NC Providers Council: DHHS / LME-MCO Update

If you are interested in Exhibiting / Sponsoring, 
CLICK HERE for more information!

Welcome Kerri Massey, COO and Executive VP of provider member agency Holy Angels, Inc. as the newest NC Providers Council Board member!  Kerri will be replacing Shannon Childress, who was elected to serve in calendar years 2019, 2020, and 2021.  Shannon recently relocated to South Carolina, and the Board held an election pursuant to Section IV-6 of the Bylaws to fill the vacant seat. 

Partnership for Community Well-Being
 Statewide Media Campaign Update
At the March Membership Leadership Forum, we announced that the
North Carolina Providers Council had contributed $10,000.00 to a 
statewide media campaign effort with partners i2i Center for Integrative Health, Benchmarks, and each of the seven LME/MCOs. 
Eckel & Vaughan is the public relations firm developing the campaign. The firm is currently doing Web site and campaign materials development. E&V is using videos and photographs provided by media campaign partners. NC Providers Council Board members participated in contributing to the images. We will continue to keep you updated on the campaign’s progress. Please see below for the Campaign name, tagline, and hashtag!
Campaign name: Partnership for Community Well-Being
Campaign tagline: Serving people. Strengthening communities.
Campaign hashtag: #CareForNC

The next Membership / Leadership Forum will be 
Monday, June 17th from 10 a.m. to 3 p.m. in Raleigh.
We hope that you will join us! Capacity at the meeting site will be limited to 100 people, so please CLICK HERE to reserve a seat. Registration is $20 and includes lunch. Rooms are available at the Holiday Inn RDU at a discounted rate of $99. Please use this booking link – NCPC June 2019 – to reserve a room and be sure to mention you are coming for the NC Providers Council meeting!

Upcoming NC Providers Council Standing Committee Meetings:
  • Network Council Call                                      May 30, 9:30 a.m. – 10:30 a.m. 
  • Regulatory / Business Practices                   June 6, 10:00 a.m. – 12:00 p.m.
  • Conference Planning Committee                  June 19, 10:00 a.m. – 11:00 a.m.

If you are interested in participating in an NC Providers Council committee, please email Sarah Pfau at The I/DD and MH/SUD Committees meet bi-monthly, and the Regulatory and Business Practices Committee meets monthly.

New in ANCOR 
(American Network of Community Options and Resources)
GAO Identifies Differences in Children with Disabilities’ Access to Special Ed Due to Variations in State Criteria
Nearly 7 million children between the ages of 3 and 21 received special education services during the 2015-16 school year under the Individuals with Disabilities Education Act. That’s about 13% of the total number of students enrolled in public school. But the percent of the population served under IDEA varies across states. Read the full report or listen to the podcast here.
ANCOR Summaries of State Legislative Initiatives Affecting Rights, Access, and MLTSS
View the May 20th State News here!

New in US DHHS
May 14 Press Release: HHS Establishing Interdepartmental Substance Use Disorders Coordinating Committee, Seeking Member Nominations NOTE: Non-federal provider members can be nominated from states.  Deadline June 14 (nomination information linked on the Web page).
Substance Abuse and Mental Health Services Administration (SAMHSA) Publication: Older Adults Living with Serious Mental Illness: The State of the Behavioral Health Workforce

The population of adults that are 65 years old and over is becoming more diverse. Of the 49.2 million adults over 65 years old, 1.4 to 4.8 percent suffer from SMIs. This brief provides a broad-based overview of workforce issues to consider when addressing the needs of older adults living with SMI:
  • The changing demographics of the aging population
  • Challenges faced by a provider workforce
  • Workforce issues
  • Ideas for strengthening the geriatric workforce to address SMI

New in CMS
Staff Departure
Chris Traylor, the Director for the Center for Medicaid and CHIP Services at the Centers for Medicare and Medicaid Services (CMS), will be departing the agency at the end of May. Calder Lynch, currently senior counselor to CMS Administrator Seema Verma, will succeed Traylor as the acting director, according to the agency.

New in NC DHHS

NC DHHS Resources for Provider Transition to Medicaid Managed Care
June 11-12 Opioid Misuse and Overdose Prevention Summit:   Information and Registration Link
Press Release: North Carolina Offers Hepatitis Vaccinations at Treatment Centers

Press Release: R.J. Blackley Alcohol and Drug Abuse Treatment Center Now Certified to Initiate Treatment for Opioid Use Disorder

National Core Indicators (NCI) survey has been open since February 2019 and will close on May 31, 2019.  Your participation is valuable! After the survey is closed, NCI will produce a public report.  DMH/DD/SAS will use the report data to help determine system of policy changes that may be needed to increase DSP quality and stability in NC. Please direct any questions about the NCI Staff Stability Survey to

New in NC Medicaid
Upcoming Medicaid Webinar: Update on BH I/DD Tailored Plan Care Management
May 30, 2019 10:00 a.m. – 11:00 a.m.
Register here!
Updates from May 17 Medical Care Advisory Committee Medicaid Transformation Meeting:
  • Tailored Plan Eligibility Projections: DHB is conducting member claims database reconciliation with LME-MCOs, starting with January 2018 data, to determine beneficiary eligibility for Standard Plans versus Tailored Plans.
  • Exemption Request Forms for the Standard Plans will be mailed with Transition Notice letters by the Enrollment Broker contractor during the enrollment soft launch period, which will begin on June 28th.
  • The next two Policy Papers to be released by DHB will be: 1) Care Management; and 2) Data Strategy. You can access all existing Medicaid Transformation policy papers  here.
  • NC Association of County Commissioners Tailored Plan Geographic Region recommendations will be submitted to NC DHHS Secretary Cohen in June 2019.

Upcoming Healthy Opportunities Pilot Service Meeting:
Tuesday, June 18, 1:00 p.m. – 5:00 p.m.
Brown Building, 801 Biggs Drive, Raleigh, NC 27603
The June meeting will focus on reimbursement rates for the services.  DHHS then plans to post the draft reimbursement rates for public notice and comment in July 2019 and submit the rates to CMS for approval in September 2019. To attend the meeting as a stakeholder, RSVP in advance by contacting
The Healthy Opportunities Pilot will fund non-medical services to address Social Determinants of Health for eligible Medicaid and NC Health Choice beneficiaries in select regions of the State.  NC DHHS has a budget of $650M to spend over five years, beginning in 2019.  Services will address:
  • Housing security;
  • Food security;
  • Transportation; and
  • Interpersonal violence and toxic stress.
Eligible beneficiaries will meet DHHS established needs-based criteria that will include:
  • Children ages 0-3 will be high-risk premature or low birthweight or NICU infants with neonatal abstinence syndrome.
  • Children ages 0 – 21 will have > 1 uncontrolled chronic conditions (ranging from asthma to a substance use disorder) OR be experiencing adverse conditions (including parental violence or sexual abuse) OR be enrolled in Foster Care or the kinship placement system.
  • Pregnant women will have a known substance use disorder OR be multi-gestational OR have had a previous baby < 1 year prior OR have a history of pre-term or low birthweight births OR be an adolescent or advanced age pregnancy.
  • Adults older than 22 years of age will have > 2 chronic conditions such as obesity, a substance use disorder, or pulmonary disease OR repeated use of the ER or hospital admissions (with “repeated use” defined as > 4 per year).
June CAP/DA HCBS Waiver Orientation and Educational Trainings for Providers

This training is intended to provide an in-depth overview of the newly implemented workflow and business steps to render CAP/DA services as outlined in the renewed CAP/DA HCBS waiver application and the amended CAP/DA Clinical Coverage Policy, 3K-2. Intended participants are adult day health providers, meal preparation and delivery providers, personal emergency response service providers, personal care providers, financial management providers and durable medical equipment providers. There are two repeat webinars in June. You may register for the one date that is best for you:
June 20, 2:00 p.m. – 4:00 p.m.
June 25, 10:00 a.m. – noon
May Medicaid Bulletin
Access the May Medicaid Bulletin here.
Clinical Coverage Policies posted for public notice and comment as of May 28, 2019:
The NC Providers Council MH-SUD Standing Committee reviewed and commented on the posted draft service definition and included a State Official on a recent Committee call to answer questions and address concerns.
Proposed Policy
Date Posted
Submit Comments
Comment Period Ends

New in DMH
JCB #325: I/DD Eligibility for State-Funded Services OF NOTE: “This bulletin addresses the requirement of a valid psychological assessment and diagnostic requirements (including the age at which the diagnosis was confirmed), and provisions for legacy beneficiaries.” The NC Providers Council I/DD and Regulatory and Business Practices Committees took concerns about the psychological assessment requirements to State officials, and clarifications in this JCB were subsequently published.
JCB #326: Research-Based Behavioral Health Treatment “The purpose of this bulletin is to clarify the use of Category I CPT Codes and Category III CPT Codes” for both Fee-for-Service and LME/MCO system provider billing.

New in LME-MCOs
Cardinal Innovations
Eastpointe May 2019 Claims Connections Newsletter
Partners Behavioral Health Provider Bulletin #93
Sandhills Center seeks B-3 Transitional Living Program provider, and has issued a Request for Proposal (RFP) for B-3 Transitional Living Programservices for young adults with mental health and/or substance abuse diagnoses. If you are interested in receiving a copy of this RFP, please contact Amanda Phillips at
Trillium Health Resources- Effective May 4, 2018, Trillium Health Resources will be implementing two new edits to our 837 EDI file verification process that may cause claims to reject prior to being processed in the CIE/Provider Direct system.
  • The first of these new edits will focus on not allowing a revenue code to be submitted as a procedure code on an 837 Professional file, as this is not an acceptable billing practice. This rejection will be documented on the Submitter Reports you receive as “The Procedure Code ‘ ‘ is not a valid CPT or HCPCS Code for this Date of Service”.
  • The second of these two edits will be checking that a valid patient discharge status is received on the 837 Institutional claims. If a discharge status is submitted and is not valid per National Uniform Billing Committee (NUBC) guidelines, the claim will not be accepted into our system and you will receive a rejection notice of “Patient Status Code ‘ ‘ is not a valid Patient Status Code” on your Submitter Report.
For questions related to these two new edits, please email
Vaya Health  Kill Devil Hills to launch first fully handicap accessible beach access.  The Grand Opening was May 13.

New in External Groups
Federal Office of Disability Employment Policy Publication
The Office of Disability Employment Policy has published manual to help states develop a strategic process to increase Competitive Integrated Employment (CIE) for people with disabilities. The manual is broken down into two sections: 1) The first section provides an overview of the eight phases of strategic planning; 2) The second section describes five strategic priorities and potential focus areas which are aligned with the ODEP Provider VOICE (Visionary Opportunities to Increase Competitive Employment) technical assistance and Vision Quest supports. To access the strategic planning manual, click here.
I2i Center for Integrative Health Pathways 2 Progress Spring Conference registration.

New Hope Summer Camp Opportunities for Children with An Incarcerated Parent:  July 15-20, Hendersonville, NC – Learn about the camp’s purpose and how to refer a child.

August 26 – 29, Baltimore MD
National Alliance for Direct Support Professional Annual Conference
Registration for September 2019

New From Provider Sponsor Members
Therap National Conference in Denver, Colorado, January 28 – January 30, 2020. Register here.

Training and CEU Opportunities
June 5, 2019 -1:00pm to 2:00pm: Leveraging Housing Vouchers for People with I/DD
This webinar will explain how the “non-elderly disabled” (NED) housing vouchers can expand supportive housing capacity for people with I/DD in our communities. Register here.
June 12, 2019 – 1:00pm to 2:00pm: DSP Online Recruitment: A Fresh Approach
Scott and Craig de Fasselle, a father-and-son team, have helped I/DD providers increase their online applications for DSP jobs by over 300%. In the course of their work, they’ve learned lessons and best practices to dramatically improve online DSP job postings and attract mission-driven candidates. Register here.

Thank you to our Elite Partners