Survey, Temp Extension of 1915 Waiver; Provider Enrollment; Credentialing Committee, Ops Manual Update

Each year, NC Medicaid contracts with The Carolinas Center for Medical Excellence (CCME) to conduct a Provider Satisfaction Survey of all the LME-MCOs participating in the Medicaid 1915(b)/(c) waivers for mental health, substance abuse, and intellectual and developmental disabilities services in North Carolina. As part of this process, providers will receive a survey from CCME.    This survey is used as a comparison of LME-MCO performance against other LME-MCOs.

Partners values our Providers and we hope that you will complete the survey.  During this time, more than any other time, your feedback is critical.  Thank you for taking the time to participate in this process.

(Note: The following information was published by NC DHHS, Division of Medical Benefits and Division of Mental Health, Developmental Disabilities, and Substance Use Services in Joint Communication Bulletin J306. To view NC DHHS’ Joint Communication Bulletins, click here.)

On September 25, 2018, the Centers for Medicare & Medicaid Services (CMS) granted North Carolina a temporary extension (TE) of North Carolina’s Prepaid Inpatient Health Plan (PIHP) 1915(b) waiver program and the concurrent 1915(c) Innovations waiver. This temporary extension will expire on December 29, 2018. As CMS has suggested that we start on January 1, 2019, the State will submit a second TE to CMS to cover December 30 and 31 as a TE can only be requested for 90 days.

The NC Innovations waiver will continue to operate at cost and utilization levels approved for the fifth year of the waiver. The NC Innovations Individual Cost Limit of $135,000 per year will continue to reset with the participants approved annual Individual Support Plans.

Authorizations for services that have ‘Life of the Waiver’ financial limits (Home Modifications, Vehicle Modifications, and Assistive Technology) may not exceed those limitations. Once the waiver is renewed, those limits will start over.

CMS is granting North Carolina this extension to complete the submission of the waiver renewal applications and to align the waiver effective dates with the federal fiscal year (FFY) quarters.

If you have any questions, please call Kenneth Bausell at 919-855-4296 or e-mail Kenneth.Bausell@dhhs.nc.gov, or call Deb Goda at 919-855-4297 or e-mail Deborah.Goda@dhhs.nc.gov.

Providers are reminded that credentialing and enrollment are two separate and distinct processes.

In order to enroll a provider (agency, site or clinician) into AlphaMCS, Partners must verify that the provider is both

1. credentialed with Partners and
2. enrolled in NC Tracks.

The effective date of the enrollment in AlphaMCS is the earliest date that the provider is both credentialed with Partners and enrolled in NC Tracks.   If Partners attempts to enroll a provider in AlphaMCS and is unable to verify your enrollment in NC Tracks, we will send you an enrollment status letter outlining the reason(s) why we cannot enroll you.  It is the provider’s responsibility to notify Partners once the enrollment problems outlined in that letter have been resolved.

Providers receive notification from NC Tracks whenever the Managed Change Request (MCR) is accepted and then a second notice is received whenever the MCR has been processed.  Partners does NOT receive any notification from NC Tracks regarding these updates.  Providers should notify us at enrollment@partnersbhm.org as soon as you receive the second notification saying that your request has been processed by NC Tracks.  Partners will NOT be able to verify the change prior to your receipt of the second notification from them.

As noted on the enrollment status letter, we will not make any further changes to your enrollment status in AlphaMCS until you notify us that the update has been made in NC Tracks.  We do NOT monitor NC Tracks updates for all providers on an on-going basis.  We rely on you to notify us whenever the information has been added to NC Tracks.  Partners will update AlphaMCS, as quickly as possible, as soon as you send us notification that the change has been made and we are able to verify the information in NC Tracks.

For more information about the difference between credentialing and enrollment please refer to our website at the following link https://providers.partnersbhm.org/provider-enrollment-credentialing.

For questions about this process please contact us at enrollment@partnersbhm.org  

Partners is seeking providers who would like to participate on our Credentialing Committee.  We are in need of providers who can represent the following areas:

• A licensed clinician who has either child or adult experience and either mental health or substance use disorder experience
• A clinician who is licensed and in a non-managerial role at a provider organization.

Providers who are interested in participating on the Credentialing Committee should contact Natalie McBride , Provider Network Manager at nmcbride@partnersbhm.org or Julie Walker, Provider Council Chair at julie.walker@thecogcon.com. The Provider Council initially approves providers who volunteer to participate, and then the nominees are reviewed by Partners’ Chief Medical Officer and Credentialing Committee Chair, Dr. Bess Stanton, for final approval.

The Partners Credentialing Committee meets via videoconference from our Elkin, Gastonia, and Hickory locations on the third Wednesday each month from 10 a.m. until 12 p.m.