Saturday, September 29, 2012

Heads of NC DHHS Medicaid Don't Even Know About Authorization Issues: Don't Bother Asking Them

I expected SMC LME to honor the Value Options authorizations that had been put into place the beginning of the year.  Sorry, but I don't have time to read every single Medicaid bulletin.  This message is from a key person at NC DHHS/ Medicaid:

Nichols, Katherine A
Sep 27 (2 days ago)
to meStephentoni.shelow
Dr. Hammond,

After doing some research in the old special bulletins, I found in the April 2012 bulletin the following excerpt:

Outpatient Behavioral Health Services in LME-MCO Areas
The unmanaged outpatient visits for adults and children will start over for each LME-MCO. In
the current Medicaid State Plan, adults may have eight (8) unmanaged outpatient visits and
children may have sixteen (16) unmanaged outpatient visits each calendar year. LME-MCOs
can increase the number of unmanaged visits per calendar year before prior authorization is
required, but may not decrease the number of unmanaged visits. LME-MCOs are required to
publish their Medicaid benefit packages on their websites.

Therefore, SMC was correct in starting their unmanged visits back over beginning July 1, 2012.  I believe they also communicated this on their website and in provider meetings.  I apologize for my error, but please note the correct information above.

Please don't hesitate to contact me should you have any further questions.




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