FY09 Wake LME Provider Operations Manual Training

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FY09 Wake LME Provider Operations Manual Training

• February 17, 2009

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HOUSEKEEPING
Restrooms Handouts Questions
Cellular Phones Registration Refreshments
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Todays Focus

• Revisions to
• Target Populations
• Benefit Plans
• UR (Authorization) Procedures
• QM Procedures Revisions
• Revised Manual is posted on www.wakegov.com/lme

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IPRS Simplification

• Fewer Target Pops
• New Target Pops
• No Concurrency allowed (i.e., in what the LME
  reports to the State)
• However, since consumers still have concurrency,
  you need to report all Target Pop eligibility to
  Wake LME!

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Target Population Changes
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Developmental Disability Target Population
Changes

• No changes to Child with Developmental Disability
  (CDSN) Target Population.
• ADMRI no longer exists.

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ADSN

• ADSN Adult with Developmental Disability Adult,
  age 18 and over, who is
• Screened eligible by the LME as Developmental
  Disabled in accordance with the current
  functional definition in GS 122C-3(12a).
• OR
• Meets the State definition of Developmental
  Disabled and having a co-occuring diagnosis of
  Mental Illness
• OR
• Was confirmed Thomas S. class member and was
  receiving MR/MI funded services at the
  dissolution of the Thomas S. lawsuit.
• These individuals must have a Developmental
  Disability Assessment based on NC SNAP 1 through
  5.

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Child Mental Health Target Populations

• CMMED, CMDEF no longer exist
• CMSED Child with Serious Emotional Disturbance
• Revised to consolidate the eligibility criteria
  for the above target populations
• Includes individuals who are homeless or at
  imminent risk of homelessness
• Wake County will continue to use the previous
  CMSED criteria as an indicator for eligibility
  for residential treatment

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Child Substance Abuse Target Populations

• CSCJO, CSWOM, and CSDWI no longer exist
• CSSAD Child with a substance abuse or substance
  related disorder
• Revised to consolidate the eligibility criteria
  for the above target populations
• Must be assessed for service eligibility
  utilizing adolescent ASAM criteria

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Child Substance Abuse Target Populations, Cont.

• CSMAJ Child with a substance abuse or substance
  related disorder and is involved in the Juvenile
  Justice System
• Revised to include youth who are adjudicated
  undisciplined or on a diversion contract with
  DJJDP
• Must be assessed for service eligibility
  utilizing adolescent ASAM criteria

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Adult Substance Abuse Target Population Changes

• ASHMT, ASDWI, ASDHH and ASHOM no longer exist
• ASTER Adult Substance Abuse Treatment
  Engagement and Recovery
• Consolidates the above
• Broadens eligibility substance abuse or
  dependency diagnoses
• Includes individuals in need of engagement,
  assessment, formal treatment and other
  treatment services and supports necessary for
  relapse prevention and continued recovery

12
Adult SA Target Population Changes, Cont.

• Other ASA target populations remain the same
  ASCDR, ASDSS, ASCJO and ASWOM

13
Adult Mental Health Target Population Changes

• AMSPM and AMSMI no longer exist
• AMI Adult with Mental Illness
• Replaces AMSPM and AMSMI
• Uses higher GAF limitation from AMSMI of 50

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Target Pop Form

• Begin using Wakes new Target Pop form
  immediately (SmartWorks HS-3051)
• Staff must review the Target Pop eligibility
  criteria on Divisions website
• http//www.ncdhhs.gov/mhddsas/iprsmenu/index.htm
• Current caseloads are being administratively
  changed to new Target Pops see your March
  caseload report.

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Authorization and Utilization Review Procedures
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Utilization Review Changes

• Wake LME participated in a Standardization
  Project with 10 LMEs to create a number of
  uniform procedures for handling Service
  Authorization Requests (SAR).
• Changes are summarized in chart titled MHSA
  Authorization Paperwork Requirements and
  Timeframes, by Type of Request in Provider
  Manual (Section III, 4 p. 17).

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Changes to MHSA Authorization Procedures (Section
III, 4)

• LME will process all properly completed and
  submitted routine IPRS authorization requests
  within 14 days.
• Within 14 days of the receipt of a complete and
  accurate SAR packet (includes all required
  forms), the LME will either authorize, deny,
  reduce, suspend, terminate, or pend awaiting
  additional clinical information.

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Changes to MHSA Authorization Procedures (Section
III, 4), Cont.

• REMEMBER
• Submit only complete packets, all required forms
  at once!!
• Respond promptly to requests or notices.
• You WILL get a timely response to your
  authorization request (within 14 days) if your
  paperwork is complete/accurate!

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Types of Authorization Requests

• Current Consumer to receive a new service (same
  or different provider)
• Transferring a consumer to another agency (when
  referring agency has a current auth)
• Requests for additional service units to an
  existing and active authorization
• Emergency Authorization requests

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Transferring a consumer

• Referring Provider contacts assigned UR Care
  Manager to request a transfer.
• Referring Provider submits written documentation
  explaining the reason for the transfer and the
  effective date.
• Referring Provider completes Contract Agency
  Discharge Data form if referring agency is
  ending all services to the consumer.
• UR Care Manager sends the referring Provider a
  Receipt of Initial Request for Services form.

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Transferring a consumer, Cont.

• Referring Provider sends copy of Receipt to the
  accepting agency.
• Accepting agency completes bottom section of
  Receipt and faxes it and a Consumer Enrollment
  form to the LME UR Team [phone].
• Upon receipt of these completed forms, the UR
  Care Manager will generate an authorization for
  that service to the accepting agency.
• Note A current, completed Fee Application will
  need to be on file.

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Additional Service Units

• Submit a completed SAR to the LME UR Care
  Manager.
• Check box indicating Request to add units to
  current auth.
• Clinical need must be clear, with an estimated
  step down plan included.
• Requests must be submitted prior to the end date
  of the current authorization.

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MHSA Benefit Plans
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Objectives of Benefit Plans

• Stewardship and accountability for public funds
• Effective management of limited funding
• Placement in most appropriate and effective level
  of care and intensity of services
• Clinical guidance regarding practice models and
  standards of care
• Public awareness of available services

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Objectives of Benefit Plans

• Improved planning of care and communication of
  benefits with consumers
• Increased consistency in UR review
• Better communication between LME and providers
  about expected course of treatment
• Planned step-down in services vs. denials
• Tool for use in Non-Medicaid appeals process

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General Expectations

• Discharge and step-down planning begin at intake
• Plan of care is based upon a comprehensive
  clinical assessment
• Well-documented plan of care
• Treatment reflects an emphasis on recovery
  principles, promotion of community inclusion and
  tenure, and use of natural supports

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Adult MH/SA Benefit Plan Highlights

• Benefits Eligibility Screening
• Authorization is 1 - 8 units within 45 days, no
  reauth
• Applicable only in conjunction with BHO, SAIOP or
  SACOT
• Covers the actual time spent by staff assisting
  the client with completing the Fee Application
  and/or acquiring needed documentation

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Adult MH/SA Benefit Plan Highlights

• Behavioral Health Outpatient BHO or OPTX
• Authorization includes clinical/psychiatric
  evaluations, assessments, individual, group and
  family/couples therapies, medication management
• Expected duration is 6 18 months
• Adults with a substance use disorder must meet an
  ASA target population and ASAM Level I criteria
• Adults with mental illness must meet AMI or AMSRE
  target population and specific diagnostic criteria

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Adult MH/SA Benefit Plan Highlights

• Community Support Adults
• Expected duration is 4 10 months
• Adults with a substance use disorder must meet an
  ASA target population and ASAM Level I criteria
• Adults with mental illness must meet AMI or AMSRE
  target population and specific diagnostic
  criteria
• Not intended to be a stand alone service
• Emphasis is expected on linkage, referral and
  coordination activities that reduce barriers to
  progress and support clinical goals

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Adult MH/SA Benefit Plan Highlights

• Community Support Team CST
• Expected duration is 4 10 months
• Adults with a substance use disorder must meet an
  ASA target population and ASAM Level I criteria,
  at a minimum
• Adults with mental illness must meet AMI or AMSRE
  target population and specific diagnostic
  criteria
• More intensive than Community Support, provides
  treatment and other interventions to reduce
  psychiatric and/or addiction symptoms and attain
  self-sufficiency

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Adult MH/SA Benefit Plan Highlights

• Assertive Community Treatment ACT
• Duration is variable
• Adults must meet diagnostic criteria for a severe
  and persistent mental illness that results in
  serious functional impairment
• Limited to individuals with the most severe
  symptoms and at highest risk for inpatient
  hospitalization

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Adult MH/SA Benefit Plan Highlights

• Psychosocial Rehabilitation PSR
• Duration is variable
• Intended for adults with severe psychiatric
  disabilities who require daily interventions to
  improve their functioning and develop skills
  necessary to live as independently as possible

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Adult MH/SA Benefit Plan Highlights

• Substance Abuse Intensive Outpatient Program
  SAIOP
• No changes in duration
• Basic admission criteria include dependency
  diagnosis and ASAM Level II.1 criteria
  (structured setting, lower levels of care
  ineffective, mental health symptoms present,
  unstable working/living environment)

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Adult MH/SA Benefit Plan Highlights

• Substance Abuse Comprehensive Outpatient
  Treatment SACOT
• Duration decreased to two 30-day authorizations
• Basic admission criteria include dependency
  diagnosis and ASAM Level II.5 criteria (same as
  above, except more severe)
• Continued involvement in some type of care is
  essential for most people to be successful in
  their recovery.

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Child MH/SA Benefit Plan Highlights

• Benefits Eligibility Screening 
• Authorization is 1 - 8 units within 45 days, no
  reauth
• Applicable only in conjunction with BHO
• Covers the actual time spent by staff assisting
  the client with completing the Fee Application
  and/or acquiring needed documentation

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Child MH/SA Benefit Plan Highlights

• Behavioral Health Outpatient BHO or
  OPTXAuthorization includes clinical/psychiatric
  evaluations, assessments, individual, group (only
  for specific evidence based models) and family,
  medication management
• Expected duration is 6 18 months
• Children/adolescents with a substance use
  disorder must meet a CSA target population and
  ASAM Level I criteria
• Children/adolescents with behavioral or emotional
  disorders must meet CMSED

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Child MH/SA Benefit Plan Highlights

• Community Support Children and Adolescents
• Expected duration is 6 12 months
• Children/adolescents with a substance use
  disorder must meet a CSA target population any
  ASAM Level of Care criteria as long as this
  service is in coordination with other appropriate
  services
• Children/adolescents with behavioral or emotional
  disorders must meet CMSED
• Should be provided with BHO rather than as a
  stand alone service
• Emphasis is expected on linkage, referral and
  coordination activities that reduce barriers to
  progress and support clinical goals

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Child MH/SA Benefit Plan Highlights

• Intensive In-Home IIH
• Expected duration is 3-5 months
• Children/adolescents with a substance use
  disorder must meet a CSA target population and
  ASAM Level I or II criteria
• Children/adolescents with behavioral or emotional
  disorders must meet CMSED and service specific
  criteria

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Child MH/SA Benefit Plan Highlights

• Multisystemic Therapy MST
• Expected duration is 3-5 months
• Children/adolescents with a substance use
  disorder must meet a CSA target population and
  ASAM Level I or II criteria

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Child MH/SA Benefit Plan Highlights

• Day Treatment for children and Adolescents Day
  Tx
•  Expected duration is 5-9 months
• Intended for children and adolescents who are
  unable to function in their academic setting due
  to functional impairments caused by emotional or
  behavioral disorders
• Primary goal is to transition back into a normal
  academic setting

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Child MH/SA Benefit Plan Highlights

• Respite
• Expected duration is 1 year
• Intended for children and adolescents to support
  continued living in their home, or, transition
  from higher levels of care to the home setting
• Clinical home service provider expected to
  monitor progress in treatment and development of
  other informal resources to prevent out of home
  placement or recidivism to higher levels of care

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Child MH/SA Benefit Plan Highlights

• Residential Treatment Level I
• Expected duration is 6 9 months
• Intended for children and adolescents who no
  longer meet medical necessity for therapeutic
  foster care but out of home care is required to
  prevent loss of therapeutic gains
• Clinical home service provider expected to
  monitor progress in treatment to assure
  appropriate and timely step-down

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Child MH/SA Benefit Plan Highlights

• Level II Therapeutic Foster Care
• Expected duration is 6 9 months
• Intended for children and adolescents with
  behavioral or emotional profiles with inability
  to manage stress and relationships at home
• Clinical home service provider expected to
  monitor progress in treatment to assure
  appropriate and timely step-down

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Child MH/SA Benefit Plan Highlights

• Level II Residential Treatment
• Expected duration is 8 14 months
• Intended for children and adolescents with
  behavioral profiles including need for increased
  supervision beyond the familys capacity related
  functioning in life domains
• Clinical home service provider expected to
  monitor progress in treatment to assure
  appropriate and timely step-down

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Child MH/SA Benefit Plan Highlights

• Level III Residential Treatment
• Expected duration is 10 16 months
• Intended for children and adolescents with
  behavioral profiles including severe functional
  problems not improved through outpatient and home
  based interventions
• Clinical home service provider expected to
  monitor progress in treatment to assure
  appropriate and timely step-down

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Child MH/SA Benefit Plan Highlights

• Residential Treatment Level IV
• Expected duration is variable
• 60 authorization only (interim while 5045
  Medicaid application is initiated
• Intended for children and adolescents with
  behavioral profiles including potentially life
  threatening chronic high risk behaviors
• Clinical home service provider expected to
  monitor progress in treatment to assure
  appropriate and timely step-down

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Child MH/SA Benefit Plan Highlights

• Psychiatric Residential Treatment Facility (PRTF)
• Expected duration is variable
• 60 authorization only (interim while 5045
  Medicaid application is initiated
• Intended for children and adolescents with
  behavioral profiles including failed treatment
  attempts across multiple settings
• Clinical home service provider expected to
  monitor progress in treatment to assure
  appropriate and timely step-down

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Obtaining Medicaid Eligibility for
Youth
Needing Residential Treatment Services

• See Section III.4 pages 20-23 of the revised
  Provider Manual

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What is 5045 Medicaid?

• Time limited, Medicaid eligibility based solely
  on the consumers clinical needs and personal
  income

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5045 Medicaid Application Process

• Facilitated by clinical home service provider
• Requires coordinated work of
• -- the legal guardian
• -- the residential treatment provider
• -- the clinical home service provider
• -- the Wake LME

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Clinical Home Service Provider

• Reviews consumers financial benefits with legal
  guardian
• Facilitates 5045 Medicaid application completion
• Obtains residential treatment admission date
• Submits complete application to Wendy Wodarski at
  Wake LME

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Wake LME Reviews Application for All Required
Elements

• Notifies the clinical home service provider of
  application acceptance
• Authorizes the first 45 days of the admission
  according to the admission date
• Submits the 5045 application on the 1st of the
  month following admission to the WCHS Medicaid
  office

• Returns incomplete application to the clinical
  home service provider with explanation
• Denies IPRS authorization
• Notifies legal guardian and residential treatment
  provider that self-pay is necessary

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5045 Medicaid Application Approval

• Reviewed and processed by the WCHS Medicaid
  office
• Granted for the duration of the authorized
  residential treatment
• Ends the day of discharge

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Temporary IPRS Funding

• Authorization granted by the Wake LME to support
  the first 45 days of residential treatment when
  no other benefits exist
• If
• the consumer
• completed income verification
• And
• meets medical necessity criteria for the service
• And
• A complete 5045 application has been accepted by
  the Wake LME

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FormsAvailable on Smart Works

• 5045 Medicaid Application Instruction Packet
• Division of Medical Assistance Certification of
  Need for Institutional Care for Individual Under
  Age 21
• Health Check/Health Choice Application for
  Children
• State Residence Verification Supplement
• Initial or Continuing Request for Room and Board
  Authorization Form
• Notice of Out of Home Community Placement Form
• Notice of Out of Home Community Placement Form
  Sample

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Developmental Disabilities Authorization and
Utilization Review
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Developmental Disability Authorization Procedure

• Entire process will take 14 days if
• all required documentation is submitted
• the service requested is appropriate
• the requested service frequency follows the
  Benefits Plan
• the Unified Person-Centered Plan is clinically
  sound

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DD Authorization Procedure, Cont.

• Data Support Specialists receive the requests.
  The Data Support Specialists send a written
  Notice to the Requesting Provider if there is
  missing documentation.
• The Requesting Provider has 3 business days from
  receipt of the written Notice to submit the
  required documentation to the Data Support
  Specialist. If the required information is not
  received, the request will be shredded.

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DD Authorization Procedure, Cont.

• Care Managers review the request. If changes are
  needed to the Unified Person-Centered Plan, the
  Care Manager will send a written Notice to the
  Requesting Provider.
• The Requesting Provider has 15 calendar days from
  the date of the Notice to make the requested
  changes and re-submit the corrected plan to the
  Care Manager in order to have the original
  requested effective date of the authorization be
  approved.

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DD Authorization Procedure, Cont.

• If the requested changes are received after 15
  days, the effective start date of the
  authorization will be the date the Care Manager
  receives the changes.
• If the Care Manager does not receive the
  requested changes from the Requesting Provider
  within 30 calendar days, the request will be
  denied and an appeal letter will be sent to the
  consumer.

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DD Benefit Plan

• In January 2009 the Benefit Plan was changed for
  Developmental Therapy for the ADSN Target Pop.
• Plan is now included in the manual for reference.

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Referral and Acceptance TimelinesDevelopmental
Disability Services
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Non-Medicaid Appeals Process
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Authorization Decisions that Result in Appeal
Notification

• Denial On an Initial Request, the service is
  determined not clinically necessary or not the
  appropriate level of care
• Reduction Units authorized are less than
  requested
• Termination Denial of a Continuing Request
• Suspension Termination or Denial due to
  incomplete information for clinical
  decision-making

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Non-Medicaid Appeals Process

• When an SAR is denied, reduced, terminated or
  suspended, a UM Decision Letter will be sent to
  the consumer (copy to Provider), giving the
  reason for the decision (per Standardization
  Project) and instructions for filing an appeal
  request.

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Non-Medicaid Appeals Process, cont.

• An appeal request can only be filed by the
  consumer, a legal representative of the consumer,
  or any other individual who does not have a
  conflict of interest and has been selected by the
  consumer and/or their legal representative.
• The LME UR Team must receive the appeal request
  in writing with 15 working days of the date of
  the UM Decision Letter.

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Non-Medicaid Appeals Process, cont.

• If the UM decision under appeal pertains to a
  reauthorization request, the end date of the
  existing and active authorization will be
  extended 15 days with the same rate of service
  units, to accommodate the appeal process. If the
  last authorization has expired, it cannot be
  extended.

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Non-Medicaid Appeals Process, cont.

• The LME Medical Director or designee with
  credentials comparable to the prior reviewer
  shall complete the clinical review and may uphold
  or overturn the original decision. A written
  clinical review decision will be sent in a letter
  dated and mailed within 7 working days of receipt
  of the appeal request.
• The Clinical Reconsideration Review will be based
  on the criteria contained in DMH/DD/SAS
  Communication Bulletin 038.

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Non-Medicaid Appeals Process, cont.

• In cases in which the reviewer overturns the
  original decision, the requested services may be
  authorized in those instances when Non-Medicaid
  funds will be made available for such services,
  and an authorization letter will be issued
  stating the date on which the denied service
  shall be authorized or the date on which the
  suspended, reduced, terminated or denied service
  shall be partially or fully reinstated.

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Non-Medicaid Appeals Process, cont.

• If the original decision is upheld, an appeal may
  be filed with the Division of Mental Health,
  Developmental Disabilities and Substance Abuse
  Services. Clinical Review Decision letters sent
  to consumers upholding original decisions will
  include a DMH/DD/SAS appeal request form with
  instructions. Providers will receive a copy of
  Clinical Review Decision letters.

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Non-Medicaid Appeals Process, cont.

• Non-Medicaid funded services are not an
  entitlement therefore, please be advised that
  filing a request for an appeal in no way
  guarantees the consumer the specified service
  regardless of the outcome of the review. Payment
  can be denied for services based on allowable
  limits in the Benefit Plan, or by other budgetary
  limitations of Non-Medicaid funding.

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Non-Medicaid Appeals Process, cont.

• Please Note Prior to the Wake County LME issuing
  a written denial, reduction, suspension or
  termination of funding for services, Wake LME may
  contact the service provider regarding an
  authorization decision.
• The service provider can verbally advise the Wake
  LME Utilization Review Team Care Manager that
  both the provider and consumer are in agreement
  with proposed modifications to the services
  requested in the Service Authorization Request
  (SAR).

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Non-Medicaid Appeals Process, cont.

• In instances of such agreement, notification of
  appeal rights to the consumer may not be
  required.
• The service provider will document the consumers
  agreement in the medical record, and the UR Care
  Manager will document the providers verbal
  agreement in the UR chart notes.

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Revised Rates
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Revised Rates

• Rates changes are documented in Section IV.3
  Reimbursement Rate Table, changes are highlighted
• CPT Code Rates changed effective 1/1/2009.
• MD rates changed, but rates for other specialties
  didnt
• Most rates increased 3 5
• H0001, H0004, H0005, H0031 rates did not change

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Revised Rates, Cont.

• Community Support transitioned to tiered rates
  in January
• Tiers determined by qualifications of provider
• QP- Licensed- 22.04 / 15 min
• QP Unlicensed- 18.25 / 15 min unit
• QP Associate Professional 10.29 / 15 min
• QP Paraprofessional 5.92 / 15 min
• Authorization at aggregate level, not by tier
• Community Support limited to 32 units per week

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Revised Rates, Cont.

• Some Enhanced Service Rates Increased!
• H0015 SAIOP, H2035 SA COT, H0035 PH, H2017 PSR,
  H2015 CS Team
• Some Rates Decreased
• H0020 Opioid Tx, H0040 ACTT, T1017 Targeted Case
  Management

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Time Limit Over-Ride Process
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Time Limit Over-Ride Process

• Submit any Pre-Approved Time Limit Overrides
  along with the claims this expedite payment and
  prevents unnecessary denials.
• Providers can still submit regular Time Limit
  Override Requests, but the claims may be held to
  the end of the fiscal year for payment if funding
  is available.

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Time Limit Over-Ride Process

• EXCEPTION Claims submitted with a Time Limit
  Override Request due to the provider having to
  wait to get an EOB or denial from the primary
  insurance are processed as received. However,
  the EOB must clearly show the claim was filed
  timely to the primary insurance. Otherwise, it
  will be held to the end of the fiscal year.

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Wakes New Computer Systemand What it Will Mean
for YOU!
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New Computer System

• Implementing Netsmart Avatar MSO System Effective
  June 2009
• Significant Changes for Provider Network
• IPRS Authorizations Requested and Issued Using
  Carelink Web Portal
• Wake LME will issue auths using Carelink
• Providers will request auths using Carelink

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New Computer System, Cont.

• Referral Process will Change
• Referrals via Carelink through Notification
  authorization
• Standard PCP Admission form, Financial Assessment
  and other required forms sent to LME as
  e-attachments via Carelink

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New Computer System, Cont.

• IPRS Claims submitted though Carelink or by using
  837 electronic claims transaction
• New format for Remittance Advise/EOB
• Hard copy RA will change
• Electronic RA (835) can be provided upon request

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New Computer System, Cont.

• For Outpatient Services, Clinicians Must be
  Registered
• Licensure and specialty information will be
  required
• Carelink Training Planned for May 2009

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QM Procedure Revisions
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Section VI.3 Complaints

• New LME Director Ad Hoc Appeal Review Committee
• New procedures for Plan of Correction from the
  State
• http//www.dhhs.state.nc.us/mhddsas/provider_monit
  or_tool/appendix-m1-09.pdf

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Section VI.5 Incident Reporting

• LME Monitoring of Providers incidents processes
• No emailing of any forms that include consumer
  information
• NEW phone number for LME Medical Director
• Quarterly reports on Level I incidents (QM 11)
  must be submitted no later than the 10th day of
  the month they are due.

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Section VI.8 Monitoring

• Frequency Extent Monitoring Tool (FEM) to
  determine providers need for routine monitoring.
• New standardized State wide tool
  http//www.dhhs.state.nc.us/mhddsas/provider_monit
  or_tool/appendix-m1-09.pdf

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Section VI.10 Appeals

• An appeal of an out-of-compliance finding does
  not negate the requirement for a POC.
• Appeals associated with a revocation of
  endorsement by the LME will be made in accordance
  with North Carolina General Statutes and will
  supersede any appeal rights associated with
  endorsement withdrawal.
• For Community Support, the Appeal Rights can be
  found Session Law 2008-107 House Bill 2436
  Section 10.15A. (e2) .

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Section VI.11 Endorsement

• Updated to reflect new policy 12.3.07
  http//www.ncdhhs.gov/mhddsas/stateplanimplementat
  ion/providerendorse/index.htm

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Section VI.13 First Responder

•          First Responder phone number on main
  agency line
•          2 hour face-to-face capacity
•          Referrals to CAS

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Section VI.14 Letter of Support (NEW section)

•          Requirements for acquiring a letter of
  support

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Section VI.15 NCcareLINK (NEW Section)

• Requirements for providers and NCcareLINK (a
  web-based Information and referral system located
  at (http//www.wakegov.com/lme)

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Print your Manual!

• Revised Manual is posted on www.wakegov.com/lme

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The End!