Benchmarks' Friday Collection-January 28, 2022

DHHS' COVID-19 Website

Read More About National Kazoo Day

Benchmarks' Upcoming Webinars

Benchmarks' Friday Membership Webinar with United Healthcare/Optum PHP & Karen McLeod

Date: Friday, February 4, 2022

Time: 8:30 am thru 9:30 am

Benchmarks' Child Welfare Webinar

Lisa Cauley Joins Karen McLeod

Date: Thursday, February 10, 2022

Time: 8:00 am thru 9:00 am

Benchmarks' Friday Webinar

Dave Richard Joins Karen McLeod

Date: Friday, February 18, 2021 thru December 16, 2022

Time: 8:30 am thru 9:30 am

(This registration is for a recurring meeting)

Benchmarks' Foster, Adoption, & Residential (FAR) Committee Meeting: Legislative Agenda Development

Date: Tuesday, March 1, 2022

Time: 9:00 am thru 10:30 am

Benchmarks' Medicaid Forum: Legislative Agenda Development

Date: Thursday, March 3, 2022

Time: 9:00 am thru 10:30 am

Benchmarks' Friday Membership Webinar with AmeriHealth Caritas PHP & Karen McLeod

Date: Friday, March 4, 2022

Time: 8:30 am thru 9:30 am

Benchmarks' Collection of Past Updates

HCBS Direct Care Worker Wage

Increase Webinar Recording

-Watch

Direct Care Worker One-Time Bonus Recording

-Watch

-Download Presentation

Associated FAQS

Tailored Care Management Updates

As part of the transition to NC Medicaid Managed Care, NC Medicaid has worked with stakeholders to design the Tailored Care Management model for the Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plan population. Tailored Care Management will launch in December of this year with the implementation of Behavioral Health I/DD Tailored Plans. NC Medicaid has the following updates related to Tailored Care Management.

AMH+/CMA Certification Round Two Desk Reviews Completed

The Department has completed desk reviews of the Round Two Advanced Medical Home Plus (AMH+) practices/Care Management Agencies (CMAs) provider certification applications and has advanced 32 providers to the site review stage of the certification process. For more information, please see Medicaid bulletin article Tailored Care Management Updates – Jan. 28, 2022.

Updated Guidance

NC Medicaid has published updated guidance on Tailored Care Management, including updates to the Tailored Care Management Provider Manual, the use of Care Manager extenders, Tailored CM 101 Frequently asked Questions and updated guidance on rates. For more information, please see Medicaid bulletin article Tailored Care Management Update: AMH+/CMA Certification Round Two Desk Reviews Completed.

All updates can be found on the Tailored Care Management webpage at: https://medicaid.ncdhhs.gov/transformation/tailored-care-management.

DHHS IDD Stakeholder Workgroup

NC Integrated Care for Kids (InCK) Pilot Begins

NCDHHS recently launched the Integrated Care for Kids (InCK) pilot program in Alamance, Orange, Durham, Granville and Vance counties. Supported by grant funding from CMS, the NC InCK model is a collaboration between Duke University Health System, UNC Health System and NCDHHS.

The pilot will cover approximately 95,000 children across InCK’s five counties. The NC InCK model aims to improve the quality of care and reduce expenditures for children under 21 years of age covered by Medicaid or CHIP (NC Health Choice) through prevention, early identification and treatment of behavioral and physical health needs. NC InCK also aims to bring together child-specific services from different agencies and providers to help meet the health, education and social needs of children and families. NC InCK also supports communities in coordinating services for children between health care and social services providers.

For more information, please see NC Integrated Care for Kids (InCK) Pilot Begins.

Patient Risk List Updates for Advanced Medical Homes Tier 3 Not Participating in Integrated Care for Kids (InCK)

As part of implementing the InCK pilot program, DHHS has added new valid values to the “Priority Population” field in the Patient Risk File layout transmitted from Prepaid Health Plans (PHPs) to AMH Tier 3s/or their clinically integrated network (CIN) or data partners.

These new valid values identify a Service Integration Level (SIL) category for beneficiaries participating in the NC InCK program. Only AMH Tier 3s participating in the InCK pilot are expected to utilize the SIL “Priority Population” designations for their associated beneficiaries.

The InCK pilot project currently includes AMH Tier 3 practices in the Duke Connected Care, UNC Health Alliance and Community Care Physician Network (CCPN) CINs in the participating counties of Alamance, Durham, Granville, Orange and Vance. However, non-InCK participating AMH Tier 3s have the option of utilizing these SIL designations when identifying priority members for care management.

For more information, please see Patient Risk List Updates for Advanced Medical Homes Tier 3 Not Participating in Integrated Care for Kids (InCK). Additional information is available on the Medicaid NC InCK webpage.

REVISED AND UPDATED!!!!

Benchmarks' has been working with DHHS and others regarding a myriad of issues related to the following updates included in the Special Bulletins below related to DSW One-Time Bonuses, etc. The updates put forth below include the following and more (Please review the updates with your team for more information and clarity):

Clarification that licensed employees that otherwise meet the DCW/support staff definition may be eligible for a bonus if there are certain funds;
Clarification that former employees are excluded;
Clarification that information should be reported for current employees “who have been employed since March 10, 2020, and accumulated at least 1,000 hours between March 10, 2020 and Aug. 1, 2021”;
Removes notice to employee requirement, including deadline (was previously 1/24/2022);
Removes provider internal appeals process; and
Extends deadline to submit from 1/31 to 2/4 (but delays payment from 3/1 to 3/31 if the provider reports after 1/31).

SPECIAL BULLETIN COVID-19 #212: Direct Care Worker and Support Staff One-Time Bonus

This bulletin was updated on Jan. 27, 2020, to include new information or clarification on eligibility, changes in the appeals process and timeline.

READ HERE

SPECIAL BULLETIN COVID-19 #224: Update on Direct Care Worker Bonus and Wage Increase Initiative

Changes to details regarding eligibility, timelines and provider requirements: In response to the significant volume of feedback regarding implementation plans for these initiatives, NC Medicaid is making a number of changes.

READ HERE

***

SPECIAL BULLETIN COVID-19 #219: Over-the-Counter Tests for Home Use

Effective Jan. 10, 2022, NC Medicaid-enrolled pharmacy providers may bill point-of-sale (POS) for FDA-approved over-the-counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting. More information

SPECIAL BULLETIN COVID-19 #220: Temporary Rate Increases Extended or Replaced

Update on temporary rates that are extending or being replaced with permanent, legislated increases. More Information

SPECIAL BULLETIN COVID-19 #221: Status of Federal Vaccine Mandates

The Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (IFC) was published by the Centers for Medicare & Medicaid Service (CMS) on Nov. 5, 2021. The IFC requires Medicare and Medicaid-certified provider and supplier types (collectively, “facilities”) that are regulated under the Medicare health and safety standards known as Conditions of Participation (CoPs), Conditions for Coverage (CfCs), or requirements to have a process or policy in place ensuring that all staff are vaccinated against COVID-19. More Information

SPECIAL BULLETIN COVID-19 #222: FDA Approves Remdesivir (Veklury) for Qualifying Pediatric Patients

On Jan. 21, 2022, the FDA approved authorization of Remdesivir (Veklury) for the treatment of COVID-19 in pediatric patients. More Information

Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.

New Medicaid Bulletin articles:

· Patient Risk List Updates for Advanced Medical Homes Tier 3 Not Participating in Integrated Care for Kids (InCK)

· North Carolina Standard & Tailored Plan Tobacco-Free Policy Requirement

· NC Integrated Care for Kids (InCK) Pilot Begins

· Guidance for Nursing Facilities Admitting Beneficiaries Assigned to a Prepaid Health Plan

Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.

Updates to SPECIAL BULLETIN COVID-19 #196 & 215

SPECIAL BULLETIN COVID-19 #196: Pfizer Pediatric Vaccine Authorized

Effective Oct. 29, 2021, Medicaid & NC Health Choice cover Pfizer Pediatric Vaccine See Updates

SPECIAL BULLETIN COVID-19 #215: NC Medicaid COVID-19 Omicron Surge Flexibilities

Additional information to what was published in COVID-19 #210. See Updates

Checkwrite for the Week of Presidents Day

In keeping with the approved checkwrite schedule, on weeks with a holiday, the checkwrite date is typically a day later than usual. Because of the Presidents Day holiday on Monday, Feb. 21, 2022, the next checkwrite date will be Wednesday, Feb. 23, 2022.

The posting and availability of funds to provider bank accounts will depend on the provider’s financial institution. Bank of America customers should see their payments in their accounts on the day that the EFT is processed, which will be Thursday, Feb. 24, 2022. Providers who bank at other financial institutions should see payments the business day following the date that the EFT is processed, which will be Friday, Feb. 25, 2022 in the afternoon. (Some may post sooner.)

The NCTracks Call Center and Pharmacy Prior Approval Unit will be open normal working hours on Presidents Day holiday, Feb. 21, 2022.

The 2022 checkwrite schedules for both DHB and DMH/DPH/ORH can be found under the Quick Links on the right side of the Provider Portal home page.

Reminder: Details on Common Error Message on Accreditation Page

It has come to the attention of NCTracks that some providers are receiving the following error message on the Accreditation Page during their Enrollment, Re-enrollment or Manage Change Request (MCR) applications:

Please add/edit taxonomy required [accreditation, certification or license] with current/future expiration date.

The accreditation, certification and license sections display exactly which agency/type is required for each taxonomy code. If the incorrect agency or type is selected, the error message displays. To avoid the error message, providers should ensure the appropriate agency and type is selected. Please note the information below:

· Doctor of Medicine (MD), Anesthesiologist Assistant (AA) and Physician Assistant (PA) license data is automatically updated monthly.

· Drug Enforcement Agency (DEA) or Clinical Laboratory Improvement Amendments (CLIA) Certification expiration dates, if the certification number is currently and accurately on a provider record, are automatically updated monthly.

For guidance on how to add or update accreditation on a record, providers are encouraged to refer to the How to Add or Update Accreditation on the Provider Profile in the NCTracks User Guide, found on the User Guides & Fact Sheets page on the NCTracks website.

Examples of Correct Selection:

The requirement shown must match the corresponding fields.

Two New Prior Approval Drug Classes

Effective Feb. 2, 2022 two new drug classes, Evrysdi and Continuous Glucose Monitoring Systems, will be available in the NCTracks Provider Portal.

New Edits for Durable Medical Equipment, Orthotics and Prosthetics Claims

To align with the rendering provider guidelines specified in clinical coverage policy 5B, Orthotics and Prosthetics, effective Feb. 1, 2022, new edits will be added to the NCTracks system for Durable Medical Equipment (DME), Orthotics and Prosthetics claims. Claims that are submitted with the codes in the table below will be subject to the new edits. If claims are denied, providers will see EOB 01620 (THE RENDERING PROVIDER TAXONOMY SUBMITTED DOES NOT MEET THE BOARD CERTIFICATION REQUIREMENTS FOR THE HCPCS CODE BILLED. CONFIRM THAT THE APPROPRIATE HCPCS CODE AND TAXONOMY WERE BILLED. IF NECESSARY, CORRECT AND RESUBMIT) on their Remittance Advice (RA).

207* denotes all taxonomy codes beginning with 207.

208* denotes all taxonomy codes beginning with 208.

363* denotes all taxonomy codes beginning with 363.

Additional Resources

The DME, and Orthotics and Prosthetics fee schedules and clinical coverage policies are available on NC Medicaid’s Durable Medical Equipment, and Orthotics and Prosthetics webpage.

Contact

NC Medicaid Contact Center: 888-245-0179

NCTracks Contact Center: 800-688-6696

Issue with CDSA Claims Being Voided or Recouped

It has been brought to the attention of NCTracks that some providers are experiencing issues with Children’s Developmental Services Agencies (CDSA) services that have been previously paid with the TL procedure code modifier being retroactively voided or recouped incorrectly. The claims are being voided with Explanation of Benefits (EOB) 06125 - CLAIM RECOUPED. CLAIM COVERED BY PREPAID HEALTH PLAN (PHP).

The services are payable under NC Medicaid Direct (through NC TRACKS) under the current Managed Care Carve Out rules and should be exempt from the retroactive void process; see the June 29, 2021 Medicaid Bulletin for additional information. NC Medicaid is aware of this issue and is currently working with NCTracks on a solution. Updates will be provided as available.

Enhanced Security for OA Change Requests and EFT Change Requests

In line with our dedication to safeguarding providers’ information and secure portal access, NCTracks is implementing additional security measures to further enhance the safety of provider accounts beginning Jan. 30, 2022.

In addition to the previously implemented process revision for requesting an NPI authorization code, which is required to complete the currently enrolled provider (CEP) registration process and office administrator (OA) change process, NCTracks is adding a security enhancement for OA change requests and electronic funds transfer (EFT) change requests.

Effective Jan. 30, 2022:

Upon submission of an OA change request:

· An email notification will be sent to the existing OA, the provider and all officers associated with the NPI referenced on the request.

· An email notification will be sent to the existing OA, the provider and all officers associated with the NPI upon approval.

Upon submission of an EFT change request:

· An email notification will be sent to the existing OA, the provider and the pay-to contact person (and the EFT authorized individual as it applies) associated with the NPI referenced on the request.

· NCTracks will also contact the EFT authorized individual or pay-to contact person by phone prior to initiating the EFT change process to confirm that the change is appropriate.*

*Please note that EFT processing will not begin until the change has been confirmed by phone with the appropriate parties.

Our aim in implementing these security updates is to prevent potential fraud or abuse of provider resources so they may serve the NC Medicaid community with confidence in the security of their information.

Updates to NCTracks Re-credentialing/Re-verification and Enrollment Due to COVID-19

Updates have been made to the NCTracks re-verification/re-credentialing and enrollment process to allow flexibilities during the COVID-19 pandemic.

The Centers for Medicare and Medicaid Services (CMS) requires that all Medicaid providers are re-credentialed. The Division of Health Benefits (DHB) must ensure enrolled providers are compliant with this via the re-verification application process. While due dates for re-verification are specific to each provider, all re-verification deadlines are currently suspended until further notice due to the COVID-19 pandemic.

In addition, effective Jan. 9, 2022, NCTracks no longer requires Medicaid and NC Health Choice providers to pay the $100 NC application fee with enrollment and re-verification applications, pursuant to NC Senate Bill 105 Session Law 2021-180 Section 9D.9(a), which waives the fee until June 30, 2023.

Providers are encouraged to check the Provider Announcements on the Providers page and watch their email for future updates regarding COVID-19 flexibilities.

Four Ways to Strengthen the Direct Care Workforce

Across the U.S., direct care workers (DCWs) are responsible for most of the hands-on care for older adults and people with disabilities. They provide essential day-to-day care — such as bathing, dressing, meal preparation, medication management, and more intensive medical care — for people who may not have family or informal caregivers.

For years, states have been grappling with how to meaningfully support DCWs — many of whom are women, people of color, and living at or near the poverty level. DCWs face significant challenges, including low wages, long hours, and few benefits. The demanding nature of the work has led to high DCW turnover and a nationwide worker shortage, with many moving to jobs with fewer hours and higher pay.

This blog post explores key recommendations for states to strengthen and sustain the direct care workforce, with an emphasis on state Medicaid agencies. It draws from a recent Center for Health Care Strategies report focused on the state of Michigan and supported by the Michigan Health Endowment Fund.

Read Blog Here

Call for Proposals

The Family Focused Treatment Association (FFTA) is seeking proposals to present at the FFTA 36th Annual Conference on Treatment Family Care, scheduled for July 17 – 20, 2022 in New Orleans, LA. For the first time in three years, we will return to an in-person conference.

The FFTA Conference Committee is interested in receiving proposals for advanced-level workshops on topics geared toward clinicians; program managers and directors; supervisors; agency CEOs and other senior-level staff; administrative staff; foster parent trainers; researchers and evaluators; and resource parents.

Learn more about our call for proposals.

Share Your Thoughts: Resources and Tools to Support the Core Competencies for Public Health Professionals

With the release of the 2021 Core Competencies for Public Health Professionals (Core Competencies), work has begun on resources and tools to support organizations in using the Core Competencies. A crosswalk of the 2021 and 2014 Core Competencies and updates to the existing competency assessments are currently in progress. What should we work on next? Share your suggestions through the PHF Pulse blog or by emailing [email protected].