Monday, December 29, 2008

Death by a diff set of Forms: Western Highlands Network LME new Mental Health Basic Level Services : improvement or same paperwork nightmare?

This was posted by Western Highlands Network LME on 12.23.2008. Thankfully, this LME is listening to providers' complaints about paperwork nightmares.

So, what's not to like?


1. This benefit is for all new MH Child and Adult consumers entering the Western Highlands Network system. This initial basic benefit includes:

• minimal paperwork to activate the consumer

• an authorization for 1 year to include:

o 1 event of assessment (90801 or H0031 or T1023)
o 1 event of medical evaluation (90801)
o 8 sessions or 32 units total unmanaged outpatient therapy package. This is the same number of sessions as last year. And the year before. And this is for state funded clients. And I would like to know is this: when the LME's start to authorize the Medicaid clients, are the providers going to have to create all of this paperwork for Medicaid also?

Please note that no activity in 60 days could result in WHN administrative case closure. Re-activation paperwork would be required to re-activate the case. So, what happens when the 8 sessions run out for the year? I guess you get to re-create the paperwork the next year.

2. There is a minimal expectation of paperwork with these consumers for the LME purposes.

Consumers must be registered or screened, and case responsibility assigned. (By the LME?)

Review of PCPs, however, would be retrospective and not required prior to the delivery of these services. What does this mean? That the PCP has to be done sometime during the year----the long version or short version or some other version? would have been useful to have a link to the PCP form expected and statement as to what this 'retrospective' thing is.

• The ONLY paperwork expected for this period is for case activation which cannot turn up via the 'search' box but via the 'provider' tab; then 'access and registration'; then click on the 'all WHN forms' link:

STR, LCAD, IPRS, DCCI and Assignment of Case Responsibility

#1. STR

#2. LCAD It must be this but you sure cannot tell from the acronym, LCAD:
LME Consumer Admission and Discharge Form (12/08/08) (PDF) (Word) : this appears to have been created by NC DHHS and so wnhy can't all the LME's just use this form w/ all the basic information instead of creating all these other sub-forms with repetitious information?
48 (so far) items associated w/ demographic data, etc.

#3. IPRS

#4. DCCI I guess its this one: Description of Consumer Clinical Issues form 092107 ;

#5. Assignment of Case Responsibility


turn this all in within 5 days of the assessment. Do they mean within 5 days of the Diagnostic Assessment? or what? .

FAX TO 828-225-2779 Another new fax number!

• The initial basic benefit does not apply if additional services (other than the
assessment, medical evaluation or outpatient therapy) are requested.

3. Additional services are requested through Concurrent Review (Utilization Management) for
re-authorization. The Basic Benefit services for Adult/Child MH can be reauthorized at any
time, as shown in the table below. Where is the concurrent review information? It does not come up via the 'search' tab at the WHN LME URL. You only get referred back to the original memorandum.


So, in summary:

* we still only have 8 sessions
*there are still 5 repetitive information forms
* who do you contact to ask questions?
*why can't there be links in the memorandum about all these matters, which take you to the forms on the WHN LME webpage?
*what is the turn-around time for the LME when the provider turns in all this information?
*what is the turn-around as associated w/ this 'concurrent review'?
*if one wanted to have more than 8 sessions, who do we contact?
*will they answer their e mail?
*where is the information for this 'concurrent review'?
*who do we contact?
*will they answer their e mail?
*is the PCP expected? which form? short or long or something else?
*why can't they combine all of these forms?
*why isn't the form that appears to have been created by NC DHHS, the LME Consumer Admission and Discharge Form (12/08/08) (PDF) (Word), good enough?
*what is the purpose of the 'Description of the Consumer's Clinical Issues (September, 2007----is that even a CURRENT form) if there is also a PCP to be done on some sort of retrospective schedule of whose making?

man, alive.


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