June 17, 2010
Dear Providers and Consumers,
You will find below the State Benefit Plans that are funded by State
dollars which are managed through Mental Health Partners (MHP) for FY
2010-2011. 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 rational 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 important.
The application of this plan is for services to be delivered during
the FY 2010-2011. In cases where authorizations were due prior to July
1, 2010, for services mostly to be delivered in the 2010-2011 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 some 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 review tool.
If you have any questions about these details, or the application of
the plan in person specific situations, please contact Sonja Bess,
Service Management Director at our main number of 828-323-2595.
We hope you find this information useful, as we all work to meet related
needs.
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
