Western Highlands Provider Friday Newsletter, 10/01/07

	Western Highlands Network
	Friday E-Mail Newsletter Number 100 10/01/2007 The Friday E-Mail is a weekly update for providers by the Services Management Department of Western Highlands Network. Please distribute to all your staff. UPDATED GRIDS! Western Highlands is releasing new Standard Care Grids for all disability groups. You will note that there are some significant changes for State Funded/IPRS care. Links to all of the documents described in this newsletter are available at the end of the document. These changes include: We have increased Utilization Review periods for most services to be more in line with the review periods now in use by Value Options for Medicaid consumers. This means you will have to request services less frequently, in some cases. We have included the Access Grid as a column along side of Level Of Care (LOC), so you can easily reference available benefits by disability area. In the spring, we were able to reintroduce a Basic Benefit for IPRS consumers for up to 8 events per year, to meet the needs of the majority of consumers who do not need enhanced services. Please remember that State Funds/IPRS funds are the funding stream of last resort. This funding stream is not an entitlement program. Clinicians from the LME and feedback from clinicians in the field in our area had input into the design of Standard Care. We have a responsibility to serve any consumer in any of the eight counties of Western Highlands to provide minimally adequate services. It is imperative that providers seek entitlement programs, and are expected to do so yearly (Medicaid, NC Health Choice) to more fully meet the needs of consumers. State funds are extremely limited, so the benefit available is also restricted to our capacity to pay for care. Division Changes to PCP and Accessing Services Beginning in late June, the Division of Mental Health and the Division of Medical Assistance radically changed how providers use PCPs, and how LMEs evaluate these plans. Although meetings scheduled throughout the state were mandatory, and many providers attended, there still seems to be confusion over which PCP to use, and when. We attempted to clarify this in Friday Email #99. Please refer to that document, as well as documents posted on the Division’s website under Accessing Care. If you would like staff from the LME to come and do training, or schedule additional training around these changes, please contact your Provider and Consumer Relations Specialist to make your needs known. For clarification, here are the current PCPs available, and how they are used: Person Centered Plan: This plan is the original 13 page document released by the state for use from 6/1/06 through 7/15/07. If there are no updates, revisions, reviews, or changes in provider, these are potentially current for a year. It is rare that these can still be used. VO is requiring updated PCPs with every Utilization Review of cases. Basic Benefit Plan: This plan is used for Basic Benefit consumers only. It cannot be used for enhanced services, and should only be used for consumers who receive Outpatient Therapy and Psychiatric visits only. This plan is 4 pages long and requires a Service Order as the signatures on this plan do not constitute the service order. Introductory PCP: This plan was introduced and made effective 7/15/07. This is a 4 page plan which includes basic information, like diagnosis, crisis plan and medical necessity signatures as well as consumer and Qualified Professional signatures. The life of this plan is only 30 days. By the end of that time frame, it is necessary to submit the Complete PCP. This PCP format is intended for use with consumers initially entering service, or those who have been out of care for at least a 60 day period. Consumer transfer between providers will require a Complete PCP to be authorized for care. Complete PCP: This plan was also introduced and made effective on 7/15/07. This plan is very similar to the 6/1/06 PCP, but is titled Complete PCP, and is also 13 pages. Many providers are skipping the Introductory PCP and moving directly to the Complete PCP. This seems to be a good plan in most cases. Please note, however, that there is no place on this PCP for the diagnostic panel, so it will be necessary to submit this information on a separate sheet of paper. We plan to include the diagnosis on the SAR in the future, just as VO has the same information on their ITR. The form used in Access, “Description of Consumer’s Clinical Issues” has also been simplified and updated. Please remember that this document also serves as the Access SAR. We have more clearly defined the information we need around symptoms and behaviors, removed redundant information, and given providers the opportunity to access services consistent with the changes in clinical homes made effective by the state 7/15/07. WESTERN HIGHLANDS POLICY ABOUT PROTECTION OF PATIENT INFORMATION: When contacting WHN about specific consumers, please do not include the consumer’s name in email transmissions. This constitutes a HIPPA violation. Our policy states that communication of this information should include only the consumers first and last initials and their Western Highlands Consumer number. You can find the updated Grids using the following link: Standard Care Guidelines for Disability Areas and Levels of Care http://www.westernhighlands.org/pr_servauthprocedures.htm The new Description of Consumer's Clinical Issues is in the Forms section at this link: http://www.westernhighlands.org/pr_registration.htm The updated SAR is located in the Service Authorization Requests section in this link: http://www.westernhighlands.org/pr_servauthprocedures.htm Western Highlands Network 356 Biltmore Avenue Asheville, NC 28801 Providers Call: 828-225-2785 or 1-800-671-6560 Fax: (828) 225-2779 E-Mail: ring@westernhighlands.org Website: www.westernhighlands.org