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Dear Benchmarks' Members,
Please see below the latest information, guidance and technical assistance posted by the LME/MCOs as of Monday morning, March 23, 2020. Benchmarks will continue to keep this update on our COVID-19 Update and Resource Webpage throughout the course of this COVID-19 period.
In order to see the latest posts from each LME/MCO, please scroll down to the Resource section on our page and click on the name of the LME/MCO you are interested in viewing. The link will take you directly to their news and announcement page for providers.
Take care of each other and stay safe and healthy!
The Benchmarks' Team
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Service Authorization Requests
In an effort to best serve our members, Alliance continues to explore ways to support our
provider network by removing as many barriers as possible that could potentially interfere with the critical task of maintaining service capacity during this time of national crisis.
To this end, effective
Monday, March 23, 2020, for the next 30 days, Alliance will be waiving requirement for concurrent authorization of both
Medicaid and state-funded enhanced community-based services as well as several of the
Medicaid B-3 services. A list of services that will be exempt from
concurrent review during the 30 day period can be found below. Concurrent authorization is defined as having an active service authorization for the same service with your agency at the time of this announcement. Although the authorization requirement is being waived for a 30 day period, members still must meet medical necessity/continued stay criteria to receive services.
Prior authorization remains required for individuals new to enhanced and B-3 services.
Services Covered Under 30-day Concurrent Review Waiver:
- Assertive Community Treatment Team (ACT): H0040
- Assertive Community Treatment Team Step-Down: H0040TS
- Community Support Team: H2015HT
- Peer Support: H0038 (individual)
- Individual Supports B3: T1019 U4
- Supported Employment Individual Mental Health: H2023U4 HE
- Opioid Treatment: H0020
- Intensive In-Home: H2022
- Supported Employment Individual (I/DD): H2023 U4
- Intercept: H0036 U3 HK
- Family-Centered Treatment (FCT): H2022 U3 HE
- Multisystemic Therapy (MST): H2033 HE
- Outpatient Therapy Plus (OPT Plus - child only): 90837 U3 HE
- Respite - B3: H0045 U4 (Individual)
- Community Guide (B3): T2041 U4
Member and Legally Responsible Person Signatures
At this time in recognition of the realities of current pandemic situation and based on guidance from the N.C.
Department of Health and Human Services (DHHS) and the U.S. HHS Office for Civil Rights, to decrease unnecessary face to face contact, promote the use of virtual care where possible and address challenges related to obtaining member signature on person center plans, treatment plans and consent to treat forms Alliance is implementing the following:
- Alliance will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person's (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf.
- Providers should document whether such consent was made via telephonic, email or other means. Any provider relying upon email consent should follow up via telephone communication with the member/LRP to secure verbal consent if possible. Providers should track consent received in this manner so they can implement a plan to obtain signatures of the member or LRP at a later time.
- To verify you are speaking with the member/LRP, best practice is to ask for another identifier (besides name and date of birth), such as Social Security number or Medicaid number. Always obtain express consent for disclosure of any substance use information. Member/LRP consent or approval should be clearly documented in the service note.
Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency
Below is a summary of a notification released by the Office of Civil Rights at the US
Department of Health and Human Services. Y
ou can access the full notification.
During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.
The Office of Civil Rights (OCR) will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately.
OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without the risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.
Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public-facing, and should not be used in the provision of telehealth by covered health care providers.
Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA
business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.
- Skype for Business / Microsoft Teams
- Updox
- VSee
- Zoom for Healthcare
- Doxy.me
- Google G Suite Hangouts Meet
State Initiatives
As mentioned in previous updates the state is moving quickly to provide increased flexibility afforded to the LME/MCO system and providers to ensure both ongoing access to behavioral health services and the health and sustainability of the behavioral health care delivery system.
A letter to the LME/MCO CEOs outlines both immediate steps and planned initiatives to achieve the above-stated goals. Alliance has already begun to exercise some of this newly afforded flexibility and will work rapidly with our
provider network partners using available funding and flexibility to address barriers that impact the ability to deliver care during this very challenging time.
Please note: Gurley's pharmacy will waive the $3.00 copay for Durham residents receiving state and county funded behavioral health services.
Alliance Health highly recommends that you monitor
Provider News and our
website daily at for any updates regarding provider services. Alliance will update this information as we receive any updates from the State in regards to COVID-19.
In the event that COVID -19 seriously impacts your ability to provide services to our members, please notify Alliance immediately by submitting the
Temporary Disruption of Service Delivery form found on our website.
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March 20, 2020 Updates
Case Support Service Established to Help Providers with COVID-19 Pandemic
Utilization Management
Cardinal Innovations understands that many providers are not able to deliver services in facilities, face to face, or at the same intensity/frequency that they may normally be doing as a result of the COVID-19 pandemic and social distancing efforts.
Many providers have communicated to us creative things that they are doing to check in on members, ensure their needs are met, and continue to provide portions of treatment when they can't deliver the full services due to existing service requirements.
We appreciate the work you are doing to continue to serve our members during this challenging time. In an effort to best support our members and simplify how these types of support are provided we have established a Case Support service. This can be billed for members established in care with providers for all covered populations: mental health, substance use, and intellectual and developmental disabilities who receive Medicaid B waiver services or state-funded services.
This service should be tracked/documented in 15-minute units but can include the following types of activities:
- Calls or other technology related outreach to members by qualified professionals or other staff that are not able to bill the newly established telephonic codes or bill tele-health
- Delivery of medication, food, or other supplies to a member at their current place of residence
- Coordination activities to link them to needed resources, assist in benefit applications, unemployment applications
- Skill building with individuals done virtually or in a member's home (when appropriate to do so)
- Coaching or training with members and their families
Some examples of how this may be used:
- An intensive in-home provider is not able to see their members face to face or meet the daily two-hour service requirement. The therapist on the team can bill the outpatient therapy codes if they can deliver these sessions via technology. The qualified professionals on the team can bill case support units for activities they deliver via telephone/through technology with the family
- An Adult Developmental Vocational Program (ADVP) provider is not able to operate their services in the facility, but is still connecting with their members daily to check in, provide support/guidance to the member and their families. The provider may also assist in connecting to local resources via case support
- A Peer Support staff is not able to see a member face to face or provide typical services to a member in the community. This staff may still call use technology to teach the member relaxation skills, check in on completion of activities of daily living, help provide social connection to decrease social isolation
Note: This is not intended to duplicate billing for services that providers continue to be able to deliver directly to members. As the situation continues to evolve, we anticipate more difficulty in face-to-face service delivery or meeting the service definition requirements and know that some site-based programs have already had to suspend operations.
We are working closely with the state to evaluate all enhanced services and determine where there can be additional flexibility on the service definition requirements, including:
- Face-to-face contact
- Number of required hours
- What can be delivered through technology (when staff can't bill the tele-health codes)
the addition of Case Support to our service array, gives providers a more immediate way to submit billing and receive payment for the activities that they are actively doing to support our members while additional flexibility and guidance is received about the broader service array. This service will not require prior authorization and once these codes are finalized in the system providers can begin to submit claims for dates of service March 16, 2020 forward.
Next Steps:
Cardinal Innovations is working to get coding finalized and set in contracts and will communicate those once they are complete. Those include the following:
- Providers delivering services to state-funded members - use the YP215 code
- Providers delivering services to Medicaid members - we are working to finalize the billing codes and communicate them within the next week
- Providers can begin documenting and tracking the units to prepare for submission on the services are loaded
The rate for this service will be $15 per 15 minute unit. The working definition can be found
here.
If providers need any additional assistance, reach out to your
Network Specialist, email us at
[email protected] or contact the provider line at 1-855-270-3327.
Documentation for Signatures during COVID-19
Utilization Management
Cardinal Innovations understands that during this time providers may not be able to secure written consent, obtain signatures on written documents from members or their guardians, or complete other required treatment forms. We do not want this to be a barrier to a member's ability to obtain care or be able to continue in treatment.
At this time, Cardinal Innovations will allow provider submissions to consist of verbal consent on required documents such as the Person Centered Plan. Providers must notate this in the respective areas on the signature page and keep documentation of the verbal contact with the member or legal guardian in their records. Once it is possible to safely obtain the required signatures for each member, Cardinal Innovations expects that the signatures to be obtained and kept on file with their provider(s).
If providers have access to technology through their electronic health records or other technology that meet the Health Insurance Portability and Accountability Act (HIPAA) requirements for e-signatures, we continue to encourage this be used when it is available.
If providers have any questions, please reach out to your
Network Specialist, email us at
[email protected] or contact our provider line at 1-855-270-3327.
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March 20, 2020
The Eastpointe Provider Council has asked us to notify the Eastpointe Provider Network that they will not have a face to face meeting this month on March 25, 2020. They asked us to let you know that if you need to reach them with any questions or concerns to please send those to
[email protected].
March 23, 2020
At this time, in recognition of the realities of the current pandemic situation and based on guidance from the N.C. Department of Health and Human Services (DHHS) and the U.S. HHS Office for Civil Rights, Eastpointe will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person's (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf.
The provider should document whether such consent was made via telephone, email or other means (e.g. through a window). Any provider relying upon email consent should follow up via telephone communication with the member/LRP to secure verbal consent if possible.
To verify you are speaking with the member/LRP, best practice is to ask for another identifier (besides name and date of birth), such as a Social Security number or Medicaid number. Always try and obtain express consent for disclosure of any substance use information. Member/LRP consent or approval should be clearly documented in the service note.
Questions
For questions related to this memo, please contact your agency-assigned Provider Relations Account Representative (PRAR). If you do not know the PRAR assigned to your agency, please contact Network Operations at (888) 977-2160 or
[email protected].
Thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.
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March 20, 2020
In This Bulletin:
- Partners Launches COVID-19 Provider-Specific Webpage
- COVID-19 Updates
- Care Plan Signature Requirements
- Monitoring Site Visits
- Authorizations
- New Service Codes - Use CR Modifier
- State News
- Partners 2020 Needs Assessment and Gaps Analysis Survey
- March Provider Council Meeting
- Provider Operations Manual
- March Quarterly Provider Webinar
- LIP Collaborative-May 13, 2020
- Attention I/DD Providers: NC-SNAP
- Claims Information
- Partners Training Academy (includes cancelation language)
- Provider Alerts (list out hyperlinks to alerts)
- Training, Announcements and Reminders
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March 20, 2020
March 19, 2020
Sandhills Center CEO Victoria Whitt issues letter to the Provider Network regarding Covid-19 response
Sandhills Center understands the important role our Provider Network plays in ensuring the availability of behavioral health services in our local communities. During times of state and national uncertainty, that strength can be tested. Taking the steps possible to reduce administrative burden and allowing the greatest amount of flexibility in continuing those services during that uncertainty is more important than ever to ensure the strength of that Network.
During the last week, we have continually reviewed the guidance of the North Carolina Department of Health and Human Services (NC DHHS) and the Centers for Disease Control and Prevention (CDC) concerning recommended steps to take in preparation and response to COVID-19. As more information about how best to mitigate the spread of the virus has been learned, Sandhills Center has developed and revised our own internal plans. To that end, the Sandhills Center steps that may be most evident to our Provider Network is a suspension of non-essential travel, suspension of non-essential meetings, the transition to virtual meetings, when possible, and the suspension of visitors, guests and stakeholders onto Sandhills Center premises.
While Sandhills Center staff have transitioned to remote working options, our intention is for communication to continue as usual with our Provider Network, individuals served and community partners. If we have transitioned to new, remote work sites well, you should notice little to no change in our responsiveness. Additionally, we are focused on reducing administrative work for our providers during this time. In an effort to assist you in reducing the number of visitors to your facilities, Sandhills Center has temporarily suspended all external audits, reviews and oversight monitoring, except for reviews involving member health and safety, that would require travel to your site.
The desktop review process will continue during this suspension to expedite the conclusion of each in progress review when appropriate. Our commitment to you is to continue to work closely with state leadership to explore all possibilities to sustain and stabilize our Provider Network during this COVID-19 emergency.
As federal or state legal, regulatory, contractual or service-definition changes are made available, we will expedite the announcement of those changes to assist in your service delivery to our members. The recent announcement of new telehealth codes by the state have been prioritized by our Provider Network staff for entering into the Alpha system and activation for your use. As other options are made available, we will continue to move as efficiently as possible to extend those options to you.
We understand you have and will be making difficult decisions as you craft your agency response to the current situation. We want to express our sincere thanks and deep appreciation to every provider organization who has developed their response plan keeping a focus on the safety and well-being of the members served. We are grateful for the teamwork demonstrated in the response to date and that will, no doubt, continue as we move forward. Your partnership is a tremendous support during this time. Even with the significant steps North Carolina has taken to contain the spread of this virus, the spread is unfortunately expected to worsen before improvement is seen.
Our thoughts go out to those around the globe who have been impacted by this pandemic, including families who have lost loved ones, individuals who are experiencing a decompensation in their behavioral health due to fear and anxiety, and those who are suffering from the economic impacts of the virus. As the situation develops and the impacts of the virus are more fully known, Sandhills Center recognizes that it is as important as ever to continue our support of the local behavioral health system, members receiving services and providers offering those services. We are proud to know the important role we play in helping our communities through and after this event. Sandhills Center is particularly proud to have the Provider Network partners we have assisting us in that effort.
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Immediate Changes under EPSDT for Children under the Age of 22
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.
Trillium is working with the North Carolina Department of Health and Human Services (NC DHHS) on service specific guidance in response to the COVID-19 virus.
The North Carolina Division of Health Benefits (DHB) coordinated with the Center for Medicare and Medicaid Services (CMS) and requested waivers that support flexibility in service delivery that both protects the public while ensuring our most vulnerable citizens are able to continue receive support for their Behavioral I/DD needs.
This guidance is in place for the duration of the declared state of emergency or until further notice or amendment. Trillium may require at some future point replacement claims to add modifiers to service codes used for billing during this event. All service notes during this time must include the following statement: This service was delivered under EPSDT during the Covid-19 State of Emergency requiring social distancing.
Trillium Health Resources is implementing the following
changes under EPSDT IMMEDIATELY
for children under the age of 22 who have active authorizations or receive unmanaged visits:
- Trillium has approved all Outpatient services to be billed for services provided under the social distancing mandate via video or telephonic presence. The outpatient treatment provider MUST have contact with each child authorized or enrolled for outpatient treatment services. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of sessions needed or that are currently authorized for each child. We also continue to expect the outpatient treatment provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting- including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home.
- Trillium has approved Day treatment to be billed for services provided under the social distancing mandate via video or telephonic presence. Each day Monday-Friday of each week the Day Treatment provider MUST have contact with each child authorized for Day Treatment services. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per day per child. These hours do not have to be consecutive nor delivered as a group. We also expect the day treatment provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all levels of staff employed in the traditional day treatment setting.
- Trillium has approved Intensive In-Home to be billed for services provided under the social distancing mandate via video or telephonic presence. Each week Intensive In-Home provider MUST have contact with each child authorized for Intensive In-Home services. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per week per child. These hours do not have to be consecutive. We also continue to expect the Intensive In-Home provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all staff employed in the traditional Intensive In-Home team.
- Trillium has approved Multi-systemic Therapy (MST) to be billed for services provided under the social distancing mandate via video or telephonic presence. Each week MST provider MUST have contact with each child enrolled/authorized for MST. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per week per child. These hours do not have to be consecutive. We also expect the MST provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home.
- Trillium has approved Research Based Behavioral Health Treatment (RBBHT) to be billed for services provided under the social distancing mandate either in the home of the member or via video or telephonic presence. Each week RBBHT provider MUST have contact with each child enrolled/authorized for RBBHT. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per week per child. These hours do not have to be consecutive. We also expect the RBBHT provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours, to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all levels of staff employed as a provider for RBBHT.
- Trillium has approved Family Centered Treatment (FCT) to be billed for services provided under the social distancing mandate either in the home of the member or via video or telephonic presence. Each week FCT provider MUST have contact with each child enrolled/authorized for MST. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per week per child. These hours do not have to be consecutive. We also expect the FCT provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all staff employed in the traditional FCT team.
- Trillium has approved Child First to be billed for services provided under the social distancing mandate either in the home of the member or via video or telephonic presence. Each week Child First provider MUST have contact with each child enrolled/authorized for Child First. Trillium wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per week per child. These hours do not have to be consecutive. We also expect the Child First provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Trillium expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all staff employed as part of Child First.
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March 19, 2020
The Community Foundation of Western North Carolina, Dogwood Health Trust and other partners have established an Emergency and Disaster Response Fund to provide funding for human service organizations to address basic needs exacerbated by the COVID-19 pandemic. The maximum grant amount is $10,000 per applicant. Learn more at
https://cfwnc.org/grants/emergency-and-disaster-response-fund.
March 18, 2020
Vaya Health is aware that providers are experiencing challenges in obtaining required signatures from members for clinical documents. At this time, in recognition of the realities of current pandemic situation and based on guidance from the NC Department of Health and Human Services and the U.S. HHS Office for Civil Rights, Vaya will accept a Qualified Professional/ para-professional or clinician signature in place of the member or legally responsible person's signature, along with a notation that the member/LRP gave oral consent for the provider representative to sign the document on their behalf.
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Benchmarks' Non-Profit Agencies
For your consideration
Urgent Request to Congress for COVID Response Parity for Nonprofit, Human Services Organizations
Please use and modify this template as you wish, while keeping its congressional ask intact, then send to all members of your congressional delegation IMMEDIATELY. Congress is making decisions about COVID relief and stimulus packages now and they need to hear from your organization.
Instructions:
- Fill in the template with your organization's information and modify the template, if needed.
- Send the email from your CEO or other designee from your organization.
- Address the email to a congressional staffer (e.g. legislative director and/or health staffer).
- If you need to find the names of your congressional delegation, go here to find your U.S. Representative using your zip code, and here to find your U.S. Senator. If you do not have the name of a congressional staffer, make a quick call to the congressional office's DC or local phone number (you can find it on their website) and ask them to give you the name and email address for the person who handles health and/or human services concerns, or the COVID-19 reponse, for the congressperson.
- cc your organization's point of contact (if different from the individual sending the email).
- If you do not hear back from the congressional offices within four hours, it is a good idea to call to follow up. Things are moving very quickly and we don't want human services organizations to be hampered in our ability to respond to this crisis.
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