Tuesday, July 10, 2012

Medicaid Waiver: Medicaid Requires LME Networks to Remain Open to Medicaid Providers 'for at least one year'

This is a series of correspondences, via e mail, between myself, WHN LME, and DMA, indicating that the LME's, as they re-credential Medicaid providers, must leave the network open to Medicaid providers 'for at least one year.'

Thank you for your note, Ms. Faulkner. I cc Mr. Reuss here also as you indicate he is the head of Provider Relations at WHN LME.

I turned in my original filing to be an In Network Provider to WHN LME 1.23.2012. Yes, your deadline was 1.3.2012 but Medicaid requires the network to be open for one year.

It is therefore not acceptable that I am not able to work as an In-Network provider, given that I have been one for Medicaid in NC for over 12 years. I have special expertise working w/ DID clients and have a doctoral psychology degree and am better trained than most of the mental health providers in NC, frankly. I have no sanctions or violations re: Medicaid or my license.

IMHO, you are simply barring me because I have had such a lot to say about the inefficiency of the WHN LME re-credentialing process. I am being processed at SMC LME and so what's the problem w/ WHN LME?

Here is what DMA has to say about the deadline matter: (see also below the complete e mail from Bert Bennett, PhD): "Medicaid requires that the LME under the labor open its doors for all existing Medicaid providers for a minimum of one year."

I therefore cc this to Mr. Bullington who is querying WHN LME about the difficulties I have experienced being allowed to be an In Network Provider at WHN LME.

Marsha V. Hammond, PhD
cc: Ureh Lekwauwa, MD, Clinical Director, DMA NC

Bill Bullington, LME liason, DMA NC


Bennett, Bert bert.bennett@dhhs.nc.gov

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: al.delia@nc.gov.

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


On Tue, Jul 10, 2012 at 8:43 AM, Melissa Faulkner wrote:

Ms. Hammond,

WHN conducted an open enrollment process from April – December 2011. WHN did not receive an enrollment application from you during that time. As of January 3, 2012 WHN began operating as a closed provider network.

WHN does recognize that there are currently three enrollees receiving services from you. The client specific applications were offered to prevent a disruption in their care.

Lastly, one minor correction, I am not the Director of Provider Relations at WHN. Donald Reuss is the Director of Provider Network Operations. I hold the position of Network Operations Manager.
Melissa Faulkner

Provider Network Operations

Western Highlands Network

356 Biltmore Avenue

Asheville, NC 28801

Phone: (828) 225-2785 or (800) 671-6560 Ext. 2922

Fax: (828) 225-2796



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