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SMC Care Coordination Department

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Llame a 1-800-849-6127 para averiguar cómo obtener los servicios y el apoyo para la salud mental, discapacidades del desarrollo y abuso de sustancias las 24 horas del día, 7 días de la semana en su comunidad. Materiales en español para los miembros se puede solicitar llamando al número anterior.

Call 1-800-849-6127 to find out how to obtain services and support for mental health , developmental disabilities and substance abuse 24 hours a day, 7 days a week in their community. Materials in Spanish for members can be requested by calling the number above.

The Care Coordination Department is staffed by clinical and administrative personnel who possess appropriate qualifications, and is organized as to ensure that expertise in mental health (MH) substance abuse (SA) and Intellectual and Developmental Disabilities (IDD) is embedded in our practice. Care Coordination practices are grounded in Smoky Mountain LME/MCO's commitment to be person-centered, emphasize principles of recovery and resilience and family involvement. Smoky Mountain care coordinators use industry standard technology, care coordination protocols, evidence based practices (EBPs) and clinical practice guidelines. Smoky Mountain's approach to care coordination is designed to provide each individual with the assistance necessary to choose services and supports to help them achieve their goals.

The Care Coordination department is comprised of several teams and individuals in order to carry out the department's responsibilities and efforts. These teams include the MH/SA Care Coordination team and the I/DD Care Coordination team.

Community Based Mental Health/Substance Abuse & Intellectual/Developmental Disabilities Care Coordinators

When Smoky Mountain became a Managed Care Organization in July 2012, the role of administrative care coordination was clearly defined by contract. Care Coordination is family focused, acts as an information hub between agencies/systems, coordinates a community level service plan, develops or ensures development of a crisis plan, focuses on understanding needs in the context of strengths, connecting people with appropriate services, ensures a multidisciplinary coordination and planning with inclusion of community and natural supports and monitors services and celebrates successes. The Care Coordination role focuses on identification, assessment, service planning, referral & linkage, monitoring and risk management & disease management with an emphasis on ensuring access to the right amount, duration and intensity of service for our consumers while reducing escalating cost trends.

Smoky Mountain provides Care Coordination for two populations: those with defined special healthcare needs and those who are considered high risk high cost. The Division of Medical Assistance defines Special Healthcare Needs for IDD as individuals who are functionally eligible for, but not enrolled in, the Innovations waiver, who are not living in an ICF-MR facility OR individuals with an IDD diagnosis who are currently, or have been within the past 30 days, in a facility operated by the Department of Correction or the Department of Juvenile Justice and Delinquency Prevention. For MH/SA, it is defined by a specific range of diagnostic codes as well as a certain LOCUS/CALOCUS/ASAM score or level of care need or a child who currently, or has been within the past 30 days, in a facility operated by Department of Corrections or Department of Juvenile Justice Delinquency Prevention.

NC General Statute, NC Division of MH/DD/SA Scope of Service Contract and implementation updates defines High Risk/High Cost as anyone who has been assessed as needing emergent crisis services 3 or more times in the previous 12 months OR whose treatment plan is expected to incur costs in the top 20% for all consumers in a disability group. It is also defined as anyone who does not have an defined behavioral health clinical home, involved with CCNC, fits into a set of specialty populations, on an outpatient commitment, adjudicated youth involved with DJJDP or TASC, youth admitted to or discharged from MH/SA residential level III and IV group homes and individuals who currently reside in an ICF-MR home who could be successfully transitioned to a community setting. Individuals involved in the United States Department of Justice and North Carolina Settlement Agreement/Transitions to Community Living Initiative are eligible for Smoky Mountain care coordination.

If you are a consumer or family member and you or your family member may be eligible for MCO Care Coordination, please contact your regional Care Coordination Manager.

If you are an MH/SA/IDD service provider and someone you serve may be eligible for MCO Care Coordination, please complete a Care Coordination referral form and email a secure copy to your regional Care Coordination Manager.

For further information or if you have questions, please contact your regional community based care coordinator.

MH/SA Care Coordination

Alleghany, Ashe, Avery, Wilkes and Watauga Counties
Jody Hill • 828-265-5315 ext. 4429 •

Cherokee, Clay, Graham, Haywood, Jackson, Macon and Swain Counties
Nancy Chastain • 828-837-0071 ext. 1160 •

Alexander, Caldwell, McDowell, Mitchell and Yancey Counties
Dustin Burleson • 828-759-2160 ext. 3316 •

Buncombe and Madison Counties
Celeste Ordiway • 828-225-2785 ext. 5149 •
Mark Van Tuyl • 828-225-2785 ext. 5239 •

Henderson, Polk, Rutherford and Transylvania Counties
James Gonzalez • 828-225-2785 ext. 1989 •

I/DD Care Coordination

All Counties
I/DD CC Director: Christy Pruess • 828-265-5315 ext. 4402 •
SIS Manager: Allison Farrington • 336- 982-4740 •

Alleghany, Ashe, Avery, Mitchell, Wilkes and Watauga Counties
Tina Clark • 828-265-5315 ext. 4416 •

Alexander, Caldwell, Madison, McDowell and Yancey Counties
John Frazier • 828-759-2160 ext. 3341 •

Buncombe County
Lindy Monteleone • 828-225-2785 ext. 5137 •

Cherokee, Clay, Graham, Haywood, Jackson, Macon and Swain Counties
Currently Vacant, Contact information coming soon!

Henderson and Transylvania Counties
Suzette Woten • 828-654-7050 •

Rutherford and Polk Counties
Ronnie Payne • 828-225-2785 ext. 1194 •

Click here for the Smoky Mountain Care Coordination Referral/Intake Form - UPDATED February 2015

URAC Accredited Health Call Center, Health Network, Health Utilization Management

Serving individuals with mental health, developmental disability and substance use issues in
Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey counties
For Immediate Help, Call 1-800-849-6127                    For Customer Services, Call 1-888-757-5726                    For TTY Calls, contact Relay NC at 711
Compliance Hotline: 1-866-916-4255 Copyright © 2009 - 2015      Smoky Mountain LME/MCO      All Rights Reserved Privacy Policy