01/27/13 — Local agency to handle Medicaid recipients

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Local agency to handle Medicaid recipients

By Matthew Whittle
Published in News on January 27, 2013 1:50 AM

As of Jan. 1, Eastpointe, the local mental health management agency, has officially taken over managing the care of Medicaid recipients in its 12 member counties.

The change is one that had been expected and planned -- and was the impetus for Eastpointe's recent merger with fellow LMEs Southeastern Regional and Beacon Center, covering Wayne, Duplin, Sampson, Lenoir, Edgecombe, Nash, Wilson, Greene, Robeson, Columbus, Bladen and Scotland counties.

Prior to the merger, Easpointe Director and CEO Ken Jones explained that combining with the other counties was necessary to qualify to become a managed care organization -- that Easpointe was required to serve an overall population of 500,000 people and a Medicaid population of 75,000. Today, with nearly 500 in-network service providers, the enlarged Eastpointe is serving a total population of 807,000 and a Medicaid population of 176,000.

It's a transition that Kathy Baker, Eastpointe communications officer, said is going well.

"We began on Jan. 1 as a managed care organization. We had spent a lot of time preparing for that and so it's been a fairly smooth transition. There are, of course, as with transition some things that need to be fine honed, but we're working on those," she said.

To help with the transition, Ms. Baker explained, Eastpointe is preparing to roll out new customer service and training opportunities for its providers, including live customer support hotlines and weekly webinars.

"We know that our providers' time is valuable, and we are continually striving to be responsive to their needs," Jones said in a written release announcing the new services.

Karen Salacki, chief of external operations at Eastpointe, echoed that sentiment in that written release, explaining that "our educational sessions have been tailored with our providers' needs in mind and will offer free, convenient access in a dynamic online group environment."

Easpointe is the sixth LME to become a managed care organization. It will now manage two Medicaid-funded plans: NC MH/DD/SAS Health Plan for mental health, developmental disabilities and substance abuse services, and NC Innovations for special home and community based services for people with intellectual and developmental disability.

Eastpointe and other state agencies are taking back over the Medicaid services that had been performed by out-of-state vendors -- a situation that Jones has said led to cost overruns due to poor planning and financial management.

Now, Eastpointe will review and approve the plans of care for people covered under Medicaid based on actual medical needs. Eastpointe also now has more control over the provider network and the rates at which those providers are reimbursed.

For the consumer, though, Ms. Baker said, it should be a fairly "seamless transition" -- even for those clients who were receiving care from a provider who did not qualify for the new network.

"If a consumer was getting services from one of those providers, we worked with the provider to transition that consumer to one who is in the network. We're trying to make it a seamless transition."

To obtain services, the Eastpointe Call Center, open 24 hours a day, 365 days a year, can be reached at 1-800-913-6109. For more information, visit www.eastpointe.net.