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Benchmarks' Child Welfare Webinar w/Lisa Cauley
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| Child Welfare Webinar:
December 10, 2020 |
Note: Benchmarks has suspended our Friday Membership Webinars for the next few weeks and will resume our meetings on January 8th with Dave Richard joining Karen McLeod!
Important Benchmarks' Request
Benchmarks is seeking participants who are interested in engaging in our FAR Subcommittee related to research regarding options for new foster parent training.
If you, or a member of your staff, is interested in participating in this important project, please reach out to Subcommittee Chair, Donna Yalch. Many thanks in advance!
Note: This update has been shortened and less detailed than is typical due to technical difficulties created by various software outages today, we will resume our regular updates when services return to normal. :-)
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Application Period Open for Tailored Care Management Certification
In June 2020, the Department released an updated Tailored Care Management Provider Manual and application questions for organizations seeking to apply for certification as Advanced Medical Home Plus (AMH+) practices or Care Management Agencies (CMA) delivering the Tailored Care Management model.
Applications for the first round of certification will be due on March 1, 2021. Interested providers should review the updated Provider Manual and application questions, and may submit applications to Medicaid.TailoredCareMgmt@dhhs.nc.gov.Tailored Care Management Certification Webinar - Thursday, Dec. 17 The Department will host a webinar on Dec. 17, 2020 at 11 a.m. EST to provide more information and respond to providers' questions. The registration link is available here.
DHSR: Vaccine Distribution and Holiday Guidance
From Michiele Elliot: Good afternoon, yesterday on our BH-IDD Provider call Deputy Secretary Kinsley spoke briefly about the vaccine distribution in North Carolina. We had several questions yesterday during the call and I have received dozens of emails in the last 24 hours inquiring about how to get signed up to have your clients vaccinated. Rather than respond individually, in the interest of time and clarity I wanted to address this with all our licensed providers.
- Facilities that signed up for the CDC's Pharmacy Partnership for Long-Term Care Program for COVID-19 Vaccinations, will be receiving communications from CVS and Walgreens over the next few weeks with next steps. DHHS will send out additional information about the vaccine next week, this will include a list of facilities that signed up for this program. I do not have this information and cannot check to see if your facility is signed up.
- Your local health department will be coordinating the distribution and administration of vaccines for congregate care settings in your area who did not sign up. Unfortunately, I cannot provide information on when the vaccine will be available for your facility.
It is also available on the NC DHHS COVID Dashboard
here. This guidance applies to clients, staff, clients' families, and visitors of nursing homes, adult care homes, behavioral health and intellectual/developmental disability facilities, intermediate care facilities, and psychiatric residential treatment facilities. We appreciate all your interest in procuring the vaccine for your clients and keeping our clients and communities safe. Stay safe.
Handouts from the Medical Care Advisory Committee Meeting
COVID-19 Vaccine Webinar with Dr. Betsy Tilson
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Please Read: New Medicaid Bulletins Available
The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles:
Dec. 8, 2020
Dec. 11, 2020
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
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A Multigenerational Approach to the Prevention & Treatment of SUDs
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| | UVM CORA Community Rounds: Suicide and Substance Use Disorders, Dr. Sanchit Maruti, 9/30/2020 |
Download Slidedeck
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CMS Proposes New Rules to Address Prior Authorization and Reduce Burden on Patients and Providers
Improving patient and provider access to medical records and reforming prior authorization processes critical in a public health emergency
Today, under President Trump's leadership, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve the electronic exchange of health care data among payers, providers, and patients, and streamline processes related to prior authorization to reduce burden on providers and patients. By both increasing data flow, and reducing burden, this proposed rule would give providers more time to focus on their patients, and provide better quality care.
The COVID-19 pandemic has shone a harsh light on many longstanding inefficiencies in the health care system-including the lack of data sharing and access. Today's proposed rule aims to improve this for patients navigating care. The proposed rule would build on the Trump Administration's Interoperability and Patient Access final rule published by the CMS in May.
"This proposed rule ushers in a new era of quality and lower costs in health care as payors and providers will now have access to complete patient histories, reducing unnecessary care and allowing for more coordinated and seamless patient care. Each element of this proposed rule would play a key role in reducing onerous administrative burden on our frontline providers while improving patient access to health information," said CMS Administrator Seema Verma. "Prior authorization is a necessary and important tools for payors to ensure program integrity, but there is a better way to make the process work more efficiently to ensure that care is not delayed and we are not increasing administrative costs for the whole system." Prior authorization is not only a leading source of burden, it is also a primary source of provider burnout, and takes time away from treating patients. If just a quarter of providers took advantage of the new electronic solutions that this proposal would make available, the proposed rule would save between 1 and 5 billion dollars over the next ten years. With the pandemic placing even greater strain on our health care system, the policies in this rule are more vital than ever."
The rule would require payers in Medicaid, CHIP and QHP programs to build application programming interfaces (APIs) to support data exchange and prior authorization. APIs allow two systems, or a payer's system and a third-party app, to communicate and share data electronically Payers would be required to implement and maintain these APIs using the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The FHIR standard is an innovative technology solution that helps bridge the gaps between systems so both systems can understand and use the data they exchange.
On behalf of HHS, the Office of the National Coordinator for Health IT (ONC) is also proposing to adopt certain standards through an HHS rider on the CMS proposed rule.
Improving Prior Authorization
Prior authorization is an administrative process used in healthcare for providers to request approval from payers to provide a medical service, prescription, or supply. This process takes place before a service is rendered. The rule proposes significant changes to improve the patient experience and alleviate some of the administrative burden prior authorization causes health care providers. Medicaid, CHIP and QHP payers would be required to build and implement FHIR-enabled APIs that could allow providers to know in advance what documentation would be needed for each different health insurance payer, streamline the documentation process, and enable providers to send prior authorization requests and receive responses electronically, directly from the provider's EHR or other practice management system. While Medicare Advantage plans are not included in today's proposals, CMS is considering whether to do so in future rulemaking.
The proposed rule would also reduce the amount of time providers wait to receive prior authorization decisions from payers-the rule proposes a maximum of 72 hours for payers, with the exception of QHP issuers on the FFEs, to issue decisions on urgent requests and seven calendar days for non-urgent requests. Payers would also be required to provide a specific reason for any denial, which will allow providers some transparency into the process. To promote accountability for plans, the rule also requires them to make public certain metrics that demonstrate how many procedures they are authorizing.
These policies, taken together, could lead to fewer prior authorization denials and appeals, while improving communication and understanding between payers, providers, and patients. They are the result of numerous listening sessions with plans and providers aimed at crafting a new process that balances the need for greater efficiency and consistency in prior authorization and its important role in preventing fraud, abuse, and unnecessary expenditures.
Increasing Patient Access to Health Information
Building on that foundational policy, this rule would require impacted payers to implement and maintain a FHIR-based API to exchange patient data as patients move from one payer to another. In this way, patients who would otherwise not have access to their historic health information would be able to bring their information with them when they move from one payer to another, and would not lose that information simply because they changed payers.
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Upcoming Events
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Wednesday, December 16, 2020
Post-Election: What Can Employers Expect in 2021?
Time: 11:00 am
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New: Tuesday, December 15, 2020
COVID-19 Vaccine Webinar: What North Caroline Practices Need to Know
Time: 6:00 pm thru 7:00 pm
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New: Wednesday, December 16, 2020
Improving Prior Authorization Processes and Promoting Patients' Electronic Access to Health Information Proposed Rule Listening Session
On December 10, CMS released a proposed rule, building on the CMS Interoperability and Patient Access final rule (CMS-9115-F) that would require certain CMS-regulated payers to improve the electronic exchange of health care data via Application Program Interfaces (APIs) and streamline the prior authorization process to reduce burden on payers, providers, and patients. This proposed rule applies to:
- State Medicaid, Children's Health Insurance Program (CHIP), and Medicare Fee-for-Service (FFS) programs
- Medicaid managed care plans
- CHIP managed care entities
- Qualified Health Plan issuers on the federally-facilitated exchanges
Target Audience: All Medicare FFS providers and industry-wide stakeholders.
Time: 1:30 pm thru 3:00 pm
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Thursday, December 17, 2020
Behavioral Health: This series features Medicaid Managed Care topics specific to clinical quality on the third Thursday of every month.
Time: 5:30 pm thru 6:30 pm
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Thursday, December 17, 2020
COVID-19 Q&A Webinar for Behavioral Health Care Accreditation
Time: 1:30 pm thru 3:00 pm
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Thursday, December 17, 2020
Social Connections Using Technology for People with IDD & Autism
Times Available:
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Thursday, December 17, 2020
Clinical Quality Webinar Series-Behavioral Health
Time: 5:30 pm thru 6:30 pm
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Tuesday, December 22, 2020
CMS COVID-19 Office Hours Calls
Office Hour Calls provide an opportunity for hospitals, health systems, and providers to ask questions of agency officials regarding CMS's temporary actions that empower local hospitals and healthcare systems to:
- Increase Hospital Capacity - CMS Hospitals Without Walls;
- Rapidly Expand the Healthcare Workforce;
- Put Patients Over Paperwork; and
- Further Promote Telehealth in Medicare
Time: 5:00 pm thru 6:00 pm
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Thursday, January 7, 2021
Medicaid Managed Care Fireside Chat Webinar Series-Policy Approvals, Process Changes & Appeals
Time: 5:30 pm thru 6:30 pm
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Friday: January 8, 2021
Dave Richard Joins Benchmarks' Friday Membership Webinar
Time: 8:30 am thru 9:30 am
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Thursday, January 21, 2021
Clinical Quality Webinar Series-TBD
Time: 5:30 pm thru 6:30 pm
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Please click on each of the following links to view details sent out from each LME/MCO.
Benchmarks' wants to be sure to make the following list handy for our members to visit and suggests a peek at least once per week to find information that may be pertinent to your agency and contracts.
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