Sunday, March 10, 2013

Western Highlands Network LME GOING DOWN : SMC LME Will Take Over (& I Can Get Paid to See my Clients Finally)

Boy, I sure did my share of kicking this can down the road, informing Smoky Mountain Center of all the problems w/ WHN LME. 

The last straw for me took place several weeks ago when I received a letter in the mail that WHN LME wanted to come over and 'review my office.'  I told them I saw my clients in their homes and I was willing to take them around w/ me if they liked. 

Prior to that, it took them over a year to put my provider status into place.  Then they gave me an out of network provider status. 

I never received any kind of ridiculous request from SMC LME re: looking at my office.  My re-application (remember: we were all already Medicaid providers when all this LME business started....) w/ SMC LME went thru smoothly.

Good riddance. 


And the mental health system spirals downward….

There is talk that Western Highlands, the Managed Care Organization (MCO) currently servicing eight Western North Carolina counties, Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey, will be the next casualty to the MCOs.

The MCOs, formerly called local management entities, are the regionally-based agencies that receive a set monthly payment from the state to provide both state- and Medicaid-paid services. With that money, the MCOs must allot services for everyone under their care.

Rumors at the Capitol is that Western Highlands may be swallowed up by Smoky Mountain Center, the MCO regionally adjacent to Western and servicing 15 counties.

Currently, Western Highlands has no CEO. No Chief Financial Officer. And the Chief Medical Director is near-retiring.

But the lack of leadership is not the only issue with Western.

Health care providers have complained that the majority of authorizations for new services or renewed services are being denied by Western.

The whole point of the MCO-based Medicaid system is to allow the state to dole out chunks of Medicaid funds to each MCO. Then the MCO approves services for Medicaid recipients until the money runs out.

Considering this is only the 2nd year Western Highlands has been servicing the 8 counties, it seems a bit odd to be denying so many services, if this is actually happening........."


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