Will Community Guides Provide the Right Service?

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1 Frequently Asked Questions Topic Question Answer ICR/MR We provide ICF/MR group home services. We have several homes with more than 40 beds; do you want a list of our facilities? Any including Substance Abuse Professionals and Provisionally employed by an agency providing behavioral health services must be credentialed with the LME/MCO. s do not apply here. CAP I/DD We occasionally do some CAP and Yes. All agencies doing business with the LME/MCO will need to be PCS work using Certified Nurse enrolled. s will need to be Assistants or sitters. We are paid credentialed. However, Certified Nurse Assistants or sitters are not thru Medicaid. Do we need to be required to be credentialed. a part of your LME to continue with home care activities? CAP I/DD Do Home Services need to be enrolled /be credentialed? How and when will I be assigned a Coordinator? Will Community Guide agencies contract with CenterPoint? Is there going to be a difference in pay between and Community Guide? Will all Coordinators work in Winston Salem? Home Services, providing CAP/MR/DD services to consumers within the Centerpoint Human Services catchment areas will need to apply and be enrolled as a provider agency. If you employ s, they will need to be credentialed by the LME/MCO. However, RN and CNA do not need to be credentialed. CenterPoint will be sending a series of letters to current recipients of case management services including education about waiver and what is involved when switching from case management to care coordination. All jobs at Centerpoint are currently posted to our website ( While most care coordinators will not actually start working at Centerpoint until November or December 2012, we are reviewing applications already and will make offers to qualified applicants with a projected hire date. Not all case managers will be hired as care coordinators. If your current case manager is hired as a care coordinator, and you would like to continue to work with them, CenterPoint will work to preserve those relationships. If your current case manager is not hired as a care coordinator at CenterPoint, you will receive written notification of your care coordination assignment no later than November Yes. Centerpoint will be posting a Request for Applications in the early Summer 2012 after training is offered to existing providers and new providers interested in providing this service. As with, authorizations for Community Guide will be in place prior to 1/1/2013. Yes. The hiring salary ranges for Coordinators range between $41,000 $47,000 annually. Coordinators must be a Qualified Professional in I/DD which means they must have at least a Bachelor s degree in a human services field with a minimum of 2 years experience post degree working with people with I/DD. Community Guide providers do not have to have a degree, but must have a high school diploma or GED and be able to demonstrate competency and knowledge of local community resources and how to access them. The reimbursement for Community Guide has changed over the years and may be changing again soon among the PIHPs already providing this service. Centerpoint will include updated information about Community Guide reimbursement rates in the upcoming training on this service in April All CenterPoint Coordinators will have an office in Winston Salem. Much of work, however, is field based and technology will be made available to staff to conduct many of their job duties in the office or in the field. There is no plan for there to be home based/satellite based offices for Coordinators.

2 Do I have to travel to Winston Salem to get? Does every person getting Management automatically get? When /how soon will an evening Community Education be scheduled? How does CenterPoint becoming an MCO impact current CAP provider s endorsement? This sounds like single portal. Is it the same thing? Can another assessment be requested? Is SIS for all age groups? Will budgets change with assessment scores? No. Consumers and families do not have to come to Winston Salem to meet their Coordinators. Coordinators will be mobile and will conduct field and home visits for assessment, plan development and monitoring, much like case managers do now. For persons with I/DD, it is most likely that every person currently getting Management will also get an assigned Coordinator. Not every recipient of Management will automatically receive Community Guide. I/DD Coordinators are assigned based on individual and family needs determined by CenterPoint s Customer Services Department. This may be more familiar to people as our Screening Triage and Referral phone line, where your need for services is assessed. Each person receiving Management now will be reviewed for their ongoing need for. If a person is on the waiting list for I/DD services, or is currently receiving any State funded or Medicaid reimbursed I/DD services, they will be assigned a Coordinator. Consumers and families have provided feedback and requested that CenterPoint provide additional Community Education sessions after business hours. CenterPoint will post an updated Community Education session schedule to the website ( include an update in the Friday , and distribute announcements through case management agencies and direct service providers. Please anticipate an updated schedule within the next few weeks. Endorsement will not be affected; however CAP providers will have to go through the CenterPoint application, contract and enrollment process for agencies. The NC Single Portal law ordered that human services afford consumers a single port of entry into the system including a consolidated case management system. This transition from Targeted Management to is slightly different. The function provided by the MCOs will afford consumers assessment, plan development, provider referral, and monitoring services. Many nonbillable case management activities can now be provided by Community Guide services. Yes. Consumers always have the right to due process and can challenge/appeal any clinical opinion or adverse decision related to their services and identified needs. The Supports Intensity Scale has both a child tool and an adult tool. The Child tool was developed for children ages 5 15 and the Adult tool is for persons age 15+. The Supports Needs Matrix is a tool developed by Piedmont Behavioral Health which takes the scores from a Supports Intensity Scale assessment and considers where the needed supports are to be delivered to consumers to determine the base budget. In the Innovations waiver, there are base budgets and add on budgets which together determine a consumer s overall service budget.

3 Under the managed care model, are I/DD services entitlements? Will Coordinators advocate? Will Coordinators do the SIS? How will a Coordinator be assigned? Can Community Guide services be provided by local people? Are the criteria for Community Guide going to be on the CenterPoint website? The Community Guide reimbursement rate is low, how will we recruit professionals? How many consumers will be on a Community Guide s caseload? Is one of the MCO s new functions to weed out providers? Medicaid is a federally mandated entitlement program. The CAP waiver (1915c) is not an entitlement program. The state sets the number of slots available for enrollment. This will not change with the implementation of managed care in NC. The role of the Coordinator is to assess needs, educate consumers about services, develop individual service plans, offer choice of providers, and monitor services. Coordinators are not advocates for consumers. At CenterPoint, each Coordinator will be trained to administer the SIS. A care coordinator who completes a SIS may not also develop a plan of care for the same consumer. Consumer choice will be honored when possible to preserve case load sizes. CenterPoint anticipates that Innovations Coordinators will need to maintain case loads of no more than 35 people to provide quality service. It is highly preferred that Community Guide agencies be located in the communities where the services will be delivered. Community guides must be at least 18 years old, have a high school diploma or GED, and have a criminal background check completed prior to going to work which presents to health and safety risks to the person who will be served. Yes. As we restructure our website, consumers and prospective providers of this service will have access to the service definition and provider criteria. The minimum educational requirements for Community Guide are a high school diploma or GED and so recruitment of Community Guides should include professionals or paraprofessionals. CenterPoint is watching some current activity regarding rate setting for Community Guide with Managed Organizations already in operation. The rate has changed from a monthly rate of $75/month to both a monthly and hourly rate (specifically used when Community Guides help consumers Self Direct their services and supports). This will be determined by the provider of the service. It will likely be a greater number than the typical CAP caseload which individuals and families may be currently used to. The purpose of the MCO is not to weed out providers. MCO s do operate a closed network of providers much like private insurance companies have a participating provider network. The reason for the closed network is to work with providers to develop robust, quality choices of service providers not to achieve a specifically lower number of participating providers.

4 If I like my current Targeted Manager, how can I keep them? Will there be a listing of Coordinators employed with CenterPoint to choose from? How can a family give CenterPoint a positive reference for a Targeted Manager applying for a Coordinator position. What if your plan is revised in June 2012, do you have to do a new one in January 2013? On January 1, 2013, will there be a service gap for some people? Will there be consumer choice for Community Guide Services? Where will community meetings be held in the future? What will a Coordinator s caseload be? When will hiring for Community Guide begin? How can parents make recommendations for potential Coordinators? Current Targeted Managers may be working at CenterPoint as care coordinators, as Community Guides or as QPs working for direct service providers. If a case manager comes to work as a Coordinator at CenterPoint, a family can request retention of that case manager, but the ultimate decision for member assignment will be of the Lead Coordinators who are working to maintain feasible caseloads. In addition, there may be incidents where a change in care coordinator could improve the overall quality of service management and delivery. Once all positions have been offered to qualified applicants and applicants have accepted the offer to work at CenterPoint, we will post the names of all care coordinators in the I/DD services care coordination department on the website. Targeted Managers are responsible for indicating their references on their application. Any addition kudos of a prospective candidate can be sent to Human Resources or to Jeff Payne at CenterPoint. Current CAP plans developed by case managers will be cross walked to comparable Innovations services by Coordinators in November 2012 without the need for a formal revision. If your CNR is in December, a new plan (not a crosswalk) will be expected to be developed by your new Coordinator and team. CenterPoint has a transition plan for Targeted. The number one objective is that no consumer will experience a lapse in service. Yes. Consumers will always be given choice of Community Guide provider agencies as they are with other services. Yes. We will announce future meetings in the following ways: Website, Friday , and a US mailing to all current I/DD service recipients in May It will vary depending on the service that a person receives. All Innovations (currently CAP) Coordinators will have caseloads of State funded Coordinators may have caseloads up to 80 people. The program enrollment expectations inform case load size. Centerpoint hopes to post a Request for Interest announcement for prospective Community Guide agencies in late Spring or early Summer. Targeted Managers are responsible for indicating their references on their application. Any addition kudos of a prospective candidate can be sent to Human Resources or to Jeff Payne at CenterPoint.

5 If you provide Home Supports, do I have to have backup documentation? Will Community Guide be authorized by CenterPoint? Will private agencies provide Community Guide? In the new system, how long will it take to start getting people off of the waiting list? Will folks that currently receive CAP lose their current worker? Is the direct care provider responsible for fine tuning the nuts and bolts of the PCP? Is the PCP sent back to the Coordinator for submission for authorization? Is it true that clients do better with goals that are below challenging, at level of reasonable expectation, or above expectation level? Is Self Direction a Comprehensive or Supports Waiver service? All Innovations services including In Home Supports will be required to identify back up staffing during annual planning development. Yes. CenterPoint will authorize Community Guide services starting January 1, Yes. It is difficult to predict the speed with which folks will start moving off of the waiting list. Currently individuals may be waiting for CAP but are enrolled in other services. Others are not receiving any services at all. With the addition of Community Guide as a new service and Respite as a B3 non waiver service, the hope is that we can offer many more folks waiting with no service, some type of support. The transition from CAP to Innovations does not require a change in provider nor change in direct care staff. The Direct Service provider will be responsible for the development of the short term goals and methodology for addressing those goals. The ISP will formally include long term goals related to needs assessed by the Coordinator. Coordinators at CenterPoint are responsible for submitting complete ISPs to Utilization management for authorization. Goal setting is a team process. The ISP should include goals that accurately reflect the desired outcomes for the person and the needs for support identified in the SIS assessment. Self Direction is not a service. Currently, recipients of CAP Supports waiver services may chose to self direct their CAP services. CAP Comprehensive recipients may not currently opt for self direction of their services. Self Direction means that the individual or family works closely with their service providers regarding direct care staff selection, retention and termination. Self Direction while giving more authority to consumers and families also has a shared accountability for these decisions. A separate training will be provided by CenterPoint in August related to Self Direction of Innovations services. If you are currently a CAP Supports waiver recipient and you are interested in Self Direction, please call Jeff Payne

6 What is a Coordinator s caseload size? Will individuals transition prior to January 1, 2013? How many Coordinators will be hired? How many additional people will get services? When is a meeting going to occur? Will Supports or Comprehensive Waivers change? My daughter is served by CenterPoint but lives in Guilford. Will she have to switch to the Guilford Center? Will all MCO s be the same? How does Medicaid between counties work? Innovations Coordinators will have caseloads of State funded/b3 Coordinators may have case loads up to 80 people. There will be a gradual transition from. CenterPoint s plan is to start providing Innovations in October, B3/IPRS in November, and High Cost /High Risk in December. Targeted Management will continue to be a Medicaid reimbursable service until December 31, Individuals currently receiving CAP services will receive CAP services until December 31, There will be 27 positions in the I/DD Department. One I/DD Clinical Director, 3 Lead Coordinators, and 23 Coordinators for Innovations, High Cost High Risk, and B3/IPRS services. It is difficult to predict the speed with which folks will start moving off of the waiting list. Currently individuals may be waiting for CAP but are enrolled in other services. Others are not receiving any services at all. With the addition of Community Guide as a new service and Respite as a B3 non waiver service, the hope is that we can offer many more folks waiting with no service, some type of support. Each enrollee will meet at least annually with their Coordinator to develop their ISP. Coordinators have a service monitoring responsibility also and will see consumers typically monthly. Yes. In January 2013, the NC Innovations will not have 2 tiers as the CAP waivers are structured now. All current comprehensive and supports waiver recipients will be cross walked to the NC Innovations waiver. The budget limits of current Supports waiver recipients will be reassessed with the SIS and the Supports Needs Matrix in the future after the SIS is implemented statewide. If she has Guilford Medicaid she will be switched to The Guilford/Sandhills Center. The Medicaid county of origin drives which MCO will serve her. Coordinators and Managers help with transitions from one MCO to another. The NC Innovations waiver will be standardized across all MCOs. DMA and DMH are working to standardize practices among all of the MCOs. There may still be some MCO specific qualities in the use of state funds and there may be unique service needs and gaps to address depending on the area of the state that the MCO is serving. If a person has Davie, Forsyth, Rockingham or Stokes Medicaid they will be served by Centerpoint. If their Medicaid comes from a county other than these stated 4, they will be assigned to a different MCO which serves the county of Medicaid origin.

7 Will Community Guides work for CenterPoint? Gap between Targeted Management and, what happens between October 1, 2012 and December 31, 2012? How do I set up billing? Will someone be available to come to my office to establish electronic billing? Is use of a cell phone an appropriate means of24/7 emergency coverage by a solopractitioner Can CenterPoint be the 24 hour back up coverage for my practice? Is Worker s Compensation required for someone in a solo practice? Where will rates and updates be posted? I operate a solo practice and DWI facility but only use my social security number. Is this okay? Who do I call/ with questions? Will clinical staff (LCSW, LPC, etc.) have to be credentialed even if they do not bill for services and operate under the hospital license? We have hospitalists and also contract with MDs. All are credentialed by the hospital. Will all MDs bill? Will the contract involve IPRS and Medicaid funding or only Medicaid? No. Community Guides will work for providers which are part of the CenterPoint network of providers. There will be a slow phase in transitioning folks who receive targeted case management into the new and Community Guide system. CenterPoint plans to transition Innovations recipients receiving case management in October, Management only recipients in November, and ICF residents and folks on the waiting list with no services in December. All providers are required to file claims electronically either via our Alpha MCS web portal or an 837 format. Prior to submitting claims, providers will be trained on how to submit claims via the web portal and 837 s will be tested. Yes, use of a cell phone for 24/7 emergency coverage is an appropriate means of coverage. No. Providers must maintain their own 24 hour coverage plan. Providers may: use pagers or cell phones; develop a "call group" with other practitioners; or engage an answering service to take after hours calls. CenterPoint's Customer Services staff will always respond to a caller who is in crisis and if appropriate may connect them with a mobile crisis team or a hospital ED. However, this should be an extremely rare occurrence as it is our belief that the treating LIP is in the best position to offer assistance and direction to their clients and it is our expectation that LIPs perform this service for their clients. Yes. The contract between the Division of Medical Assistance (DMA) and the LME/MCOs require that all practitioners maintain the coverage. Rates and updates will be posted on CenterPoint s website at All billing providers must have a NPI. Credential@cphs.org. Clinical staff, billing under the hospital contract and credentialed via the hospital, are not required to be credentialed via CenterPoint. However the LME/MCO is required to review the hospitals credentialing process. LME/MCOs are not required to credential licensed independent practitioners who are credentialed by the hospital. The LME/MCO would only need to review the hospital s credentialing process. The contract will involve Medicaid only unless a separate IPRS contract is established with your agency.

8 Will we need to have our LIPs make application? Does this include the MDs? Will H codes be billable after January 1, 2013? Does psychological testing require prior authorization? Will CenterPoint utilize CAQH? Yes. When will the Benefit Design Plan be posted? Are rates statewide? What is required to be included in a medical record? Why are there no LMFTs on the credentialing committee? I am a solo practitioner who has chosen to establish a practice with Federal EIN. The initiation Form asks for my SSN and license number. All my billing will be made to the account with my company EIN, not my SSN. I am an Contractor providing Specialized Consultative Services for individuals receiving CAP ID/DD funding. I do not provide any other services as a sole practitioner. Do I need to complete the LIP application if I am not in group or sole practice? We only bill IPRS, do we have to be credentialed? If you are credentialed with an agency, will you need to be credentialed for private practice? Outside of practitioners billing under a hospital setting and credentialed via the hospital, yes to both questions. We do not know at this time. The billing codes for provisionally licensed providers are determined by the DMA. DMA has not extended the use of H codes for provisionally licensed providers beyond June 30, 2012 yet. Yes. Current benefit designs, and any updates, are posted at LME/MCOs operating waivers have the option to revise rates in response to local needs. During the first year of operation, CenterPoint will offer Medicaid rates. Medical Record Requirements may be found in the Records Management and Documentation Manual at The Credentialing Committee will be able to access specialty providers as needed. You will still need to provide your SSN so we can complete the required criminal background check. Yes. If you are, providing behavioral health or ID/DD services, you will need to be credentialed by the LME/MCO. Yes. This is required by our accreditation and quality control standards. Yes. You will need to complete two (2) separate Credentialing Initiation Form to each entity with which you will be billing.

9 I am a provider of CAP MR/DD Services, soon to be CAP I/DD, do I need to be credentialed? If you are credentialing through Sandhills or another LME MCO, is it necessary to also credential through Centerpoint? Do you need licensed practitioners agency wide or just those that would be working with CenterPoint clients? We offer Level III services which require us to contract with an LCWS. She does not bill for any service under our group home. Our MD Specialty Clinic Staff bill under Medical codes that do not fall under behavioral health services, do they need to be enrolled or just the licensed staff providing Day Treatment and Outpatient? In regards to the Credentialing Initiation For, our HR Department completes the credentialing applications for all of our group/agency licensed practitioners. How should this be documented on the Initiation Form to ensure all e mails come to a specific person? Should we use HR e mail address rather than using the actual practitioner's e mail? We are a 501C3 "not for profit organization", we do not have any owners or shareholders or partners, we have a Director. How do we complete page 2 of Initiation Form? Yes. Yes. You must be credentialed and enrolled with each LME from which your current client's Medicaid originates. We will only need to credential s who are and will provide services within the CenterPoint catchment areas. We would need to credential the (LCSW) if she provides services in your agency even if there is no billing done under your agency. If your MD Specialists are not billing behavioral health codes, they would not need to be credentialed. No. the e mail communication will go to the preferred e mail address given on the Credentialing Initiation Form completed by the individual practitioner. This e mail will be how CAQH will contact the practitioner and the LME's communication avenue. As an agency, you will need to complete the Name/Address boxes to identify yourself and other staff members managing the EFT account. You will need to check the appropriate box for Manager (applies to Director) on the first box, then complete the second box for the EFT Authorized Staff.