Friday, June 22, 2012

Medicaid Waiver under Smoky Mountain Center LME: Confusion re: already authorized Medicaid Services

Here is my letter to the Director of Provider Relations at SMC LME-MCO regarding an announcement today sent out by Stephanie Gibson at SMC LME-MCO:

FROM: Marsha V. Hammond, PhD Clinical / Health Psychology  NC Licensed Psychologist
cell: 828 772 1127  e mail:

TO: Patty Wilson, Director of Provider Relations, SMC LME-MCO

RE: Stephanie Gibson's announcement re: continuation of authorizations for Medicaid clients

Date: July 22, 2012

Dear Patty Wilson:

Stephanie Gibson sent out this e mail a moment ago. I called her; she hung up on me after I stated my name and nothing else; I called back; the operator told me she wanted me referred to you, Patty Wilson.

Here is the e mail Stephanie Gibson just sent out and my questions are below the e mail. Thank you for your reply.

The memo is confusing to me and this is compounded by the matter that I have Medicaid patients who are already authorized by Value Options to receive services, pretty much, through the end of this year. Her memo is, I believe, an attempt to speak to this matter but it is confusing.

"Stephanie .. Gibson

12:48 PM (30 minutes ago)

TO: SMC Providers

RE: I. ATTENTION ICF/MR Providers: Utilization Review Information

DATE: June 22, 2012
__________________________________________________________________________________________________________ ATTENTION ICF/MR Providers: Utilization Review Information

As previously communicated to providers, SMC is required by DMA to honor authorizations completed by VO that extend beyond June 30, 2012.

ICF-MR providers do not complete the UR--utilization review--process (have their services authorized) through VO. However, SMC wants to honor the end dates of the current URs for ICF-MR residents. To do this, we are asking the ICF-MR providers to send in a copy of all current UR forms for residents whose Medicaid county of eligibility is one of the 15 SMC counties. We will use this as the end date of the “authorization”. We will need you to send an updated UR AT LEAST 10 days prior to the expiration of each resident’s current UR.

The NC Innovations LOC Determination is to be utilized when ICF-MR agencies submit UR under the Innovations Waiver. This form is to be utilized at the next UR submission for an individual served in the ICF-MR facility. Additionally, this form will be utilized by ICF-MR facilities for initial UR submissions as well."
Here are my questions:

1. What does ICF refer to?

2. I ask this question as I have several Medicaid patients who received extended authorizations from Value Options earlier this year; they have mental illness diagnoses; they are not MR; does this announcement pertain to these patients?

3. If so, the above statement, specifically: "we are asking the ICF-MR providers to send in a copy of all current UR forms"----are you asking for me to print out from the Medicaid website the authorization for the patient? If so, Stephanie's additional statement that, "We will need you to send an updated UR AT LEAST 10 days prior to the expiration of each resident’s current UR."----does this mean that you do not need the authorization printed out from NC Medicaid UNTIL the authorization is about to expire? If so, how is the Medicaid Waiver going to overlap in terms of SMC LME assigning some kind of number to the billing process which now takes place via the HP Webclaims Portal.

4. Who do I send this authorization to, if it is so that you need a print out of the Medicaid authorization?

5. Are there any additional numbers that need to be attached to Medicaid billing as per the Medicaid Waiver going into effect July 1, 2012, as re: these already authorized sessions?----or do I simply continue to bill utilizing HP Webclaims portal as before.

6. I ask that question as HP lost its contract and some other company, landed by Lanier Cansler prior to he becoming Secretary of NC DHHS, is to sometime become the agency that handles the billing for Medicaid patients.

7. Do you know how much longer the HP Webclaims portal will be in effect?

8. As associated with that portal, which I know well from having used it efficiently for years, there is no place for any SMC LME number. When I bill there, I simply put in the Medicaid number of the patient. So, if SMC is going to require a number as re: this Medicaid waiver, assuming that I will be allowed to be an In-Network provider as I continue to work with Medicaid patients under SMC LME, how is this going to be handled?

thanks for your reply.

Marsha V. Hammond, PhD

cc: Ureh Lekwauwa, MD, DMA


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