that all providers receive EFT payments as outlined in signed contracts, all providers are required to submit the proper financial documentation that includes banking information. If you need to add new banking information or are requesting a change to current banking information, you may email acash@partnersbhm.org or call 704-884-2523.

April 2022: Medicaid—Number of Days to Process and Pay All Claims
Received Date to Paid Date: 9.3

 

Top Five Medicaid Claim Denials for April 2022

Claim Denial

Provider Recommended Action Steps

Duplicate claim. The claim has previously been submitted and adjudicated. Do not refile.
Service is not authorized. Verify Service Authorization for member. Contact Utilization Management.
Claim received after billing period. Write off charges as non-billable. Do not rebill.
No coverage available for Patient/Service/Provider combo.

 

Go to Patient -> Patient Search and search for the patient in question. Check the insurance to ensure the patient has effective insurance coverage to the date of service submitted on the claim. If this is correct, contact the LME/MCO for further assistance.
Billing taxonomy submitted is not associated with the billing NPI. Rebill claims with the correct taxonomy/NPI information.

 

State News and Updates

NCDHHS Resources:

Provider Meetings and Collaboratives

Partners’ Provider Council

May 27, 2022, 9:30 a.m. (Register)

The Partners’ Provider Council is a professional representative of and advocate for all service providers in the Partners’ service area. The Council facilitates an open exchange of ideas and brings forward concerns and solutions while promoting collaboration and mutual accountability among providers. Meetings are held on the fourth Friday of the month.

Partners’ Quarterly Webinar

June 8, 2022, from 1-3 p.m. (Register) 

Partners hosts a quarterly provider webinar to communicate important information and detailed updates to our providers about a variety of topics. All providers in the Partners’ provider network are invited to attend.

Partners LGBTQ Collaborative

June 16, 2022, 3 p.m. (Register)

Partners sponsors a monthly provider-led LGBTQ Collaborative. Topics covered include brainstorming provider initiatives, case consultation, addressing LGBTQ topics of interest and support, celebrations of accomplishments, resource sharing and training needs. Please join us for this interactive session of learning and community. All meetings are held virtually on the third Thursday of each month.

Provider Training

Partners’ Training Library: Are you looking for a recent presentation from a previous Partners’ Training Academy event? Our on-demand training library is available as a resource in the Partners’ Training Academy. Presentations are listed in chronological order, from newest to oldest. Find slide decks, tip sheets and video tutorials at https://www.partnerstraining.org/training-library/.

Community Support Team (CST) Service Definition Training

Community Support Team (CST) is a behavioral health support service designed to help people experiencing severe mental illness develop recovery and resiliency-oriented skills. You can now view previously recorded trainings here:

Quality Management Provider Monitoring

Sessions:

Please join Partners Training Academy to learn more about provider monitoring to include an overview of:

  • Provider Monitoring Process
  • Post Payment Review Areas of Importance
  • Documentation
  • Staff Qualification Areas of Importance
  • Cultural Competency

This is a prerecorded webinar. Please submit any questions following the session to training@partnersbhm.org. NBCC credits are not offered for this course.

Surviving and Thriving as a Helping Professional

May 24, 2022, 1-4 p.m. (Register)

Join Partners’ Training Academy for an interactive training to examine the challenges of compassion fatigue, compassion satisfaction, and burnout. Participants will assess their individual measures in these areas and emerge with in-depth knowledge and better understanding of ways to expand their own resilience as helping professionals.

This is a virtual live event; you will need to participate using audio and video capabilities. If you cannot access audio and video you will need to wait to take a face-to-face class. If you are not participating by video, you will be removed from the session. NBCC credit for up to three hours is available.

If you need accommodations to attend this training email training@partnersbhm.org.

Trainer: Joanna Linn

Provider Open House

June 2, 2022, 9-10 a.m. (Register)

The Provider Open House is a virtual event that occurs the first Thursday of each month from 9 to 10 a.m. and is open to new and existing providers in the Partners Health Management Network. You can enter questions in the question/comment box during registration.

The Provider Open House, much like other essential elements of our work, is shifting in its design and function beginning June 2, 2022. You will note that the scheduled day and start time of the Provider Open House remains the same, yet the session is reduced to one hour. You will also note that we seek to be more intentional about how we spend your time.

The Provider Open House begins promptly at 9 a.m. and is staffed by all the usual department representatives ready to respond to your questions. We ask that you use our Zoom Registration process in advance of the open house and add your question directly into the Zoom Questions and Comments box. This effort on your part, will help us better help you. Of course, your questions are welcome during the open house as well. You may place them in the chat box upon entering the Zoom. Our intention is to address your question or concern in a private one-on-one breakout room, and we understand that your question may require further follow-up. We look forward to your participation.

If you need accommodations to participate in the Provider Open House, please email training@partnersbhm.org

Person Centered Thinking (PCT) Training

June 6-7, 2022, 8:30 a.m. to 5 p.m. (Register)

Person Centered Thinking (PCT) is a foundation and philosophical framework for those involved in supporting people with disabilities. This activity-filled, two-day training consists of applied stories, guided exercises, group work and discussion. This approved National Learning Community Curriculum meets the requirements of North Carolina service definitions.

Person Centered Thinking (PCT) is a foundation and philosophical framework for those involved in supporting people with disabilities. This activity-filled, two-day training consists of applied stories, guided exercises, group work and discussion. This approved National Learning Community Curriculum meets the requirements of NC service definitions.

This is a virtual live event. All participants will be required to have audio and visual capabilities for the full two days (June 6 and 7). You will receive a Learning Community Certificate for completing the class. No partial credit will be given. This class meets the required 12 -hour Person Centered Thinking requirement for North Carolina.

Cognitive Behavioral Therapy (CBT) Learning Community

June 15, 2022, 2-3:30 p.m. (Register)

Join like-minded providers in a learning community to explore skills, concepts, case studies and expand your techniques. This learning community will teach you practical ways to use evidence-based practices in your day-to-day work with members. This session does not offer NBCC CEs.

Cognitive Behavioral Therapy Foundations Training June 2022

June 21 and 23, 2022, 9 a.m. to 12:15 p.m. (Register)

Cognitive Behavioral Therapy (CBT) is an evidence-based practice focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems.

Training will take place over two days, June 21 and 23 from 9 a.m. to 12:15 p.m. Participants must be present with audio and visual capabilities for all sessions to receive credit. No Partial credit will be given.

NCSAPPB approved for up to 6 hours NBCC Approved for up to six hours. Partners has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6932. Programs that do not qualify for NBCC credit are clearly identified. Partners is solely responsible for all aspects of the programs.

If you need accommodation to attend this training, email training@partnersbhm.org. Trainer: Eric Ottinger

Community Support Team (CST) Service Definition Training

August 24, 2022, 8:30 a.m.-11:45 a.m. (Register)

Community Support Team (CST) is a behavioral health support service designed to help people experiencing severe mental illness develop recovery and resiliency-oriented skills.

This webinar meets the requirement for three hours of CST Service Definition Training. Registrants will view a previously recorded training that includes two 10-minute breaks. In order to receive a training certificate, registrants will need to view the full webinar and pass a 10-question quiz with a score of 80% or greater.

Cognitive Behavioral Therapy Foundations Training September 2022

September 20 and 22, 2022, 9 a.m. to 12:15 p.m. (Register)

Join Partners for Cognitive Behavioral Therapy (CBT) Foundations training on September 20 and 22.

CBT is an evidence-based practice that focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems.

This is a virtual live event. You must participate using audio and video capabilities. If you cannot access audio and video, you must wait to take a face-to-face class. If you are not participating with your video, you will be removed from the session. This training is for two (three-hour sessions) on September 20 and 22. You must attend both trainings to receive credit. No partial credits will be given. Trainer: Eric Ottinger

NCSAPPB and NBCC approval for up to 6 hours. Partners has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6932. Programs that do not qualify for NBCC credit are clearly identified. Partners is solely responsible for all aspects of the programs.

If you need accommodations to attend this training, email training@partnersbhm.org.

On-Demand: Abuse, Neglect and Exploitation Training: https://www.partnerstraining.org/training-library/

Trainer:  Chandra Henson, Catawba County Social Services.

The Partners’ Training Academy Learning Library offers on-demand material (less than 30 minutes) for providers. Learn about Adult Protective Services (APS) processes, provider responsibilities, as well as signs and symptoms of potential mistreatment, exploitation and abuse. No National Board of Certified Counselors (NBCC) continuing education credits will be offered.

On-Demand Housing Training:  https://www.partnerstraining.org/training-library/

The Partners’ Training Academy Learning Library offers brief on-demand materials for providers who work with members seeking housing. These are designed for those new to the material. Ideal for new staff orientation and training.

Housing Tutorials

  • Housing Resources Overview
  • Housing First Model
  • Homelessness and Housing for People with Behavioral Health Challenges

Technical Assistance Collaborative (TAC) materials

  • Section 8 Made Simple
  • Vouchers Database by County in NC

Community Training

All Trainings are virtual via Zoom and last two hours unless otherwise specified. For more information contact Jeanne Patterson, jpatterson@partnersbhm.org, or Amber Matthews, amatthews@partnersbhm.org

Partners Community Café
Fourth Wednesday of the month, 10-11 a.m. (Register)

Join Partners for our monthly Community Café, where we focus on relevant issues, concerns and ideas to improve the lives of those we serve.

Human Trafficking: Keeping Our Children Safe

Sessions to choose from:

Human Trafficking is a global problem, even in the United States. Children may be spending more time online than usual. Learn about trafficking around the world and some ideas about how to keep our children safe.

Community Resilience Model® (CRM)

Sessions to choose from:

The Community Resilience Model® instructs participants about the impact of trauma and chronic stress on the nervous system, behavior, and long-term health. Participants learn how to reset the nervous system with easy to learn, concrete, coping skills. One of the goals of CRM is to create trauma-informed and resilient communities.

QPR (Question Persuade Refer) Suicide Prevention

Two sessions to choose from:

Many have experienced recent losses. The risk of suicide is still high. This training teaches the skills to intervene in a suicide crisis.

**The maximum number of people allowed to participate in a virtual QPR training at one time is thirty; registration is on a first come first serve basis.

Introduction to Trauma and Resilience

Sessions to choose from:

Most of us have experienced trauma at some time. This can have a lasting effect on our learning, behavior and health. Learn about trauma and how to address the effects as well as how to develop resilience.

Domestic Violence: How to Help

Sessions to choose from:

Many of us are still home more than usual, and the risk for domestic violence is high. Learn how to spot the signs of domestic violence and how to help.

Risk & Resilience Buffering Toxic Stress Modules 1-3

Sessions to choose from:

This training provides information about how early childhood stress and trauma can result in negative outcomes in areas of learning, behavior and health throughout the lifespan. The definition of early childhood mental health as promoting healthy social emotional development through nurturing young minds from birth throughout early childhood is the core principle of this training.

Risk & Resilience Buffering Toxic Stress: Module 4-Limbic Calming and Module 5-Cortical Coping

June 9, 2022, 10 a.m. (Register)

This is a follow-up to Modules 1-3. Module 4 teaches how to help children calm their limbic systems. In Module 5, we will learn about healing the cortical brain to develop active coping skills such as impulse control and problem solving.

Risk & Resilience Buffering Toxic Stress Module 6: Building Adult Resilience

June 10, 2022, 10 a.m. (Register)

In past modules, we focused on young children and how we can support their development. This final one-hour module shifts to the importance of well-being in adults and how we can continue to build our resilience. Modules stand alone and there are no prerequisites to attend any of the modules.

An Introduction to Child and Family Teams: A Cross-System Training from The Family’s Perspective (Part 1)

June 14-15, 2022, 9 a.m.-4 p.m. (Register)

CFT 1 is a two-day experiential training (when you register, you are agreeing to attend both days) with a goal of providing an overview of Child and Family Team meetings from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing Child and Family Teams through the lens of multiple systems as they affect families in their everyday lives. Agency representatives and parents/family members over 18 years of age are encouraged to attend this training. Sessions must have a minimum of 10 participants. Please do not schedule other appointments during this training. Register soon, this class will fill quickly.

Darkness to Light

Sessions to choose from:

This training provides education about child sexual abuse and the steps you can take to prevent and report child sexual abuse. Seats are limited. Please register early.

Mental Health 101

June 29, 2022, 2 p.m. (Register)

In this two-hour training, learn about some of the more common behavioral health disorders. The class includes treatment and what to do in a crisis.

Trauma Informed Care

Two sessions to choose from:

Let’s look at how our behavior affects others with trauma history. What are some simple changes we can make using what we know about trauma?

Additional Events and Training

Disability Support Professional Training: Mount Eagle College and University is now offering Disability Support Professionals (DSPs) the opportunity to earn national certification in their field through an accredited curriculum instructed by individuals with lived experience. To learn more about the program, please email mjames@mounteag.com or visit https://mounteag.com/contact/ to submit a contact form.

Partners Community Collaboratives: Partners sponsors a monthly community collaborative in each of the counties in the service region. Community Collaborative groups consist of representatives from local government agencies, community organizations, and service providers, as well as individuals, families and advocates who work together in a specific community to identify and solve problems for children, adolescents, adults and families struggling with mental health and substance use.

Together, group members:

  • Identify gaps in services
  • Partner with agencies and families
  • Develop helpful resources
  • Assist providers and families with issues related to services
  • Ensure access to quality services

Currently, all collaboratives are meeting virtually. If you are interested in learning more about a

group or attending, please email Partners Community Engagement.

Select a county below to go to the associated collaborative information:

–      Burke

–      Cabarrus

–      Catawba

–      Cleveland

–      Davie

 

–      Forsyth

–      Gaston

–      Iredell

–      Lincoln

–      Rutherford

 

–      Stanly

–      Surry

–      Union

–      Yadkin