| May 28, 2004
Dear Community Partners:
Over the next few months our public mental health system will be
undergoing many significant challenges and changes. I want to make you aware
of a change that will be happening in the near future.
On June 1st the North Sound Mental Health Administration will implement
the Washington State “Access to Care” criteria. These criteria, which
determine clinical eligibility for publicly funded mental health services
for Medicaid enrollees, were developed through a state-sponsored
collaborative process that included providers, NSMHA staff, consumers and
advocates in response to the Federal Center for Medicaid and Medicare
Services requirements.
These new criteria are designed to assure that Medicaid enrollees with
the greatest mental health needs receive all the services that are medically
necessary. We believe they are fair and reasonable. However, it is possible
that they are more stringent than the standards we have used in the past and
it is also possible that some individuals who might previously have
qualified for services may in future not be clinically eligible.
NSMHA and our provider network will make every effort to ensure the
consistent application of the criteria, and to notify enrollees of their
rights if they are denied admission to services. We have required that our
Medicaid clients currently in service remain in treatment for as long as it
remains medically necessary.
During this transition we ask for your patience. We are doing everything
possible to mitigate the impact on our clients and their communities, but if
you have concerns please do not hesitate to contact our Ombuds or Quality
Manager, Wendy Klamp for assistance. We continue to strive to promote the
Vision of Hope and Paths to Recovery as we go forward.
I thank you for your support.
Sincerely,
/S/
Charles R. Benjamin
Executive Director
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