Medicaid Waiver: Western Highlands Network Provider Relations Employee Asking for Submission of Quality Management Plan Which is No Longer Required for Licensed Independent Practitioners

June 16, 2012

Dear Ms. Donna Oliver:

I sent the Provider Enrollment Application Request Form to Ms. Stein in Provider Relations last week. She came back to me in an e mail and told me to resubmit : my tax return (I sent it to Ms. Faulkner in January, 2012); my Market Analysis (I sent that to Ms. Faulkner in January, 2012); my Emergency Response System statement (I sent that to Ms. Faulkner in January, 2012). She also asked for a Management Plan.

I don't know if she realizes this or not, given that she is working in Provider Relations, but that was taken off as an item to be submitted by LIP's sometime ago. Therefore, I am not sending that.

I am resending all of these documents to you, personally, as apparently Ms. Stein does not know that the Quality Management Plan is no longer necessary, as per your own Provider Enrollment Application Request Form.

Please let me know what else you need.

Sincerely, Marsha V. Hammond, PhD
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Here is Ms. Stein's e mail to me:


June 14, 2012

Marsha V. Hammond, PhD

Re: Status of In Network Agreement

Dear Dr. Hammond,
         
The In Network Agreement submitted by Marsha V. Hammond, PhD was received on June 14, 2012.  The following required materials were not included with the Application:
·          Copy of your emergency response plan - (i.e., plan you have in place for clients in crisis, when you are unavailable)
·          Market analysis demonstrating need for services (this could be information on the need for the type of services you provide in your service area)
·          Copy of most recent tax return
·          Copy of Quality Management Plan

Please submit the materials listed above within five (5) business days so that your request may be processed in a timely manner.  No further action will be taken until all of the documents requested are submitted, reviewed and approved.

Should you have any questions, please contact me at 828-225-2785, ext 2979.

Sincerely,

Kelley Stines
Provider Network Operations
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The old Provider Enrollment Application Request Form did require a Quality Management Plan, whatever that is for a solo, Licensed Independent Provider.

The new form states specifically that this is not required: here is the link:

Well, my goodness, since Friday of last week, WHN LME has removed all its links to Provider enrollment and stated this:

"Notice: As a waiver site WHN is no longer offering contracts to all interested providers, but will enroll providers based on the needs of the local recipients and on provider network performance. WHN became an operational waiver site as of January 3, 2012. WHN held its open enrollment period during the implementation of its 1915 b/c waiver, from April 2011 through December 2011". 
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Does the right hand know what the left hand is doing? 


The above is a puzzle given that DMA is stating that the enrollment period continues for 'at least a year.'