Magellan Announces Provider Changes

In June, Magellan announced changes to their provider contracting system primarily affecting provisionally-licensed therapists. Here is the text of that letter:

Dear Provider:

As you are aware, Magellan Behavioral Health* (Magellan) manages mental health and substance abuse services for Nebraska Medicaid Managed Care Plan (NMMCP) members. In collaboration with the Division of Medicaid and Long-Term Care, Magellan is implementing changes in policies regarding the inclusion of provisionally licensed clinicians for the NMMCP provider network. These changes are applicable to provisionally licensed psychologists, provisionally licensed mental health practitioners (PLMHPs), and provisionally licensed alcohol and drug abuse counselors (PLADCs).

Effective July 1, 2008, we will implement the following guidelines regarding the inclusion of provisionally licensed clinicians for the NMCCP provider network:

• Provisionally licensed clinicians who are currently NMMCP network practitioners in private or group practices will be "grandfathered in" and will remain in active status in the NMMCP network for up to two years, or July 1, 2010. As of July 1, 2010, practitioners must be fully licensed to continue network participation in private or group practices.

• Provisionally licensed clinicians who are employed by an NMMCP-contracted organization will continue to be accepted for network participation. However, provisionally licensed clinicians who terminate their employment from an NMMCP-contracted organization will not be eligible for network participation in group or private practices until such time they become fully licensed.

• Provisionally licensed clinicians who are not currently credentialed and contracted for the NMMCP provider network will not be accepted for network participation in private or group practices.

• In order to remain in active network status, existing NMMCP network practitioners in private or group practices who have a provisional license due to expire prior to July 1, 2010, must become fully licensed prior to the expiration of their initial provisional license. Practitioners will not be allowed to continue network participation on a renewed provisional license.
  

Thank you for your cooperation with this matter. If you have any questions, please contact Teresa Danforth at (402) 437-4241 or Kathy Dinges at (402) 437-4214.

APPT Survey: After-Hours Emergency Policy

Recently, the Association of Private Practice Therapists conducted a survey of its members to determine if there is a local standard for how after-hours emergency calls are handled.

The survey was commissioned by the APPT Board of Directors in response to an insurance/managed care company's request for a therapist's after-hours emergency policy.

The full results of the survey will be reported in the October 2008 issue of The Compass, the newsletter of the Association of Private Practice Therapists. Beyond the results, however, it appears as if therapists may be struggling with their ethical requirement to serve clients with the practical applications of after-hours service -- of particular issue with sole practitioners.

"We have maintained the cost of a 'company' cell phone and a live answering service for many years," one therapist writes. "We have begun to question the need and utility of this, and will likely drop this soon. At the end of the day, if someone has a crisis that is life-threatening, talking to us just delays going to the hospital."