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Benchmarks' Child Welfare Webinar
Featuring NC DSS & Karen McLeod
February 8, 2024
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Upcoming Benchmarks' Events
Benchmarks' Friday Membership Webinar with Trillium's Leadership Team and Karen McLeod: Consolidation
(Jay is unable to join us due to an unanticipated conflict.)
Date: Friday, February 16, 2024
Time: 8:30 am thru 9:30 am
Register
Benchmarks' Members Child Welfare Webinar with NC DSS and Karen McLeod
Date: Thursday, March 7, 2024
Time: 8:00 am thru 9:00 am
Register
Benchmarks' Friday Membership Webinar with Jay Ludlam and Karen McLeod
Date: Friday, March 15, 2024
Time: 8:30 am thru 9:30 am
Register
Mark Your Calendars! Benchmarks Foster, Adoption, & Residential (FAR) Meeting
Date: Friday, March 22, 2024
Time: 10:30 am thru 2:30 pm
Location: Children's Home Society of NC, 604 Meadow Street, Greensboro, NC 27405
Register
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Joint Legislative Oversight Committee on Health & Human Services Meeting Handouts: February 6, 2024
Joint Legislative Oversight Committee on Medicaid Meeting Handouts: February 6, 2024
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2024 NC Child Welfare Joint Planning Session
North Carolina’s 2024 Child Welfare Joint Planning Session will take place on Tuesday, March 5th from 8:30am-3:30pm at the McKimmon Center (1101 Gorman Street, Raleigh, NC 27606).
Joint Planning allows NC to engage youth, families, counties, courts, tribes, providers and additional partners to identify and work toward shared child welfare goals, and to assess outcomes and plans to increase the safety, permanency, and well-being of children and their families who experience the child welfare system.
Registration for this event is required and will close on February 16th at 5pm. Please register at this link: https://forms.office.com/g/7Yb8gsVLTV. You will receive a follow-up email by February 23rd regarding the acceptance of your registration.
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DCDL: Now Procedure for Foster Home Licensing Submissions
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Implementation of New and Revised State-Funded Withdrawal Management (Detoxification) Services
Revised Implementation Date
This bulletin is intended to inform LME/MCOs, providers and other interested parties that the implementation of the new and revised state-funded withdrawal management (detoxification) services has been postponed until May 1, 2024. The change in the implementation date is to provide sufficient time for providers to be in compliance with the amended policies and obtain the required licensure waiver.
The 2023 State-Funded Enhanced Mental Health and Substance Use Services (DMHDDSUS State-Funded Service Definitions) document with the following state-funded services will be re-posted until April 30, 2024: Ambulatory Detoxification, Social Setting Detoxification, and Non-Hospital Medical Detoxification.
If you have any questions, please contact Starleen Scott Robbins at [email protected].
Read Bulletin
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NC Managed Care Capitation Rates – Updated Care Management Assumptions
The North Carolina Department of Health and Human Services (NCDHHS) is releasing updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Standard Plan Prepaid Health Plans (Standard Plans), including consideration for Medicaid expansion effective Dec. 1, 2023.
As of Dec. 1, 2023, people ages 19 through 64 years with higher incomes are eligible for Medicaid coverage in North Carolina. For this expansion population, on average, $13.65 per member per month (PMPM) is the assumed cost of delivering care management in accordance with NCDHHS’s requirements, compared to $10.17 for non-expansion populations for State Fiscal Year 2024 (July 1, 2023-June 30, 2024).
This information is based on a set of assumptions about care manager staffing ratios by care management need level and qualifications, which should be understood as averages rather than policies about how each care team must be constructed. In reality, care teams will vary in how they are staffed according to the needs of individual members and assigned panels. NCDHHS has not established minimum care management fees and maintains the expectation that Standard Plans and practices will arrive at mutually agreeable rates that are commensurate with the intensity and breadth of the care management being provided.
By providing additional information on the assumptions NCDHHS used to develop components of the care management component of capitation payments, Standard Plans and AMH Tier 3 practices will be better positioned to enter into care management contracts that enable all parties to meet NCDHHS’ expectations in the execution of care management responsibilities and achievement of improved health outcomes.
Details on the current care management rate assumptions can be found in the Care Management Assumptions document updated Jan. 3, 2024. Additional information on NC Medicaid’s AMH program can be found on the Advanced Medical Home webpage.
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NCDHHS Consolidates Local Management Entity/Managed Care Organizations Ahead of Tailored Plan Launch
The North Carolina Department of Health and Human Services consolidated the state’s Local Management Entity/Managed Care Organizations to improve access to health care services in preparation for the launch of the Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans July 1, 2024.
Tailored Plans are integrated health plans designed specifically to serve individuals with significant mental illnesses, substance use disorders, or long-term care needs including I/DD and traumatic brain injury.
Eastpointe and Trillium Health Resources have consolidated into one entity, and Sandhills Center has dissolved, at the direction of the North Carolina General Assembly and NCDHHS Secretary Kody H. Kinsley. To help ensure continuity of care and a smooth transition, NCDHHS and the LME/MCOs have developed a transition plan to best support beneficiaries and recipients, providers and counties during consolidation.
Trillium will now support the counties Eastpointe, Sandhills and Trillium previously served, with the exception of three counties: Partners Health Management will serve Davidson County, Alliance Health will serve Harnett County and Vaya Health will serve Rockingham County.
The department and the LME/MCOs have sent educational materials and resources to beneficiaries who will experience a change of LME/MCO to help them navigate services, including information on their new LME/MCO. Beneficiaries and recipients do not need to take any action. They will continue to receive the services they receive today and will be able to see the same providers.
Additional information for beneficiaries and recipients, as well as an overview of the consolidation for providers, are available to address frequently asked questions and provide contact details for LME/MCOs throughout the consolidation process.
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NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations Feb. 1, 2024
The Centers for Medicare & Medicaid Services (CMS) is mailing letters to 534,840 North Carolinians based on information provided to HealthCare.gov that indicates they may be eligible for NC Medicaid. With the expansion of Medicaid, more people are eligible, including those ages 19 through 64 years with higher incomes.
The letters will arrive in mailboxes on or after Feb. 1, 2024, and will direct individuals to contact HealthCare.gov to update their information currently available in their HealthCare.gov case file. Sample letters are available on the Medicaid website.
NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations (FFM-D) Feb. 1, 2024. This change allows the FFM to make the eligibility determination for individuals who apply for coverage through the Federal Marketplace at HealthCare.gov and whose eligibility is determined following modified adjusted gross income (MAGI) rules.
This change means NC residents who apply for Medicaid through the Federal Marketplace (HealthCare.gov) and are determined fully eligible for Medicaid by the FFM will no longer require an eligibility determination by the local Department of Social Services (DSS) caseworker. Once NC Medicaid receives notification of eligibility, NC FAST will review the case to determine which full MAGI benefit program the individual qualifies for and will send the appropriate final notice of eligibility to the individual.
For more information, visit HealthCare.gov.
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Tailored Care Management Rate Proposal: Sent to CMS on January 30, 2024
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NCDHHS Launches Child Behavioral Health Dashboard
This week, NCDHHS announced the launch of its Child Behavioral Health dashboard as part of its commitment to improve the health and well-being of North Carolina children and families.
North Carolina has been ranked 42nd among states with the highest prevalence and lowest access to mental health services for youth, and suicide is now the second leading cause of death for North Carolina youth ages 10-18.
The Child Behavioral Health dashboard builds a data and analysis infrastructure across child-serving sectors to provide a more complete picture of the state of behavioral health in North Carolina. An important feature of the new dashboard is users can drill down the data by geography, race, ethnicity, age and gender to provide additional visibility into child behavioral health in underserved populations.
The information shared through this publicly available tool will help the department, as well as behavioral health providers, policymakers and stakeholders, to identify and address gaps and disparities in behavioral health services for children. Metrics will continue to be updated quarterly, based on data from Medicaid claims, and yearly, based on the Youth Risk Behavior Survey.
If you or someone you know needs support now, call or text 988, or chat at 988lifeline.org. You can also view the department’s “Open to Care” resources at ncdhhs.gov/opentocare.
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Funding for Counties to Help Children in DSS Custody
This week, NCDHHS distributed funds to county departments of social services (DSS) to help improve placements for children in DSS custody who have complex behavioral health needs. These critical funds come at a time when an average of 32 children are living in DSS offices each week because there is no place for them to go that is appropriate for their care.
The DSS Emergency Placement Fund is a pilot program funded by the NC General Assembly in the 2023 North Carolina state budget. The program provides nearly $2.3 million this year and $5.5 million next year to assist county DSS offices in creating better, more reliable placement options for children in their custody who have behavioral health needs.
The funds will help to improve outcomes by preventing children and youth from having to stay in a DSS office overnight while they await placement into Medicaid-funded treatment. The work is made possible by the Medicaid expansion signing bonus, which provided a historic $835 million investment to transform behavioral health for everyone in North Carolina, including children and families.
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RFP Application Opens for Children and Family Specialty Plan
This week, NCDHHS released the request for proposal to hire the organization that will help manage the Children and Families Specialty Plan (CFSP). The first-of-its-kind statewide health plan will ensure access to comprehensive physical and behavioral health services for Medicaid-enrolled children, youth and families served by the child welfare system.
The plan will cover an array of Medicaid-covered physical and behavioral health benefits regardless of the geographic location or situation the beneficiary is experiencing. It includes a broad range of behavioral health services and will be responsible for addressing unmet health-related resource needs, including housing, food, transportation and interpersonal violence. Organizations that are interested and eligible to submit a proposal to help manage the CFSP are encouraged to apply.
The selected organization will be responsible for providing comprehensive benefits and robust care management that will serve as the central point of accountability for managing the health of members enrolled in the CFSP.
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NC Medicaid Guidance on Sunsetting of Innovations Waiver and TBI Appendix K Flexibilities
Permanent flexibilities approved in the Innovations Waiver amendment effective March 1, 2024
In response to the COVID-19 public health emergency (PHE) in March 2020, the Centers for Medicare & Medicaid (CMS) approved several flexibilities to the Innovations Waiver to support waiver members to ensure they remain safe in their communities during the PHE. While some of the flexibilities have been added as a permanent part of the Waiver, other flexibilities will end effective Feb. 29, 2024.
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Access Monitoring Review Plan Posted for Public Comment
A Message from NCTracks on Behalf of NC Medicaid
The NC Medicaid Access Monitoring Review Plan (AMRP) provides an overview of access to care for NC Medicaid Direct beneficiaries from 2019 through 2022. Medicaid Direct is the traditional fee-for-service Medicaid program in North Carolina. The review plan can be found on the NC Medicaid Quality Management and Improvement webpage.
The AMRP analyzes the extent to which the health care access needs of NC Medicaid Direct beneficiaries are being met by examining provider availability and accessibility, beneficiaries’ utilization of services, health care performance measures and measures of patient experience. Access to care is important for all NC Medicaid beneficiaries, and this report is just one tool NC Medicaid uses to track and analyze that access.
This AMRP will be posted for public comment for 30 days, closing on Feb. 28, 2024. Please share comments with [email protected]. Thank you in advance for your feedback.
February Provider Training Schedule Now Available
Registration is open for the February 2024 provider training courses listed below. NCTracks zoom courses can be attended remotely from any location. Courses offered this month include:
- New Office Administrator
- Submitting a Professional Claim Provider NEMT
- Prior Approval Medical
- How to Add or Update Credentials
- Submitting a Time Limit Override
See the document linked below for more information on course schedule and access to zoom links and QR codes:
February 2024 Provider Training Schedule
Issues List Updated
An updated version of the NCTracks Issues List, which documents known issues and their statuses, has been uploaded. The issue list can be found under Quick Links on the Provider Portal home page . Providers are encouraged to check this list to see if an issue they are experiencing is already known before calling in about an issue, as well as to check the status of any issue.
Collaborative Care Model (CoCM) Provider Learning Collaborative
Role of the Psychiatric Consultant/Systematic Caseload Review
A Message from NCTracks on Behalf of NC Medicaid
The North Carolina Department of Health and Human Services (DHHS) has partnered with NC AHEC to provide educational and practice-based support to primary care practices interested in implementing the Collaborative Care Model (CoCM) -- a team-based, interdisciplinary approach to deliver evidence-based diagnoses, treatment and follow-up care for patients with mild to moderate behavioral health needs.
Join us on Thursday, Feb. 15, 2024 from 12:30 to 1:30 p.m. for the CoCM Provider Learning Collaborative which will focus on the role of the Psychiatric Consultant/Systematic Caseload Review.
CoCM Provider Learning Collaboratives (LCs) are designed for primary care providers, behavioral health professionals, and others who have implemented or are implementing CoCM for integrating behavioral health in a primary care setting. Independent primary care practices, FQHCs, and rural health clinics may find CoCM especially helpful for meeting some of the behavioral health needs of their patients. Provider LCs will highlight collaborative care team integration and the role of the CoCM Behavioral Health Care Manager for practices new to the model and those established with implementing CoCM.
Additional Provider LCs, which will run once a month through June 2024, will include:
- Role of Behavioral Health Care Manager/Registry Tracking (March 21)
- CoCM Billing (April 18)
- Communicating about CoCM Across the Care Team (May 16)
- Caseload Management/Relapse Prevention Plan (June 20)
Register for CoCM Learning Collaboratives
For more information, visit www.ncahec.net/practice-support/collaborative-care-2/
New Medicaid Bulletin Articles Available
The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles:
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NC Medicaid Accepting Federally-Facilitated Marketplace Eligibility Determinations - NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations Feb. 1, 2024
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NC Managed Care Capitation Rates – Updated Care Management Assumptions for Expansion Population - Includes rate considerations for Medicaid Expansion members effective Dec. 1, 2023.
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NC Medicaid Guidance on Sunsetting of Innovations Waiver Appendix K Flexibilities - Permanent flexibilities approved in the Innovations Waiver amendment effective March 1, 2024.
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NC Medicaid Guidance on Sunsetting of Traumatic Brain Injury Appendix K Flexibilities - Permanent flexibilities approved in the TBI Waiver amendment effective March 1, 2024.
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NC Medicaid Managed Care Provider Update – Jan. 30, 2024 - Includes information on LME/MCO consolidation, Innovations and TBI waivers, federal fee increase, updates to NCTracks, Medicaid expansion and more.
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Electronic Visit Verification for NC Medicaid-Funded Personal Care Services and Home Health Services - Manual entries and Sandata Mobile Connect 2.0.
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Over-the-Counter COVID-19 Test for Home Use Pharmacy POS Coverage - CorDx, GoToKnow, FaStep COVID-19 AG Home Tests added to coverage.
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Quality of Care Fact Sheets Available- Fact sheets provide key findings, trends, improvements and new programs.
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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Clinical Consolidation Communication Bulletin 13
Provider Office Hours Extended for Limited Time
This communication provides information about additional Provider Office Hours. The purpose of the Provider Office Hours is to answer providers that have contracts with legacy Sandhills and Eastpointe and to answer providers' questions about consolidation. To continue to support providers through the transition of consolidation, Trillium will extend the Provider Office Hours to the following dates and times:
Sessions will continue on the following days from 12 – 12:30 p.m.
Tuesday, February 20
Thursday, February 22
Monday, February 27
After Friday, February 16, 2024, providers will be encouraged to submit their questions to the Network Service Ticket System at the following email address: [email protected].
Submitting questions through the Consolidation for Providers webpage will no longer be available after February 16.
Important to Know:
· Providers will continue to have the same Provider Relations Representatives that were assigned to them with legacy Sandhills and Eastpointe. Please continue to reach out to these staff for assistance.
Providers are encouraged to review the Consolidation for Providers webpage.
· Sandhills Center Provider Portal
· Eastpointe Provider Portal
Eastpointe Legacy Alpha+ Portal
Eastpointe iTransact Portal
· Frequently Asked Questions (FAQs)
· Contact Information for Incident Reporting, NC-TOPPS, NC-Snaps
· Please do not submit questions unrelated to the New Network Provider Packet to [email protected] email address. If you do, this will delay providers from getting answers to their questions. This email address will be decommissioned on Thursday, February 29. After this date, providers will submit their packets to Network Service Ticket System: [email protected]. For more information, about the New Network Provider Packets, please read Clinical Consolidation Communication Bulletin #03.
We continue to ask for your patience as we continue to do our best to assist providers with their questions and concerns during this consolidation period.
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Clinical Consolidation Communication Bulletin 12
Consolidation Rates and Contracting
Trillium Health Resources looks forward to serving residents in Guilford, Randolph, Montgomery, Moore, Lee, Hoke, Richmond, Anson, Scotland, Robeson, Sampson, Duplin, Wayne, Lenoir, Greene, Wilson, Edgecombe, and Warren counties starting Feb. 1, 2024.
We understand this change comes during a time of many changes, and our goal is to avoid or minimize any provider abrasion. In a consolidation of this size and the short timeframe to merge data and systems, we expect there will be some issues identified. Trillium is in the process of identifying potential issues and finding solutions to mitigate the effect these issues will have on providers.
We are anticipate there may be some discrepancies in rates; however, Trillium will correct the issues that are identified promptly. To troubleshoot the issue, Trillium’s Finance Department plans take the following actions:
1. We are working diligently to ensure providers maintain their funding levels for the services they provide to our members. Please continue to bill at your contracted rates and we appreciate your patience as we work quickly to resolve any issues.
2. Please note: Member-specific rates will transfer to Trillium. End dates between Feb. 1, 2024 and Feb. 28, 2024 will be extended to Feb. 29, 2024 to allow for providers to follow the Trillium process for submitting a continuation request. Member-specific rates that are set to expire past June 30, 2024 will be set to expire June 30, 2024. Post-consolidation, all requests should follow the Trillium member-specific rate request process.
For more information and to submit questions, please visit our Consolidation page
All questions related to this Clinical Consolidation Communication can be sent to [email protected]. Questions will be responded to as quickly as possible. We are working to address other questions and concerns as quickly as possible. Thank you for your patience while we transition.
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Clinical Consolidation Communication Bulletin 11
Registry of Unmet Needs Communication
Individuals who think they may qualify for NC Innovations services need to complete Trillium’s “Registry of Unmet Needs” (RUN) application and send it to Trillium with supporting documentation.
Trillium reviews applications and adds individuals who are potentially eligible for the Innovations Waiver on the waitlist under an Innovations Waiver slot becomes available. Starting 2/1, all applications and questions for the Registry of Unmet Needs should be submitted to [email protected]. This includes new submissions for members that were previously served by Eastpointe and Sandhills. Please note that any applications previously approved by Eastpointe and Sandhills will be honored by Trillium using the member’s original date of waiting on the Registry of Unmet Needs.
Additional information regarding the RUN and Innovations Waiver services can be found: NC Innovations
· The RUN Application can be found: RUN Application
Relative/Legal Guardian Direct Support Employee (RDSE) Communication
Effective February 1, 2024, the following change to the current Verification of Relative/Legal Guardian as Direct Support Employee (RDSE) will go into effect for members and providers previously with Eastpointe and Sandhills:
A new online form will replace the current Verification of Relative/Legal Guardian as Direct Service Employee process.
Effective February 1, 2024, please use the following link to place initial and annual requests for Relative as Direct Support Employee: Innovations Waiver - Relative as Direct Support Employee Application.
Tips for Submitting RDSE Applications:
· RDSE’s are tracked by the member’s ISP year for annual recertification and, for initial RDSEs, forms should be submitted 30 days prior to the new RDSE’s proposed start date.
· Forms should be submitted for all RDSEs regardless of the number of hours per week each RDSE will provide.
· Those providing up to 40 hours/week are submitted for tracking purposes only.
· Those submitted for 41-84 hours/week are submitted for prior approval (except for those tracked under the Appendix K flexibilities that end 2/29/2024).
· Forms submitted for Appendix K flexibilities through 2/29/2024 will continue to be submitted for tracking purposes only.
· Trillium’s process is being updated to reflect the waiver amendment changes implementing 3/1/2024:
· Parents of minors can be RDSE up to 40 hours/week of Community Living and Supports.
· Adults members’ RDSEs may be approved to provide 41-84 hours/week.
· RDSEs may provide Supported Living.
Questions regarding these changes can be directed to [email protected]
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Clinical Consolidation Communication Bulletin 10
This communication provides information about updating diagnosis codes in the HHAeXchange portal.
EVV Diagnosis Code Updates
We have worked with our EVV Vendor, HHAeXchange, to transfer members and providers to Trillium. As a part of this process, members were linked to providers without an authorization. Since these members do not have an authorization there may not be a diagnosis code in the patient portal. Please ensure you have updated the diagnosis code in the patient portal prior to submitting claims. Claims submitted without a diagnosis code may be held in Billing Review in the HHAeXchange portal. The below Job Aids, available in the HHAeXchange Support Portal, will help answer any questions related to how to add the diagnosis code and correct any claims being held for review:
· Provider - Managed Billing Diagnosis Codes, Page 3
Process Guide – Billing, Page 19 “UnBilling”
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Clinical Consolidation Communication Bulletin 009
Update from Consolidation Bulletin 8 in reference to EPSDT
This section provides information around requirements for non-covered EPSDT requests all Eastpointe, Sandhills, and Trillium providers beginning 2/1/2024 as a result of the consolidation.
Any Medicaid service that is a non-covered service, must be reviewed for prior approval. The non-covered form can be found on the Trillium website on our Early and Periodic Screening Diagnosis and Treatment (EPSDT).
Any non-covered previously approved services prior to 2/1/1014 will be honored.
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Attention EVV Providers
Thank you for your patience during our Harnett County consolidation.
At this time Alliance Health is working closely with our HHAex partners to help ensure a smooth EVV transition. Please allow additional processing time for your Harnett County members to be visible in your Alliance Health HHAeX portal.
Please watch Alliance Health Provider News for updates or contact our dedicated EVV Help Desk at [email protected].
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Feb 05, 2024 06:31 am
This revised two-day experiential training developed in partnership with families from across North Carolina will provide an overview of Child and Family Team meetings from the family’s perspective. Families, through focus groups and direct involvement in curriculum writing, provided essential
The post Child and Family Team Training from the Family Perspective Thursday, February 29 – Friday, March 1 appeared first on Alliance Health.
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Feb 02, 2024 02:18 pm
Alliance has informative trainings available for all of our providers as we prepare for Tailored Plan. Learn more about these trainings and register here. Please note the following training of particular importance to providers serving children: Early and Periodic Screening,
The post Tailored Plan Trainings for Providers appeared first on Alliance Health.
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Feb 02, 2024 12:30 pm
February 19, 2024, 9 am – 1:15 pm. This program will provide a framework for understanding the dynamics of intimate partner violence (IPV), highlighting current understandings of why individuals often stay in and/or return to IPV relationships. Psychological abuse is
The post SR-AHEC Training: Psychological Abuse and Coercion in Intimate Partner Relationships appeared first on Alliance Health.
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Recent Posts:
Waitlist Reporting for State-funded Providers
Provider Contracts and Rates for Sandhill Providers that Served Harnett Members
SR-AHEC Training Announcement: Substance Abuse and Integrated Care – CEUs Offered
New UAFL Tool Coming
Billing and Enrollment Provider Training
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Partners has increased the Family Centered Treatment (FCT) Rate effective 1/1/2024. | |
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Providers should bill the new rates for the FCT codes for dates of service from 1/1/2024 forward.
If providers want claims adjudicated at the higher rate and you have already submitted for dates of service starting 1/1/2024, you will need to submit replacement claims at the higher rate.
If you submitted your claims for dates of service 1/1/2024 forward at the higher rate, the claims will be re-adjudicated.
If you have questions, please contact your assigned Provider Account Specialist or contact [email protected].
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Attention Davidson County Providers: Rate Information
Partners Health Management will continue to pay claims for Davidson County members at the rate previously paid by Sandhills Center to ensure care continuity for members and provider stability. Beginning on Feb. 1, 2024, services for Partners’ new Davidson County members will be reimbursed at historical Sandhills Center rates.
What is happening?
To ensure continuity of care for members and provider stability, Partners will continue to pay the rate previously paid by Sandhills for dates of service beginning Feb. 1, 2024.
What do providers need to do?
Providers should submit claims to Partners for Davidson County members at the rate that Sandhills Center has been paying for dates of service beginning Feb. 1, 2024, and going forward.
For dates of service prior to Feb. 1, 2024, providers should bill Sandhills Center for services provided to Davidson County members.
Who should providers call if they have questions?
Providers should email [email protected] if they have questions.
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Using NPI to Bill for RB-BHT Services
NC Licensed Behavior Analysts are now able to use their NPI to bill as a licensed clinician for Research Based Behavioral Health Treatment (RB-BHT) 97151 or 97151GT once their NPI is loaded in NCTracks and the provider’s contract is updated.
What is happening?
NC Licensed Behavior Analysts can use their NPI to bill as a licensed clinician for Research Based Behavioral Health Treatment (RB-BHT) 97151 or 97151 GT once their NPI Is loaded in NCTracks and the provider’s contract is updated.
Utilization Management authorizes RB-BHT using an “all code” for each base code, providers will need to bill the appropriate code/modifier combination.
When does this take effect?
It is in effect now.
Which RB-BHT code should providers use?
Code: 97151
· 97151 or 97151GT is clinician based and should be billed with the clinician’s NPI.
· 97151NC or 97151GTNC should be billed with the facility NPI and is intended to be used by Occupational Therapists (OT) or Speech and Language Pathologists (SLP) only.
Code: 97152
· 97152 or 97152GT is clinician based and should be billed with the clinician’s NPI.
· 97151NC or 97151GTNC should be billed with the facility NPI and is intended to be used by the Occupational Therapists (OT), Speech and Language Pathologists (SLP), certified QP or paraprofessional.
Codes: 97153-97157
· 97153- 97157 are not clinician based and should be billed with the facility’s NPI.
What if a provider’s 97152 claim has denied?
Partners is reprocessing all claims that have been submitted for 97152. Please submit replacement claims for any that have denied due to not using the appropriate modifier and NPI.
Who do providers contact if they need assistance?
· For issues related to claims: [email protected]
· For issues related to authorizations: [email protected]
· For other provider issues, providers should reach out to their assigned Provider Account Specialist. If providers do not have contact information for their specific account specialist, they may email [email protected].
For service code changes: To add or remove service codes, please complete the Provider Change Form.
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Issue 34: Communication Bulletin
Feb 01 2024
IN THIS ISSUE: Provider Touchpoint | New: Vaya 2024 Provider Satisfaction Survey | New North Carolina Caregiving Workforce Recommendations Report | COVID-19 Mitigation Funding Announcement | New Substance Use Services and Licensure Waiver Announcement | Non-Medicaid Residential Services Management Process | Facility-Based Crisis Service and Rate Revisions | Standardized NC CORE Payment Model for IPS-SE | NC Medicaid Issues Guidance on Sunsetting of Innovations Waiver and TBI Appendix K Flexibilities
Download PDF
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Issue 35: Communication Bulletin
Feb 08 2024
IN THIS ISSUE: Provider Touchpoint | Now Open: Vaya 2024 Provider Satisfaction Survey | Reminder: Guidance on Sunsetting of Innovations Waiver Flexibilities | New Implementation Date for State-Funded Withdrawal Management (Detoxification) Services | 1915(i) Waiver Services Reminders
Download PDF
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An Update on the Federal Overdose Prevention Strategy.
FORHP’s Rural Communities Opioid Response Program figures prominently among ongoing federal grant programs that are part of the strategy that is now entering its third year. The effort involves every one of the 12 operating divisions of the U.S. Department of Health & Human Services and, in 2023 alone, featured groundbreaking changes to policy that include:
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Eliminated the Drug Enforcement Agency waiver for prescribing medications for opioid use disorder (MOUD) and made temporary rules for prescribing via telemedicine permanent; (See more details about SAMHSA policy changes for MOUD in the next item.)
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Increased Medicare payment rates for opioid treatment programs (OTPs), including services provided by mobile units;
- Expanded the clinical workforce that may bill Medicare by including marriage and family therapists, licensed professional counselors, and others to provide behavioral health services;
- Established Medicare payment for Intensive Outpatient Program services, which can be furnished in hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics, and OTPs.
The latest initiative in the overdose prevention strategy was announced earlier this week. The Substance Abuse and Mental Health Services Administration will invest more than $20 million to advance health information technology in behavioral health care and practice settings.
SAMHSA Finalizes Rule on Medications for the Treatment of Opioid Use Disorder.
On January 31, the Substance Abuse and Mental Health Services Administration (SAMHSA) published final revisions to federal regulations surrounding opioid use disorder treatment standards, including accreditation and certification standards for opioid treatment programs (OTP). The final rule addresses several longstanding barriers to broader use of medications to treat opioid use disorder. Among other changes, the revised policy formalizes various methadone treatment protocols at OTPs that were put in place during the pandemic, and expands access to take-home methadone. The finalized rule also adds to the workforce and their capabilities, expanding the definition of OTP practitioner to include Nurse Practitioners and Physician Assistants, among other types of clinician, and allowing for MOUD prescribing via telehealth. The effective date of this final rule is April 2, 2024 and the compliance date is October 2, 2024.
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Medicaid Home-and-Community-Based Services (HCBS): CAHPS HCBS Chartbook
January 25 Lewin for AHRQ announced, Westat prepared, HCBS CAHPS (Consumer Assessment of Healthcare Providers and Systems) chartbook.
Learn more here.
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Advancing Measurement-Informed Care in Behavioral Health
January 30 NCMW CoE for Integrated Health Solutions webinar materials.
Learn more here.
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CMS Launches “Value-Based Care” Spotlight Web Site
January 30 CMS announced web site.
Learn more here.
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CMS Launches “Value-Based Care” Spotlight Web Site
January 30 CMS announced web site.
Learn more here.
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International Journal for Direct Support Professionals
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NEW SERIES!
We are excited to share our new three-part series of briefs: Harnessing the Power of Family Treatment Courts!
Each brief covers key strategies to improve practice along with tools and resources for more in-depth information. Download a copy today to learn how your Tribe, state, or county can harness the power of family treatment courts to improve services and outcomes for families affected by substance use.
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NC: NC social service leaders say more state funding needed for child welfare workers, foster homes (Includes video)
WRAL - February 06, 2024 Half the counties in North Carolina lack sufficient social service workers to meet the needs for child welfare and other services. That's according to DHHS Human Services Director Susan Osborne, who asked state lawmakers Tuesday to consider reinstating targeted aid to counties where resources are scarcest. Osborne said smaller counties are seeing more than half their child protection staff turn over every year. She said high turnover and vacancy rates increase the chances that reported abuse won't be investigated quickly, potentially leaving children in danger, or that existing cases are delayed, leaving children and families waiting months or years for services or foster placements.
Read Here
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NC: From foster care to university: How to secure financial stability (Includes video)
WTVD - January 26, 2024
Studies show that people from historically disadvantaged communities, especially the Black community, struggle with obtaining and retaining wealth in America. The financial disparities have only worsened following the pandemic. According to 2020 census data, the median net worth of Black households is only $18,430, which is the lowest among any race or ethnicity in America. In comparison, the median net worth of all U.S. households is about 7.6 times higher than Black net worth. The racial wealth gap has widened in recent years, which has prevented many Black Americans from building generational wealth. However, there are nonprofits, companies, and individuals working to reverse these statistics.
Read more
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Upcoming Webinars & Events | |
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Thursdays: February 11 & 19, 2024
A Responsive Framework of Care for Children and Youth with Emotional and Behavioral Health Challenges
Time: 1:00 pm thru 3:00 pm
Register
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Monday, February 12, 2024
Money Follows the Person (MFP) Lunch and Learn
Time: 12:00 pm thru 1:00 pm
Register
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New: Tuesday, February 13, 2024
Innovations Supports Budget Evaluation Town Halls
(Flyer)
Time: 1:00 pm thru 2:30 pm AND 6:00 pm thru 7:30 pm
Join Here
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Thursday, February 15, 2024
Rulemaking 101 Training
Time: 9:00 am thru 12:00 pm
Link to Join
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New: Thursday, February 15, 2024
Navigating the Competency to Stand Trial System for Individuals with I/DD
Time: 1:30 pm thru 3:00 pm
Register
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Friday, February 16, 2024
Benchmarks' Friday Membership Webinar with Trillium & Karen McLeod: All Things Consolidation
Time: 8:30 am thru 9:30 am
Register
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Friday, February 16, 2024
Key Strategies to Evaluate Your Family Treatment Court
Time: 12:30 pm thru 1:30 pm
Register
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New: Friday, February 16, 2024
Money Follows the Person Roundtable
Time: 12:30 pm thru 1:30 pm
Register
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New: Tuesday, February 20, 2024
Special Long-Term & Behavioral Health Committee of the State Health Coordinating Council
Time: 10:00 am thru 12:00 pm
Join Here
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New: Tuesday, February 20, 2024
NC Stakeholder Monthly Call
Time: 11:00 am thru 12:00 pm
Register
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New: Wednesday, February 21, 2024
Interactive Monthly Update
Time: 10:00 am thru 11:00 am
Register
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Wednesday, February 21, 2024
Interactive Monthly Update
Time: 2:00 pm thru 3:00 pm
Register
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New: Wednesday, February 28, 2024
NC Department of Justice Webinar Series:
Protecting the Next Generation of North Carolinians
NCDOJ Partners with NCDHHS: Kelly Crosbie, Randy Abbott, Jarmichael Harris, and AG Josh Stein
Time: 12:00 pm thru 12:45 pm
Register
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New: Wednesday, February 28, 2024
Listen Up! Enhancing Employee Well-being Through Active Listening
Time: 1:00 pm thru 2:00 pm
Register
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New: Thursday, February 29, 2024
Collaborative Action for America’s Health:
Short- and Long-Term Strategies Across Public Health, Health Systems, and Social Services
Time: 3:00 pm thru 5:00 pm
Register
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New: Monday, March 4, 2024
Side-by-Side w/DMHDDSUS
Time: 2:00 pm thru 3:00 pm
Register
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New: Thursday, March 7, 2024
Benchmarks' Members Child Welfare Webinar with NC DSS & Karen McLeod
Time: 8:00 am thru 9:00 am
Register
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Monday, March 11, 2024
Money Follows the Person (MFP) Lunch and Learn
Time: 12:00 pm thru 1:00 pm
Register
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Friday, March 15, 2024
Medical Care Advisory Committee (MCAC)
Time: 10:30 am thru 12:30 pm
Join Here
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New: Friday, March 22, 2024
Benchmarks' Foster, Adoption, & Residential (FAR) Meeting: In Person
Time: 10:30 am thru 2:30 pm
Location: Children's Home Society of NC, 604 Meadow Street, Greensboro, NC 27405 (There is NO virtual option)
Register
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New: Thursday, April 11, 2024
Duke-Margolis Annual Health Policy Conference: Refreshing Health Innovation Strategies for the Next Decade
Time: 12:00 pm thru 5:00 pm
Register
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Tailored Care Management Educational Offerings
Ongoing Webinar Sessions and Trainings: Some are free, some require a fee, and some are for CMA organizations that have passed the desk review only.
NC AHEC has partnered with the NC Department of Health and Human Services and Division of Health Benefits to equip Tailored Care Management (TCM) candidates with the tools and knowledge to effectively provide care management services to North Carolina’s Tailored Plan beneficiaries through Continuing Professional Development (CPD) opportunities. Find a list of monthly offerings below and join us for one or for all!
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