June 3, 2011

Dear Providers and Consumers,

You will find below Mental Health Partners’ State Benefit Plans that are funded by State dollars for FY 2011-2012. These plans identify the array of services available to consumers that are supported by those limited State dollars that are allocated to MHP for these purposes.

As required, MHP has the responsibility to show the levels of care it will pay for through an organized system of determining what kinds of services are provided, for what reasons, and at what frequency. These plans illustrate the limits of care to be offered under varying levels of illness/condition acuity. Those with the more severe issues will have access to greater service levels. Those with lesser issues will receive more minimal services.

With finite State Dollars to fund these services, it is necessary to have a strategic way of rationing the limited resources. If persons are eligible for other funding sources like insurance, Medicaid, Medicare, or personal funds, then these limitations do not apply. State funds are to be used as the last funding source. However, most funding sources also have funding parameters that providers and consumers need to know about when services are sought.

During more restrictive economic times, it is even more important to enforce these “benefit plans” to assure that all persons will truly get what they need. Otherwise, limited resources would be consumed on a “first come, first served” basis. Therefore, your understanding of these plans is critical.

The application of this plan is for services to be delivered during the FY 2011-2012. In cases where authorizations were due prior to July 1, 2011, for services mostly to be delivered in the 2011-2012 fiscal year, the plan has already been applied. The plan sets forth the guidelines for authorization of services, and requests above those limits will be denied unless there is strong additional clinical justification to support an exception.

This benefit plan will be reviewed quarterly against actual utilization and available resources and adjusted accordingly. An increase or decrease in resources may result in a plan modification, or just a change in the number of people receiving these services. There has been and will continue to be a careful look at appropriate clinical criteria, application of best practices, demand for services, and availability of resources to keep the plan properly balanced and functional as a utilization management tool.

If you have any questions about these details, or the application of the plan in person specific situations, please contact Elizabeth Lackey, Service Management Director at our main number of 828-327-2595.
We hope you find this information useful, as we all work to meet the needs of our consumers.

Sincerely,

John M. Hardy, Area Director

State Benefit Plan Adult Mental Health
State Benefit Plan Child and Adult Developmental Disabilities
State Benefit Plan Child Mental Health and Substance Abuse
State Benefit Plan Substance Abuse II

Documentation Requirements for Auths

Developmental Therapy Service Definitions