Wednesday, June 06, 2012

NC Department of Medical Assistance (Medicaid) indicates Open Enrollment for Providers for 1 year but LME's Say Something Else

Why is it that NC Medicaid indicates that the enrollment period will continue 'for at least a year' as associated with this Medicaid waiver while the LME's have all these little tight deadlines for continuing as a Medicaid provider?

The following is from the SMC LME website re: the Medicaid waiver.

I continue to have problems w/ Western Highlands Network LME re: continuing to be a Medicaid provider.  Looks like another call to Board member Nettie Jones who looks after Buncombe county residents is in order.

And it looks like Al Delia needs to know what is going on also (new Secretary of DHHS, taking Lanier Cansler's place).

So, I called him today and this is what I found out: Mr. Delia's secretary advised me to call Steven Jordan 919 733 7011, State Director of Mental Health:

So, I called him.  He was in a meeting.  So I sent him this e mail:

FROM: Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 1127
e mail:
NC Mental Health Reform blogspot, since 2007:

TO: Steven Jordan Steven Jordan 919 733 7011, State Director of Mental Health:
RE: Provider Enrollment periods for WHN and SMC LME

June 6, 2012

Dear Mr. Jordan:

Thank you for reading my e mail. 

This is a query as to why the two LME's in western NC, specifically, SMC LME and WHN LME, are creating barriers regarding Medicaid providers continuing to work w/ their mentally ill patients. 

I understand as per Bert Bennett, Ph.D., Division of Medical Assistance, Clinical Policy, Behavioral Health Section from his e mail to me in February, 2012, that the enrollment period is 'at least a year.' 
The reason I am asking this question is that it has been very difficult to carve out time to fill out the reams of paperwork in order to continue to see my mentally ill patients and be paid. 

Can you advise me as to why the LME's have created these narrow timelines so that providers may enroll whileas Dr. Bennett, and assumably, DMA, state something completely different?
Thanks for your help.

I enclose below the e mail I received from Dr. Bennett in February, 2012.

I also have cut and pasted the SMC LME statement from their website which is causing me to scramble to get all the paperwork in before they deem the network to be closed.  I have quite a few Medicaid patients, very ill, under SMC LME. 
Thanks for your time. 
Marsha V. Hammond, PhD, Licensed Psychologist, NC
Here is the SMC LME statement on the provider period for enrollment so one can continue to see and be paid for seeing one's Medicaid patients:


"....The enrollment process to become a provider in SMC's Provider Network is open at this time to those behavioral health providers that have provided and billed a Medicaid behavioral health service for a Medicaid enrollee whose county of Medicaid eligibility is within SMC's catchment area in the six months prior to SMC's go live date as an MCO. The enrollment process will remain open through June 30, 2012 and on July 1, 2012, the SMC Provider Network will be closed. If you or your agency have not provided and billed a Medicaid behavioral health service for a Medicaid enrollee whose county of Medicaid eligibility is within SMC's catchment area since January 2012, you are not eligible to join the SMC Provider Network at this time....."

Contrarily, this is what DMA has advised me as of February 27, 2012:

Bennett, Bert
Feb 27
to Katherine, me
Dr. Hammond:
Thank you for your questions.  As for the name and contact and permission for Secretary Cansler's replacement, that would be Al Delia as Acting Secretary of the N.C. Department of Health and Human Services. His telephone number is: 919-855-4800 and his e-mail address is:

The next question about Western Highlands and their ability to close the network, Medicaid requires that the LME under the labor open its doors for all existing Medicaid providers for a minimum of one year.  During that year, the LME/MCO has the ability to evaluate the capacity of their network and, after a year, they do have the ability to choose which providers will be in their network.

Thank you for sharing some of the specifics of the difficulties and "barriers" that you have dealt with.  I will pass this information on to the individual responsible for managing the contracts with Western Highlands.  I am sorry that you had such difficulty transitioning to the MCO.

Bert Bennett

Bert Bennett, Ph.D.
Division of Medical Assistance
Clinical Policy, Behavioral Health Section
2501 Mail Service Center
Raleigh, NC 27699-2501
336-724-4539 - Voice
336-722-2899 - Fax


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