After a 10-page report revealed the organization’s $3 million debt, Western Highlands Network faces another 10-page document: an extensive plan of correction from the state. However, if the managed-care organization doesn’t adhere to the recommendations, consequences could be great.
A plan of correction is issued to an organization when a locally managed entity, managed-care organization, or provider is found to be in noncompliance with current policy due to a deficiency or violation. For Western Highlands Network, the 10-page plan of correction issued by the state’s Division of Medical Assistance directly addresses issues found at Western Highlands in regard to four items: management reporting, financial operations, information technology and claims and clinical operations. However, before the board went into a closed session that would ultimately fire its chief financial officer and appoint Charles Schoenheit as its interim CEO, the state’s Medicaid director Michael Watson weighed in on the issues surrounding Western Highlands.
“I tend to see this really as an issue of management, accountability and ― maybe even more important ― just having the right information to carry out the role that you’ve assumed,” he asserted. Going forward, Watson told the board, “What you’re going to get from us is a lot of attention,” in regard to the plan of correction.
For example, the organization will be expected to participate in weekly monitoring meetings. The first of these meetings will take place at the Dorthea Dix Campus in Raleigh, N.C. on Aug. 6. Board members will be face-to-face with DHHS staff. “Going forward, the plan, in simple terms, is to respond to the request for corrective action,” Schoenheit says. Otherwise,“If they don’t fulfill the terms of the plan of correction, the last resort would be for the state to take over their operation and either merge them into another MCO, or find another provider to manage that,” says DHHS spokesperson Julie Henry.
Currently, Western Highlands provides mental health, substance abuse and developmental disability services to consumers in Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey Counties. Since January 3, Western Highlands has provided these services as a managed-care organization.
Look for a more extensive article in the Aug. 8 issue of Xpress