Western Highlands Network

Friday E-Mail Newsletter

SPECIAL EDITION
03/10/2006

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.

WHN ANNOUNCES CROSS WALK OF CBS AND CASE MANAGEMENT TO COMMUNITY SUPPORT.

What follows is a brief summary regarding the conversion of Case Management and Community Based Services to Community Support as the new service definitions take effect on 3-20-2006.

Western Highlands will automatically issue a new Community Support authorization so it will not be necessary for providers to submit a new Service Authorization Request (SAR), except in circumstances not covered in the descriptions below. This conversion does not apply to DD services.

Definitions:
CM = Case Management
CBS = Community Based Services
CS = Community Support Services

1. Existing Medicaid authorization that ends after 3-19-06:

WH will combine the previously authorized CM and CBS units, convert the total to CS units, and automatically authorize that total (up to a maximum of 3512 units). This new CS authorization will lapse approximately 60 days after the originally authorized lapse date. (The previous CM and CBS authorizations will no longer be valid after 3-20-06.)

Example: 600 units of CM + 2000 units of CBS set to lapse on 4-2-06 will yield an authorization automatically generated by WH for 2600 units of CS set to lapse on 6-2-06.

2. Existing Medicaid authorization that was truncated to end on 3-19-06:

WH will combine the most recent authorization for CM and CBS units, convert the total to CS units, and automatically renew an authorization for that total (up to a maximum of 3512 units). This new CS authorization will lapse approximately 60 days after the originally requested lapse date. (The previous CM and CBS authorizations will no longer be valid after 3-20-06.)

Example: 600 units of CM + 2000 units of CBS originally set to lapse on 4-2-06 but truncated to lapse on 3-19-06 will yield an authorization automatically generated by WH for 2600 units of CS set to lapse on 6-2-06.

3. New Medicaid authorization:

For services beginning before 3-19-06, providers may submit the usual authorization request paperwork (using the current CM and CBS definitions), and, if the authorization ends on or after 3-19-06, the automatic conversion by WH described in # 1 above will take place. Authorization for services beginning on or after 3-20-06 must be for CS.

4. Existing IPRS authorization that ends after 3-19-06:

WH will convert the previously authorized CM and CBS units into CS units, and automatically authorize up to a total of 24 units per week. This new CS authorization will lapse approximately 30 days after the originally authorized lapse date. (The previous CM and CBS authorizations will no longer be valid after 3-20-06.)

Example: 600 units of CM + 2000 units of CBS set to lapse on 4-2-06 will yield an authorization automatically generated by WH for 24 units of CS per week set to lapse on 5-2-06.

5. Existing IPRS authorization that was truncated to end on 3-19-06:

WH will convert the most recent authorization for CM and CBS units into CS units, and automatically authorize up to a total of 24 units per week. This new CS authorization will lapse approximately 30 days after the originally requested lapse date. (The previous CM and CBS authorizations will no longer be valid after 3-20-06.)

Example: 600 units of CM + 2000 units of CBS originally set to lapse on 4-2-06 but truncated to lapse on 3-19-06 will yield an authorization automatically generated by WH for 24 units of CS per week set to lapse on 5-2-06.

6. New IPRS authorization:

For services beginning before 3-19-06, providers may submit the usual authorization request paperwork (using the current CM and CBS definitions), and, if the authorization ends on or after 3-19-06, the automatic conversion by WH described in # 4 above will take place. Authorization for services beginning on or after 3-20-06 must be for CS.

Note:
A Letter of Notification (LON) will be sent to the case manager to confirm the new authorization for CS and the lapse date.

At the end of the authorizations noted above, the usual process for requesting authorizations for services will apply.

Beginning 3-20-2006 all new service authorization requests formerly for CM and CBS must be for CS or CS Team.

The above continuation authorizations are, of course, contingent upon endorsement.

WH policy does not allow for retroactive authorizations.

Charlie Schoenheit
Director of Services Management
Western Highlands Network
356 Biltmore Avenue
Asheville, NC 28801
Telephone: (828)258-3511 x2219
FAX: (828) 225-2779
E-Mail: Charlie@westernhighlands.org
Website: westernhighlands.org