Benchmarks' Upcoming Webinars
Benchmarks' Child Welfare Webinar
Lisa Cauley Joins Karen McLeod
Date: Thursday, October 7, 2021
Time: 8:00 am thru 9:00 am
Benchmarks' Friday Webinar
Dave Richard Joins Karen McLeod
Date: Friday, October 15, 2021
Time: 8:30 am thru 9:30 am
Benchmarks' Child Welfare Webinar
Lisa Cauley Joins Karen McLeod
Date: Thursday, November 11, 2021
Time: 8:00 am thru 9:00 am
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Announcements:
From Kody Kinsley: Please see the note from Secretary Cohen below. It is bittersweet to announce that Victor will be transitioning to a new leadership role in the Department, the Chief Health Equity Officer. While his time is too short at the Division, his impact on our work and those we serve has been vast. And I know he will carry with him his passion for serving the mental health, developmental disability, traumatic brain injury, and substance use communities as he takes on his new role.
We’ve said for some time that serving those the Division is focused on is all about equity. Our communities have long been historically marginalized populations. Serving them puts equity at the center of what we do. I’m so proud that our Department leadership has chosen Victor, with his leadership experience in behavioral health, to be the inaugural holder of this new Chief Health Equity Officer Role. I believe this will not only give us an opportunity to focus on equity, in multiple aspects, but will allow us to lead from this role with a continued commitment to integrated health.
Even with his transition to his new role, he will remain a close collaborator with the Division and the broader Health Team.
We will be saying more about next steps for leadership at the Division in the coming days. But for now, let’s savor Director Armstrong’s commitment to those we serve, the way he has led this team, and the great things he will continue to do for our Department and North Carolina in his new role.
Vic, truly, thank you. And Congratulations!
On a broader note, I want to add how I’m also thrilled to have former state senator Angela Bryant joining our Department. It’s been a pleasure working with her through our COVID-19 response and also through the Governor’s commitment to re-entry and our work on justice-involved populations at the Division. She’ll enrich and bolster our work Department-wide.
From Sec. Cohen: I am very excited to share that our Department has hired its first-ever Chief Health Equity Officer. This is another step forward in our collective commitment to advance health equity and reduce disparities in opportunity and outcomes for historically marginalized populations.
It is with great pleasure that I announce that Victor Armstrong will serve in this role. As Chief Health Equity Officer, Victor will lead the overarching strategy and operational goals to promote health equity, diversity, and inclusion across all the agency’s health and human services. He will serve as a member of the executive leadership team. He will be responsible for developing, implementing, facilitating, and embedding health equity strategic initiatives into every aspect of DHHS’ programs, services, actions, outcomes, and internal employee culture; as well as overseeing the Office of Health Equity, Office of Rural Health, and the Office of Diversity and Inclusion.
As you know, Victor is a current member of the DHHS team. He joined DHHS as Director of the NC Division of Mental Health, Developmental Disabilities, Substance Abuse Services (DMHDDSAS) in March 2020. In the midst of the pandemic, he jumped in as an advocate for those we serve and the team player we all needed to navigate an incredibly complex period. Time and time again, Victor has been a resource across the Department in holding conversations about our collective mental wellbeing and our commitment to equity and belonging.
Chief Armstrong will begin his tenure as Chief Health Equity Officer on October 1st. Chief Deputy Secretary Kody Kinsley and Victor are working together to ensure a smooth transition for DMHDDSUS and will be outlining plans for replacing the leadership at the Division soon. Victor’s full bio is below.
I am also pleased to announce our new Assistant Secretary for Equity and Inclusion. We have been very fortunate to recruit Former State Senator Angela Bryant to join our team. In this leadership role, Angela will work hand in hand with the Chief Health Equity Officer to develop, operationalize, and evaluate the Department’s healthy equity work. She also will lead the Department’s internal diversity and inclusion work overseeing the Office of Diversity and Inclusion, as well as stakeholder engagement with community stakeholders.
Angela served in the NC General Assembly representing Halifax, Vance, Warren, and parts of Wilson and Nash Counties from 2013 to 2018. In addition to serving as an elected official, she has dedicated her career to supporting a broad range of organizations in creating welcoming and successful environments for all cultural groups. She co-founded Visions, Inc. – a non-profit educational organization that has provided diversity and inclusion services to over 100,000 individuals and 600 organizations, including health care organizations and staff -- with the mission to empower the creation of environments where differences are recognized, understood, and appreciated.
Assistant Secretary Bryant’s first day will be on October 1st. Her bio is below.
Please join me in welcoming Victor and Angela in their new roles.
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Angela Bryant
Angela has more than 40 years of legal experience and has a distinguished career in N.C. local and state government as an administrative judge, UNC- Chapel Hill trustee, UNC university system board of governors member, city council representative, twelve year legislator and most recently as a state agency appointee, Commissioner of the NC Post-Release Supervision and Parole Commission. She earned BS and JD degrees from UNC-Chapel Hill. She is a co-founder of VISIONS Inc. -- visions-inc.org – a non-profit educational organization that has provided diversity and inclusion services to over 100,000 individuals and 600 organizations, including health care organizations and staff, since 1984. She has extensive experience consulting with and training individuals and organizations in applying principles of justice to interpersonal problem-solving, organizational development and systemic change. Angela started her legal career in government as the first Black Deputy Commissioner of the NC Industrial Commission during the era of Brown Lung Disease and the development of occupational disease law in NC. Angela also helped launch the NC Office of Administrative Hearings and was in the first panel of administrative law judges for that agency.
Angela is also the co-founder of VISIONS’ award winning community development project – The Wright’s Center Inc. – providing adult day health care services to elders and disabled adults for over 30 years – a program run by and rooted in the Black community in Rocky Mount that serves and supports a diverse regional constituency. She has been involved with Community-Based Participatory Research (CBPR) for over 15 years as a community -based organization consultant with Project Grace and UNC Sheps Center for Health Services Research on HIV and CVD prevention in Nash and Edgecombe Counties. She recently co-founded the Nash-Edgecombe Black Community Vaccine Equity Collaborative and serves on the Advisory Boards for the UNC Health Office of Health Equity and the Covid Vaccine Equity Reimagined for NC (COVER NC). She has consulted for several years with the UNC Center for Health Equity Research (UNC CHER) and the RWJF Clinical Scholars Leadership Program and is a 2018 Legislative Fellow of the NC Institute of Medicine.
In the NC House and Senate in various redistricting configurations from 2007-2018, Angela represented Nash, Halifax, Franklin, Wilson, Vance and Warren Counties. During her legislative career, Angela was the primary sponsor of 53 bills that were enacted into law. During her time in the Senate, Senator Bryant served on the Oversight Committee for Medicaid and Health Choice and as Chair of the NC Legislative Black Caucus. She also introduced bills to expand Medicaid and raise the minimum wage in every session. She won various awards as Legislator of the Year during her eleven years of service- six in the House and five in the Senate.
Angela serves on the Board of Trustees of the Z. Smith Reynolds Foundation and the NC Legislative Black Caucus Foundation. Her awards and recognitions include: UNC- Chapel Hill Distinguished Alumni Award for contributions to humanity in striving to overcome racism, sexism and ageism and to achieve social justice for all; Defender of Justice Award from the NC Justice Center; Champion of NC Working Families from NC Families Care; Service to Humanity Award from the Rocky Mount Human Relations Commission for the Wright’s Center Project in 1991 and for “reaching beyond boundaries of self to provide quality service and compassion to the community” in 2010.
Her life partner is Lorenzo Ellis, who is retired, and they share two sons and their families, Senior Chief Petty Officer Lorenzo Ellis, USN and Helen, Norman Ellis and Hope, four grandchildren and several god-children and god-grandchildren.
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Victor Armstrong
Victor Armstrong joined NC DHHS as Director of the NC Division of Mental Health, Developmental Disabilities, Substance Abuse Services in March of 2020, with responsibility and oversight of the public community-based mental health, intellectual and other developmental disabilities, substance use, and traumatic brain injury system in North Carolina. Prior to accepting this role, Victor spent six years as Vice President of Behavioral Health with Atrium Health.
Based in Charlotte, NC Victor had responsibility for operations of Atrium’s largest behavioral health hospital, Behavioral Health Charlotte. Victor has over 30 years of experience in human services, primarily dedicated to building and strengthening community resources to serve historically marginalized individuals and communities. Victor is a nationally recognized speaker on issues regarding health equity and access to healthcare, particularly as it relates to individuals living with mental health challenges. He is also considered a national expert, and sought-after speaker, on suicide prevention and awareness, especially pertaining to historically marginalized communities.
Victor currently serves on the board of directors for the American Foundation for Suicide Prevention (AFSP) of NC, and United Suicide Survivors International. He is also former board chair of NAMI NC, and member of National Association of Social Workers (NASW). Victor is a former member of the board of directors of National Council for Behavioral Health, i2i Center for Integrative Health, and RTI International.
Victor’s awards and recognitions include Mental Health America’s 2021 H. Keith Brunnemer, Jr. Award for “Outstanding Mental Health Leadership”, 2019 Black Mental Health Symposium -Mental Health Advocate of the Year, 2019 Atrium Health Excellence in Diversity & Inclusion Award, 2018 Distinguished Alumni Award from East Carolina University School of Social Work, Pride Magazine 2018 "Best of the Best", and i2i Center for Integrative Health 2018 Innovation Award for "Whole Person Care", 2012 National Alliance on Mental Illness (NAMI) NC, Mental Health Professional of the Year.
Victor graduated, Magna Cum Laude, from North Carolina Central University with a bachelor’s degree in Business Management and received a Master of Social Work (MSW) from East Carolina University. He is the husband of Dr. Charletta Armstrong and the father of 3 sons, Carter, Alonzo, and Victor Jr.
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More Announcements:
From Kody Kinsley: I am very pleased to announce two leadership changes on my team.
Karen Burkes has been selected as Director of the Division of State Operated Healthcare Facilities (DSOHF) along with the appointment of Deepa Avula as Interim Director of the Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS). These two divisions play a crucial role in driving whole-person health through engaging with external partners and stakeholders, providing services, and innovating policies and programs for North Carolinians with mental health, substance use, developmental disability, and traumatic brain injury needs. Their experience operating large and complex systems and proven ability to partner to deliver meaningful outcomes for North Carolina will be so valuable at this pivotal time.
• In her nearly three years with the Department of Health and Human Services, including roles as Deputy Director and COO of DMHDDSUS, PPE Lead for the COVID-19 response, and Interim Director for DSOHF, Ms. Burkes has transparently led large teams, passionately served North Carolina collaboratively and creatively solved problems, managed risk and complex challenges, and eagerly accepted larger roles and responsibilities. I am grateful she will continue to do so as Director of DSOHF in a permanent capacity. Karen succeeds former DSOHF Director Helen Wolstenholme, who retired at the end of 2020 following decades of service to North Carolina.
• Ms. Avula joined us this summer as Interim Deputy Director and COO of DMHDDSUS, and her time with us has been very impactful. Deepa served for several years as a member of the Senior Executive Service (SES) in the federal government, the highest level of career civil servants and elite cadre of executives. Before joining the Department, she was CFO and Chief of Staff at the Substance Abuse and Mental Health Services Administration (SAMHSA) in Washington, DC. She is a rare executive that has deep experience in grants and financial oversight, budget implementation, strategic planning, communication and stakeholder engagement, and management. I appreciate Deepa stepping into this role to ensure continued strong leadership for the Division during this period of transition and know her attention to detail and ability to operationalize complex systems will be of great value at this important time. Deepa will take over leading DMHDDSUS in an Interim capacity from Victor Armstrong, who Secretary Cohen announced last week as the Department’s first Chief Health Equity Officer.
We will be recruiting for both the Director and Deputy Director roles at DMHDDSUS very soon. Once those positions are posted, we will appreciate everyone’s support in identifying top candidates for these critical roles.
As I mention above, this is an incredibly pivotal moment in North Carolina -- the lasting impacts of the pandemic, the coming launch of tailored plans, the pressure on our crisis system, an incredibly overstretched direct-care and healthcare workforce, a legacy of inequity in care and access, the need for diversion from our justice-system, homelessness, the impact on others and our families of intergenerational trauma, and underscoring it all, the insufficient insurance coverage for too many in our state – all call us to action. The work and needs are vast. Yet, I am humbled, every day, by the dedicated public servants in these two Divisions, and across the entire Department, that hold with personal passion and commitment to solve these unwieldy and long-standing problems. And I know that in the midst of all this work, each of our team members has been personally living with their own impacts from the pandemic, and daily they still rise and recommit themselves to the service of others.
I am incredibly humbled and honored to work alongside such hard working public servants. And I am glad to have these two leaders joining us all in this large #OneDHHS mission to improve the health and wellbeing of North Carolina. Further, I am grateful to each of you for your partnership and lasting dedication to the work here in North Carolina.
Now, once again, please join me in congratulating Karen and Deepa and welcoming them into these roles! Full bios for both Karen and Deepa are below.
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Karen Burkes
Prior to serving as Director of the Division of State Operated Healthcare Facilities, Karen Burkes was Deputy Director for Operations and the COO for DMHDDSUS where she was responsible for all internal operating and mission-support functions of the Division. She also led the state’s COVID-19 PPE effort to ensure that PPE was available across the state especially in historically marginalized communities. Prior to joining the DHHS, Karen worked at the Department of Treasury for over 8 years where she led efforts to drive operational improvements, developed strategies to drive management initiatives, and managed the implementation and maintenance of several software systems. Karen has also worked as an IT Consultant for in Chicago where she primarily worked on educational software implementation projects for Chicago Public Schools. Karen also taught mathematics in Baltimore County Public Schools.
Karen holds a Bachelor of Science in Mathematics from the University of Maryland and a Master of Business Administration from Stephen M. Ross School of Business at the University of Michigan. She is a certified Lean Six Sigma Green Belt, a certified Yoga Instructor, a Excellence in Government Senior Fellow with the Partnership for Public Service, and a Fellow with The Coaching Fellowship.
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Deepa Avula
Deepa Avula is an experienced executive with a long and successful tenure in the public sector government. Prior to joining the North Carolina Division of Mental Health, Developmental Disabilities and Substance Use Services as Interim Deputy Director and COO, she was Chief of Staff and CFO for the Substance Abuse and Mental Health Services Administration. In this capacity she was responsible for SAMHSA’s nearly $6 billion-dollar budget and 500 person staff, including funding for block and discretionary grant programs and program management.
These activities include reaching consensus on agency-wide program priorities and cross cutting issues as well as the development and monitoring of budget submissions to the department, the Office of Management and Budget, the Office of National Drug Control Policy and Congress. She was also responsible for managing SAMHSA's budget execution process, including approving apportionments, allotments and allowances for each organizational unit, generating and monitoring monthly payroll reports and quarterly and year end status of funds reports and performing financial control assessments and developing and monitoring corrective action plans.
Prior to assuming this role, Avula worked for the Office of the Chief Financial Officer in the Office of Justice Programs (OJP) where she had primary responsibility for the development of the agency’s strategic plan and its new approach to performance management including budget and performance integration. Prior to her work at OJP, Avula served in several capacities in SAMHSA’s Center for Substance Abuse Treatment, including Chief of the Quality Improvement and Workforce Development Branch where she provided leadership on programs related to workforce development in the behavioral health field, the provision of recovery support services, the development of quality measures for behavioral health and health financing.
Deepa holds a master’s degree in public health from the University of North Carolina-Chapel Hill and a bachelor’s degree in criminal justice from George Washington University.
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Quarterly Medical Care Advisory Committee (MCAC) Meeting Handouts
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LME-MCO Joint Communication Bulletin # J402
Amendment to Joint Communication Bulletins #J301 and #J328 – Submission and Monitoring of Individual Placement and Support (IPS) In-At Risk Checklists
This bulletin amends Joint Communication Bulletin #J301 and Joint Communication Bulletin #J328, which were distributed on Aug. 17, 2018, and June 6, 2019, respectively, to provide information on policies and revisions made to the In-At Risk Checklist used by IPS providers to identify individuals who are part of the In-At Risk population.
The amendment is a result of findings from monitoring efforts completed by the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) staff and feedback from the Independent Reviewer. The findings are:
- The IPS Verification Excel master spreadsheet that is managed by DMH/DD/SAS accounts for a significant number of people who, despite being referred, have not received the IPS service.
- A significant number of people did not meet In-At Risk criteria for homelessness.
- The number of Transition to Community Living (TCL) recipients and people who meet criteria for In-At Risk being successfully enrolled in the IPS service remains very low. A significant number of people who meet In-At Risk criteria who are referred to the IPS service are not representative of people with serious and persistent mental illness (SPMI) who may be at risk of placement in a congregate living facility. In order to meet substantial compliance with the Settlement Agreement, it is vitally important that the IPS service is serving those most at risk
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SPECIAL BULLETIN COVID-19 #179: Temporary Provider Rate Increases and Clinical Policy Changes Extended
NC Medicaid is extending all current COVID-19 temporary provider rate increases through Nov. 30, 2021. While the rate increases for providers authorized under SL 2020-4 were set to expire on June 30, 2021, NC Medicaid has discretion to continue these and other temporary rate increases assuming budget availability. More Information.
SPECIAL BULLETIN COVID-19 #180: 9th Amendment to the Public Readiness & Emergency Preparedness Act
NC Medicaid licensed pharmacists are authorized to order and administer REGEN-COV monoclonal antibodies and pharmacy technicians/interns may administer it, in accordance with the conditions of their licensure and/or scope of practice. More Information.
SPECIAL BULLETIN COVID-19 #181: NC Medicaid Accepting Requests for COVID Response Facilities
Due to the rapid increase in COVID infection and related hospitalization occupancy, NC Medicaid is reactivating its consideration of Response Facility Designation Requests submitted by skilled nursing facilities. More Information.
SPECIAL BULLETIN COVID-19 #182: Temporary Availability of the Hospital at Home Program
Effective Sept. 1, 2021, the Acute Hospital Care at Home (HAH) program will be available to North Carolina hospitals that have been granted a waiver from CMS and service NC Medicaid beneficiaries. NC Medicaid is planning to implement this program to be effective Sept. 1 through Dec. 31, 2021, unless this flexibility is terminated prior to Dec. 31, 2021. More Information
SPECIAL BULLETIN COVID-19 #183: M0201 COVID-19 Vaccine Home Administration
Effective June 8, 2021, Medicaid will pay an extra $35, in addition to the standard administration payment (approximately $40 per COVID-19 vaccine dose), for a total payment of approximately $75 for a vaccine dose administered in a patient's home. More Information
SPECIAL BULLETIN COVID-19 #184: Update on Vaccination Counseling Code Reimbursement
This bulletin provides information extending the vaccination counseling coverage date from Sept. 22, 2021 to March 31, 2022 and is an update to COVID-19 Bulletin #170. Details
SPECIAL BULLETIN COVID-19 #185: Casirivimab and Imdevimab, for Intravenous Infusion or Subcutaneous Injection
The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved products casirivimab and imdevimab to be administered together for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients who are at high risk for progressing to severe COVID-19 and/or hospitalization. This Special Bulletin updates SPECIAL BULLETIN COVID-19 #177: Casirivimab and Imdevimab Approved for Emergency Use. Details
SPECIAL BULLETIN COVID-19 #186: Booster Dose of Pfizer-BioNTech COVID-19 Vaccine
This article provides guidance related to the Centers for Disease Control and Prevention (CDC)'s latest recommendations for Pfizer-BioNTech COVID-19 Vaccine booster shots. Beginning Sept. 24, 2021, NC Medicaid vaccine providers may begin administering the booster dose of mRNA COVID-19 vaccine to those beneficiaries who qualify by self-attestation. More information
SPECIAL BULLETIN COVID-19 #187: NC Medicaid Replacing Outbreak Rates with Single, Uniform Public Health Emergency Rate
NC Medicaid is updating the special focused financial assistance to Skilled Nursing Facilities (SNFs) provided through outbreak rates. These rates were designed to address the higher costs of caring for Medicaid beneficiaries who were COVID-positive (COVID+).
SPECIAL BULLETIN COVID-19 #188: Extension of Temporary Suspension of Prior Authorization for Post-Acute Placements
Due to the COVID-19 Public Health Emergency (PHE) and to expedite a hospital’s ability to discharge patients to lower levels of care when medically appropriate, the prior authorization (PA) waiver is extended to Oct. 15, 2021 for:
- Medically necessary new admissions who are being directly discharged from a hospital setting into a nursing home; and
- Medically necessary Inpatient Rehabilitation and Long-Term Care Hospital admissions.
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles:
· Reminder: NC Medicaid Managed Care Beneficiary Choice Period Ends Sept. 30, 2021
· NC Medicaid Managed Care Provider Update – Sept. 15, 2021
· Private Duty Nursing Clinical Coverage Policy 3G-1 for Beneficiaries Age 21 and Older
· Keep NCTracks Records Current to Avoid Claims Processing Issues
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
National Correct Coding Initiative (NCCI) Reminder
The National Correct Coding Initiative (NCCI) is a program owned by the Centers for Medicare & Medicaid Services (CMS), which is responsible for all decisions regarding its contents. Following is general information regarding NCCI to help better understand its purpose and use.
What is the NCCI?
The National Correct Coding Initiative was developed by CMS to control improper coding leading to inappropriate and duplicate payment. The Affordable Care Act (ACA) requires that all state Medicaid programs incorporate “NCCI methodologies” in their claims processing; these edits are not specific to North Carolina Medicaid policies.
Types of NCCI Edits
The NCCI contains two types of edits:
· NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should never be reported together. There are some code pairs that should only be used together under certain conditions by using specific modifiers. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
· Medically Unlikely Edits (MUEs) define for each HCPCS/CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.
Resources relating to NCCI Edits
· CMS Website
· Provider User Guides and Training
· Claims Submission
· Medicaid NCCI Manuals
Note: This article has also been published as an NC Medicaid Bulletin, available here.
Due to a recent update in the NCTracks system, providers may now select and terminate a taxonomy on their record in suspension status if the provider deems the taxonomy as no longer applicable to services rendered. Previously, providers were not able to terminate a suspended taxonomy until it was systematically terminated from lack of provider response.
To terminate a suspended taxonomy, the provider should initiate an NCTracks Manage Change Request (MCR) and navigate to the Taxonomy Classification page:
1. Select the Edit button for the taxonomy
2. Click the End Date It checkbox
3. Select a reason for the termination from the drop-down menu
4. Enter an end date
5. Click the Save button
Once a taxonomy is terminated, it may only be reinstated by submitting an MCR to add the taxonomy with the appropriate begin date. Therefore, providers are advised to carefully select the specific taxonomy that is no longer needed when deciding to terminate so as to not select an incorrect taxonomy.
Enhanced Source Verification for Enrollment and Re-verification
Effective Oct. 24, 2021, new primary source verification measures will be added to the NCTracks re-verification process in compliance with 42 CFR 455.450.
Primary verification methods will apply to enrollment requirements including licenses, accreditations, certifications and other enrollment criteria necessary for participation in NC Medicaid and Health Choice. These additional measures are designed to further safeguard the validity of NC Medicaid and Health Choice provider networks.
Providers must now review and update their provider record (including required accreditation, certification and license data), during the re-verification process, similar to the review process when completing a full Manage Change Request (MCR)*. No action is required until re-verification applications are due.
*Enrollment requirements by provider type may be found in the Provider Permission Matrix which is available under Quick Links on the Provider Enrollment page.
Reminder - Updating North Carolina Medical Board Licenses
NCTracks receives North Carolina Medical Board (NCMB) provider license information directly from NCMB. NCTracks receives this update file from NCMB once a month (by the 15th) for the previous month.
When the monthly NCMB file is received, NCTracks automatically updates the expiration dates in the provider record. If you receive a letter that you need to update your NCMB license, make sure it is updated with NCMB and that NCTracks has the correct license number on file.
Occasionally, there is time gap between NCTracks receiving NCMB data with updated expiration dates and providers’ licenses expiring and an update being required to prevent suspension.
As of May 9, 2021, providers have the ability to enter or correct the expiration date on file for their NCMB license if NCTracks has not yet received the NCMB data to update the license. Providers are able to enter the expiration date themselves to prevent suspension or termination due to expired credentials. This information will still be validated with NCMB once the file is received, but will prevent suspension for expired credentials if the NCMB file is not received in the appropriate timeline for license expiration. Providers are encouraged to ensure their record expiration date is updated to prevent suspension.
For more information, please see the North Carolina Medical Board Licenses section of the user guide How to Add or Update Licensing and Accreditation on the Provider Profile in NCTracks located on the User Guides & Fact Sheets page.
Extension of School Immunization and Health Assessment Requirements
To ensure that children are not excluded from school because of increased demands on health care providers amid the ongoing COVID-19 pandemic, Governor Roy Cooper issued a new Executive Order and State Health Director Dr. Elizabeth Tilson issued a State Health Director Memo that suspends, but does not waive, documentation deadlines for proof-of-immunization and health assessment requirements for school and child-care facilities.
The Executive Order is needed because increased case rates and viral transmission caused by the Delta variant have limited providers’ ability to schedule immunization and health assessment visits. According to the North Carolina Pediatric Society, pediatricians are experiencing record levels of demand for sick visits due to viral illnesses.
In typical years, proof of required immunizations and health assessments are required within 30 days of the first date of attendance of school. After the 30 days, children are to be excluded from school until the family provides documentation of requirements. This year, the 30-day "grace period" for all students will begin on Nov. 1, 2021. Extending these deadlines by will allow more time for families, schools and providers to facilitate access to needed immunizations and health assessments.
Families are required to provide the school or child care facility proof of an upcoming appointment (which could include a written statement from a parent or guardian) by Oct. 8, 2021, and are strongly encouraged to obtain the required immunizations for their children on a timely basis.
The Executive Order and State Health Director Memo will apply to students enrolled in public, private, or religious educational institutions, including child care facilities and K-12 schools. The Order also extends the deadline for each child entering a North Carolina public school for the first time to submit proof of a health assessment with that proof of an upcoming appointment.
Whether children are home-schooled, attend school in-person or by remote learning, they are required by state law to be immunized based on their age for certain vaccinations as recommended by the Centers for Disease Control and Prevention (CDC). More information on North Carolina’s requirements for vaccines can be found on the NCDHHS website.
Upcoming NC Medicaid Managed Care Provider Webinars
Virtual Statewide Primary Care Quality Forum
Tuesday, Oct. 12 | Noon to 1:30 p.m. - Register
The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five prepaid health plans, will host a Virtual Statewide Primary Care Quality Forum to help providers, practice managers and quality managers succeed with NC Medicaid Managed Care quality initiatives. Join us for this informative session which will cover:
· Legislative/DHHS Updates
· DHHS Quality Strategy
· Performance Improvement Initiatives
· Childhood Immunizations
· Diabetes Control
· Timeliness of Prenatal/Postpartum Care
· Advanced Medical Home Measures
· Data and resources
Healthy Opportunity Pilots: Impacts to Advanced Medical Homes/Integrated Care for Kids
Thursday, Oct. 14 | 5:30-6:30 p.m. - Register
Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars, as well as recordings, slides and transcripts from previous webinars.
October 2021 Provider Training Now Available
Registration is open for the October 2021 instructor-led provider training courses listed below. Slots are limited. NCTracks Zoom courses can be attended remotely from any location with a computer and internet connection. Please note that as of Jan. 1, 2021, training will be conducted through Zoom; individualized meeting information has been created for each course. Please see the Training Enrollment Instructions section below for registration details.
Submitting a Dental/Orthodontic Claim (Zoom)
Wednesday, Oct. 13, 2021, 1:00 p.m. - 4:00 p.m.
This course will provide instructions for authorized users to submit dental claims electronically in NCTracks. At the end of this training, the authorized user will be able to:
· Create a dental claim via the NCTracks web portal
· Save a claim Draft
· Submit a claim
· Search claim status
· Review claim status
· Copy a claim
· Void or replace a previous claim
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 160 978 3248#
3. Press the # key
4. Enter meeting passcode 0568538665#
· Providers may choose to use the computer audio instead of dialing in
Prior Approval Medical (Zoom)
Thursday, Oct. 14, 2021, 9:30 a.m. - Noon
This course will cover:
· Submitting Prior Approval requests, to help ensure compliance with Medicaid clinical coverage policy and medical necessity
· Inquiring about Prior Approval requests to determine their status
· Voiding a Prior Approval
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 160 875 3590#
3. Press the # key
4. Enter meeting passcode 7865117435#
· Providers may choose to use the computer audio instead of dialing in
Submitting a Professional Claim (Zoom)
Thursday, Oct. 14, 2021, 1:00 p.m. – 4:00 p.m.
This course will show authorized users how to electronically submit a Professional claim. At the end of training, authorized users will be able to:
· Submit a Professional claim via the NCTracks web portal
· Create a claim
· Save a claim draft
· Use Claims Draft Search
· Submit a claim
· View results of a claim submission
· Perform a Claim Status Search
· Copy the claim
· Resubmit a claim
· Void or replace prior claims
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 160 875 6814#
3. Press the # key
4. Enter meeting passcode 7162533824#
· Providers may choose to use the computer audio instead of dialing in
Prior Approval Institutional (Zoom)
Thursday, Oct. 21, 2021, 9:30 a.m. – Noon
This course will cover:
· Submitting Prior Approval requests, to help ensure compliance with Medicaid clinical coverage policy and medical necessity.
· Inquiring about Prior Approval requests to determine their status.
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 160 515 5659#
3. Press the # key
4. Enter meeting passcode 8755041861#
· Providers may choose to use the computer audio instead of dialing in
Submitting an Institutional Claim (Zoom)
Thursday, Oct. 21, 2021, 1:00 p.m. – 4:00 p.m.
At the end of training, the authorized users will be able to submit an institutional claim via the NCTracks web portal:
· Initial claim
· Save a claim Draft
· Use Claims Draft Search
· Submit a claim
· View results of a claim submission
· Perform a Claim Status Search
· Copy a claim
· Resubmit a claim
· Void or replace a prior claim
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 160 497 6516#
3. Press the # key
4. Enter meeting passcode 5461339574#
· Providers may choose to use the computer audio instead of dialing in
Provider Web Portal Applications (Zoom)
Tuesday, Oct. 26, 2021, 9:30 a.m. – Noon
This course will guide you through an overview of the Enrollment, Re-enrollment, Re-verification, Abbreviated Manage Change Request, Manage Change Request, Maintain Eligibility, and Fingerprinting required application processes. At the end of this training, authorized users will be able to:
· Understand the Provider Enrollment Application process
· Navigate to the NCTracks Provider Portal and understand how to complete the following Provider Enrollment Application processes:
· Provider Enrollment
· Out-of-State (OOS)
· Ordering, Prescribing, and Referring (OPR) Lite
· Re-enrollment
· Re-verification
· Abbreviated Manage Change Request
· Manage Change Request (MCR)
· Maintain Eligibility
· Fingerprinting Required
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 161 014 3616#
3. Press the # key
4. Enter meeting passcode 5680427501#
· Providers may choose to use the computer audio instead of dialing in
Prior Approval Pharmacy (Zoom)
Wednesday, Oct. 27, 2021, 9:30 a.m. – Noon
This course will cover:
· Submitting Pharmacy Prior Approval requests, to help ensure compliance with Medicaid clinical coverage policy and medical necessity.
· Inquiring about Pharmacy Prior Approval requests to determine the status.
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 161 867 8084#
3. Press the # key
4. Enter meeting passcode 4768416531#
· Providers may choose to use the computer audio instead of dialing in
Provider Re-Credentialing/Re-Verification (Zoom)
Wednesday, Oct. 27, 2021, 1:00 p.m. – 2:30 p.m.
This course serves as a refresher for the steps taken by the provider for re-verifying their credentials and qualifications through NCTracks. At the end of training, authorized users will be able to:
· Explain why provider Re-Verification is requested and what the process entails.
· Complete the Re-Verification process in NCTracks.
· Update Owners and Managing Relationships if necessary while completing the Re-Verification application process.
Meeting Information
Follow the steps below for audio and visual access to the Zoom online training sessions:
1. Dial US Toll Free 833-568-8864
2. Enter meeting ID 161 616 7847#
3. Press the # key
4. Enter meeting passcode 1761621631#
· Providers may choose to use the computer audio instead of dialing in
Training Enrollment Instructions
Providers can register for these courses in SkillPort, the NCTracks Learning Management System. Log onto the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled Provider Computer-Based Training (CBT) and Instructor Led Training (ILT). The courses can be found in the sub-folder labeled ILTs: Remote via WebEx (although this is the sub-folder name, please note that, as previously mentioned, courses will now be conducted via Zoom and not WebEx).
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NC HIEA Seeking Focus Group Participants to Inform Legislative Recommendations
The N.C. Health Information Exchange Authority (NC HIEA) is seeking participants for two focus groups in October. We want to hear from health care providers, practice managers, and others in the payer and health care quality communities about the challenges and barriers connecting to the statewide HIE, NC HealthConnex.
The feedback will be included in NC HIEA’s March 2022 report to the N.C. General Assembly and will inform its recommendations related to the Health Information Exchange Act, per North Carolina Session Law 2021-26.
These groups will meet virtually via Webex due to the Covid-19 pandemic.
NC HealthConnex’s Event Notification Service NC*NOTIFY to Release Version 4.5 Enhancements
Health care providers are often unaware when their patients receive care outside their facility or electronic health records (EHR) network. Providers also have a growing need for timely notifications of certain events to support successful transitions of care and improve care management.
NC HealthConnex is pleased to announce additional enhancements slated for the next version of NC*Notify (4.5) that will bring greater value to the overall user experience. The updates being released in the next few weeks include:
• New event triggers
• Reports on patient panel loading
• EHR system integration
• Centers for Medicare & Medicaid Conditions of Participation fields
Some NC*Notify subscribers may need to make changes to accept new fields. Subscribers will also be able to directly integrate NC*Notify into certain EHR systems.
Updated specification documents will be provided over the next few weeks. If you have specific questions about these upcoming changes and how to prepare for them, contact [email protected].
Athena Single Sign-on to NC HealthConnex Coming Soon
The N.C. Health Information Exchange Authority (NC HIEA) and Athena are working to develop single sign-on access to the NC HealthConnex clinical portal. This allows Athena customers to access the NC HealthConnex clinical portal without logging into another system or leaving their electronic health record workflow.
Utilizing the NC HealthConnex clinical portal has many benefits.
HIE Act Changes Extend Deadline; Providers Encouraged to Continue Onboarding Due to Large Onboarding Queue
The N.C. Health Information Exchange Authority (NC HIEA) previously announced the Health Information Exchange Act deadline extension until January 2023 after a collaborative effort to bring additional relief to health care providers on the front lines of the COVID-19 pandemic. NC HIEA advocated on behalf of providers to allow them additional time to complete the technical onboarding process without being out of compliance with the HIE Act.
Why You Should Connect Now
As North Carolina moves to managed care, all Medicaid providers will benefit from NC HealthConnex's more complete, aggregated health information on Medicaid patients across the care continuum. It will help providers focus on managing patient health rather than the fee-for-service model. In addition to allowing providers direct access to patients' health information via NC HealthConnex, Medicaid has begun to look at quality measures on their beneficiaries from HIE data to improve the program.
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DHHS Approves Warren County Realignment with Eastpointe
We received DHHS’s official approval of Warren County’s realignment with Eastpointe.
Warren’s first day in our catchment area will be December 1. Until then, the county’s members will continue receiving services through Cardinal.
Eastpointe has already started collaborating with DHHS, Cardinal, and Warren County leadership. Each organization is committed to ensuring members’ uninterrupted access to services and a smooth transition for all stakeholders.
Eastpointe will be contracting with all Warren County providers in good standing. We will also be conducting a network assessment to identify any additional coverage needs.
I will provide additional information as it becomes available. If you have any questions, please contact me directly at [email protected].
Thank you for all that you do in service of our members!
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Survey Finds Disability Service Providers On The Brink
Disability service providers across the nation are in crisis, with a majority reporting that they’re shutting down programs, turning away new referrals and struggling to maintain standards.
A survey out this week of 449 organizations that provide services to those with intellectual and developmental disabilities paints a dark picture of the current state of the industry a year and a half into the COVID-19 pandemic.
Of those surveyed, 58% of providers said they’re discontinuing programs or services, 77% are turning away new referrals, 84% are delaying the launch of new offerings and 81% said they are struggling to achieve quality standards. Meanwhile, 40% of providers said they’re seeing higher frequencies of reportable incidents.
Disability service providers across the nation are in crisis, with a majority reporting that they’re shutting down programs, turning away new referrals and struggling to maintain standards.
A survey out this week of 449 organizations that provide services to those with intellectual and developmental disabilities paints a dark picture of the current state of the industry a year and a half into the COVID-19 pandemic.
Of those surveyed, 58% of providers said they’re discontinuing programs or services, 77% are turning away new referrals, 84% are delaying the launch of new offerings and 81% said they are struggling to achieve quality standards. Meanwhile, 40% of providers said they’re seeing higher frequencies of reportable incidents.
“This is the first time since the deinstitutionalization movement that we are actually going backwards,” said Barbara Merrill, CEO of the American Network of Community Options and Resources, or ANCOR. The organization, which represents disability service providers across the nation, conducted the survey during a five-week period starting in August.
“Programs are being closed, people aren’t taking new referrals. We’re getting concerned that people are going to be moved to larger settings. We’ve never seen anything like it,” Merrill said.
Insufficient staffing is at the root of most of the problems providers are experiencing, according to the ANCOR report. The industry has long struggled to attract and retain direct support professionals, but that situation has only gotten worse. Nearly 93% of providers surveyed said that “industries that previously paid comparable wages now pay employees more than my organization can afford to pay” while 86.2% said that the pay for direct support professionals is less than what people can receive from unemployment and other government safety net programs.
And there’s not much that providers can do about the situation since their pay rates are largely determined by the reimbursement they receive from Medicaid.
As a result, the disability service provider industry is “extraordinarily fragile and beginning to break down,” Merrill said, and that means families and people with disabilities aren’t getting what they need.
“Services aren’t being staffed at the levels that they need to be staffed to be safe and to allow people to experience the community,” Merrill said. “We’re concerned about basic human safety here. That’s why providers are moving to close and consolidate programs.
They’re not going to run programs where people aren’t safe.”
The survey is just the latest ANCOR has conducted of member organizations to assess how they’re faring. Even before the pandemic, providers were struggling to maintain or expand services and keep up standards, but since COVID-19 emerged, circumstances have worsened by nearly every metric, ANCOR said.
The latest data comes as Congress continues to weigh President Joe Biden’s plan to inject $400 billion in the nation’s home and community-based services system. Most recently, lawmakers in the U.S. House of Representatives shrunk the proposal to $190 billion, a figure that disability advocates say is inadequate to address the massive waiting list for services and the needs of the direct support professional workforce.
Read Story Here
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The Uncertain Prognosis For Telehealth
Patients and doctors who embraced telehealth during the pandemic fear it will become harder to access
Washington Post
By Frances Stead Sellers
When the pandemic hit, the little health center on Vinalhaven, an island 15 miles off the coast of Maine, was prepared in ways many larger facilities were not. The Islands Community Medical Services had long been using telehealth to provide primary and behavioral care to its 1,500-strong year-round community, relying on grants to cover costs. As the public health emergency lifted many restrictions on virtual care, the clinic ramped up its offerings.
“We were able to pivot pretty quickly,” said former operations director Christina R. Quinlan, describing a scramble to add specialized medical and social care.
Across the country, in urban and suburban settings, the same pattern played out as federal and state regulators issued scores of waivers to telehealth access and coverage rules, making it easier for hospitals, health centers and clinics to offer a wider range of remote services and be reimbursed for delivering them.
A question that remains to be answered, experts say, is how many rules will tighten once the public health emergency is over. This summer, more than 430 health-related organizations, including hospitals, professional bodies and patient-advocacy groups, urged congressional leaders to keep open the gateways to telehealth. They argued that much of health-care delivery has moved online “not only to meet COVID-driven patient demand, but to prepare for America’s future health care needs.”
Lawmakers on both sides of the aisle have shown support for making the shift to telehealth permanent through mechanisms such as the Connect for Health Act. But many states have already rescinded the licensing waivers that allowed clinicians and some other providers to practice across state lines, or are preparing to do so. Other decisions at the state, federal and individual health-care system levels remain uncertain.
“It’s frustrating,” said Steven A. Epstein, chair of psychiatry at Georgetown University School of Medicine. He said the pandemic not only fixed logistical challenges for physicians treating patients in adjoining states, but offered many clients welcome convenience when they were able to connect with therapists without having to show up at a clinic.
“The no-show rates dropped off significantly,” said Epstein, who has heard of patients who now drive across state lines to talk to therapists from their cars.
Over the past 18 months, providers have revamped their practices, taking advantage of the pandemic-fueled flexibility that allows consultations in people’s homes rather than in approved clinical settings and via phone instead of only on video. Some have been using platforms that did not meet pre-pandemic standards for privacy and security. Many have invested in new computer systems and signed up for training in a new skill for the modern tech-savvy physician — a good webside manner. (Rx for doctors: Look into the laptop camera, not at the screen.)
“The floodgates opened during covid,” said Danielle Louder, program director for the Northeast Telehealth Resource Center, which supports the growth of telehealth in New England and New York.
Kimberly Brandt, a partner at the consulting firm Tarplin, Downs & Young and former principal deputy administrator for operations and policy at the Centers for Medicare and Medicaid Services, known as CMS, said that in areas such as behavioral health, the uptick has been too big to reverse. But she wondered whether the range of covered services, which expanded to include physical and speech therapy, would continue.
“In general, I do not see us going back,” Brandt said.
For Bernard Forcier, a manager at Portland Glass in Maine, telehealth transformed the chore of traveling to his doctor every three months to monitor his diabetes.
“First thing you know, an hour and a half has gone by and I’ve seen my doctor for 20 minutes,” Forcier said, recalling driving several miles and then sitting in a waiting room. Now he checks in from his own office. “I stop work for 15 minutes. Then I’m right back at it,” he said.
Forcier’s private insurance may well continue to allow him to continue his appointments, but Medicare patients will not be able to if CMS reverts to its pre-pandemic requirement that the “originating site” from which patients consult with doctors is a clinical setting.
“We’ve learned a lot from the covid-19 pandemic, including how telehealth can connect people to care,” a CMS spokesperson said. “As we look forward, CMS will look at expanding access to care with health equity in mind.”
Among many telehealth-related changes CMS is proposing in its 2022 Medicare Physician Fee Schedule, it would allow certain pandemic-era services to continue through 2023 to evaluate whether they should be made permanent.
Some of the proposals could be accomplished through regulatory changes; others would require acts of Congress.
In a Washington Post Live interview, Xavier Becerra, secretary of the Department of Health and Human Services, said: “We are absolutely supportive of efforts to give us the authority to be able to utilize telehealth in greater ways. We want to make sure that we don’t leave anyone behind.”
The striking change during the pandemic was the increased demand for direct-to-consumer care.
At the same time, clinicians took advantage of new flexibility to practice across state lines. Most states lifted the requirement that physicians be licensed in the state where their patient is located — a change that in many states is already being reversed. Use of the Interstate Medical Licensure Compact, an agreement between states that streamlines the process of applying for individual state licenses, grew by almost 50 percent during the pandemic, according to the American Medical Association. But only 30 states belong to the compact, which falls far short of a national licensing system.
The reason for insisting doctors be licensed in their patients’ state is that complaints are handled through state licensing boards.
“The main function of licensure is that it allows states in the current setup to really hold physicians accountable for the care they provide,” said Jack Resneck, president-elect of the American Medical Association, in a Washington Post Live interview.
Still, telehealth’s pandemic-driven rise in popularity reflects patients’ widespread appreciation of flexibility in how and where they seek care. In March and April of 2020, the Mid-Atlantic Telehealth Resource Center, one of 14 Health Resources and Services Administration-funded regional centers, received more than 400 inquiries from providers — an 800 percent jump over the same two months in 2019.
Questions frequently came from clinicians whose patients are covered by Medicare and Medicaid, as CMS issued dozens of waivers of its pre-pandemic regulations, including opening the door to reimbursement for telehealth visits delivered in a patient’s home.
The pandemic also prompted interest from private practitioners, including primary care doctors, who recognize that, going ahead, the ability to provide online visits will be necessary to retain patients and attract new ones, according to Kathy Hsu Wibberly, the Mid-Atlantic center’s director.
"What we are seeing now is private practices missing out on the ability to access patients if they don’t at least have hybrid access of care,” Wibberly said.
What’s holding up progress to even greater use of telehealth is uncertainty about the future web of state and federal regulations over public and private systems.
“That’s the barrier much more than any one thing,” Wibberly said. “Everything is so complex.”
There are signs of support for telehealth. Congress is considering legislation that would make some changes permanent. The $550 billion infrastructure bill that the U.S. Senate passed this month included $65 billion for broadband, which should give patients in rural areas access to Internet connections fast enough for video visits as well as uploading data from wearable medical devices.
And last month, the Biden administration announced a $19 million investment in telehealth in the form of awards aimed at stimulating innovation and expanding access to services in underserved areas.
Among the recipients of the 36 awards is MaineHealth, a nonprofit network that includes community hospitals, physician practices and health-care organizations — and has used telehealth for two decades.
The award will be used to examine the impact of caring for diabetic patients at home, as well as collaborations between primary care physicians and pharmacists.
Last year’s sudden shift to direct-to-consumer care put a new spotlight on primary care — including the shortage of easily used hardware.
“We had IT teams running out to Best Buy 100 miles away to buy video cameras, speaker phones, second monitors,” recalled Jasmine Bishop, MaineHealth’s director of telehealth.
Virtual visits jumped from about 1,200 per month before the pandemic to 30,000 by May 2020, after Medicare lifted its restriction on reimbursing in-home visits.
The new opportunities, including audio visits, also raised concerns from patients, wondering, for example, whether they would be billed for an audio appointment if a physician called with lab results.
“Every time I get a phone call from my doc, am I going to get a co-pay?” Bishop said she would hear.
Bishop uses the digital access to collect data and patient satisfaction surveys, which suggest that for some patients, telehealth will be the best way to provide care for the long term. For the immunocompromised and those seeking mental health care, the clinical setting is always a cause for concern, Bishop said. And many time-consuming urgent care questions, such as checking a tick bite, are more efficiently resolved online.
While Medicare had previously only reimbursed telehealth visits for rural patients, Bishop said virtual care also appeals to urban patients, sometimes because they can’t access city physicians who often have a huge number of patients to choose from.
“There is no geographic restriction on wanting to stay home,” Bishop said. In many ways, the new enthusiasm for telehealth builds on experience in areas like the Maine islands, where clinicians have long had to figure out ways to treat remote communities.
“We did it because we saw the value of telehealth for access,” recalled Quinlan of the Vinalhaven clinic, which, like other Federally Qualified and Rural Health Centers, had not been paid for delivering telehealth services to Medicare patients until the pandemic.
The most remote island communities have long relied on the nonprofit Maine Seacoast Mission to show up in its 75-foot steel-hulled floating clinic, the Sunbeam V.
The mission’s nurse, Sharon Daley, coordinates with mainland doctors, sometimes consulting with out-of-state specialists like vascular neurologist Anand Viswanathan of Massachusetts General Hospital, who accompanied her on a recent trip to meet patients he usually sees online.
Daley’s experience with everything from unreliable Internet access to physicians’ state-based licensing arrangements is central to today’s debates in Washington. But day-to-day, her focus is less on policy than on integrating the tools of technology with the traditions of good care — a challenge that all practitioners face as they adapt to telehealth.
That often means acting as an intermediary for physicians whose patients live, literally, out of reach.
“I’m their hands,” Daley said.
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The reports are both based on surveys HHS-OIG conducted with Medicaid directors from 37 states as well as various stakeholders in early 2020. The surveys were particularly focused around telemental health delivery through managed care organizations, however most stakeholders focused on general telehealth issues in their responses. While the information was gathered pre-pandemic, HHS-OIG applies the findings to support understanding and recommendations to the Centers for Medicare and Medicaid Services (CMS) around post-pandemic telehealth policy.
Key Challenges: Lack of Telehealth Training and Limited Broadband
In terms of challenges related to care delivery via telehealth, the number one issue reported by 32 out of 37 surveyed states, was a lack of provider and enrollee training. In HHS-OIG’s interviews, stakeholders described not only provider issues related to use of telehealth technology, but also lack of education around telehealth coverage and reimbursement policies. Lack of internet access came in as the second highest challenge, reported by 31 out of 37 states. Broadband issues raised included not only enrollees having insufficient broadband speeds, but some clinics in rural areas having no broadband access at all.
Other challenges provided by state Medicaid programs included:
- Concerns around how providers protect patient privacy and personal information.
- Lack of interoperability between provider electronic health record systems and how to increase provider sharing of patient information.
- The high costs of telehealth infrastructure, such as initial equipment costs as well as maintenance and repair costs.
- A lack of licensure reciprocity across states.
- A lack of understanding around telehealth consent policies.
Citing how CMS has given states broad flexibility in how they structure their telehealth policies, the recommendations from the report to CMS focus on increasing creation and dissemination of additional informational and educational resources, such as best practices amongst states, funding options related to broadband and interoperability, and creating a state plan amendment template that could additionally assist states in covering some ancillary infrastructure costs.
Evaluation: Telehealth Data and Oversight
Within the Evaluation Report which focused more on data collection and analysis, HHS-OIG found that only 3 out of 37 states are unable to track which services are provided via telehealth, however only 2 out of 37 states have evaluated that data specific to impacts on access to behavioral health services and only one state has evaluated telehealth impacts on cost. The report notes that though other states didn’t directly evaluate telehealth data however, they did provide information on observational telehealth impacts based on their experiences with telehealth. For instance, 17 out of 37 states reported that telehealth increases access to providers and a few states also noted potential cost savings, while 6 out of 37 said the impact of telehealth on cost is largely uncertain.
The final focus of the Evaluation report was related to telehealth quality assessments and oversight by Medicaid agencies. While 10 out of 37 states noted concerns around quality, one state mentioned quality as more of a clinical practice issue, and two states believed provider training could address such concerns. In regard to oversight, only 11 states were said to conduct monitoring specific to telehealth, while other states noted they oversee all services the same. HHS-OIG made much stronger and more specific recommendations when it comes to state oversight and evaluation, suggesting the need for additional telehealth specific measures by CMS, states, and managed care organizations.
Looking Ahead
The HHS-OIG reports highlight many of the broad issues and questions related to telehealth that have become forefront in policymakers’ minds over the past year and half, such as challenges around addressing the digital divide and how to best evaluate telehealth impacts. The recommendations point toward a few different potential post-pandemic pathways for CMS mainly around increasing education and oversight. As we’ve seen confusion grow around what state Medicaid agencies believe CMS allows them to do as permanent telehealth policy, such as around federally qualified health centers (FQHCs), perhaps the most essential recommendation made by HHS-OIG comes back to increasing coordination amongst state Medicaid agencies with CMS.
The reports’ limited scope to behavioral health services through managed care organizations is also notable in terms of policy application even though state and stakeholder responses may have been more general. For instance, many states and policymakers seem to be focused around Medicaid fee-for-service policies more so than managed care, as well as reimbursement challenges, such as payment parity and similar fee schedule considerations. In addition, the HHS-OIG study did not break down any differences or feedback by telehealth modality, while many states and stakeholders have been focused on the future of audio-only availability – especially as a way to address the challenge of limited broadband access.
In terms of evaluating data, while many states may have not had a data evaluation plan in place at the time of HHS-OIG survey, many now do as a result of recently enacted legislation predicated on the surge of use and attention to telehealth during the pandemic. Therefore, it may be interesting for HHS-OIG to consider conducting a similar more broad survey in a year or two after states have had more time to collect and wrap their heads around the data.
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Monday, October 4, 2021
FFTA Family Search & Engagement Training 4-Parts
Session 4: Focusing on Engagement in FSE
Time: 1:00 pm thru 2:30 pm
Free for FFTA members
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Tuesday, October 5, 2021
State Level Advocacy
Time: 9:00 am thru 11:30 am
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Tuesday, October 5, 2021
NC Children with Complex Needs Training Series
Evidence-Based and Promising Practices to Support the Workforce and Partners Serving Individuals with Mental Illness and Intellectual and Developmental Disabilities
Session 2: Adaptation of Dialectical Behavior Therapy for Work with Autistic Youth: 1.5 Contact Hours
Time: 10:00 thru 11:30 am
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Thursday, October 7, 2021
Benchmarks' Child Welfare Webinar
Lisa Cauley Joins Karen McLeod
Time: 8:00 am thru 9:00 am
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New: Thursday, October 7, 2021
Joint NC DMHDDSAS and DHB Update for NC Providers
Time: 3:00 pm thru 4:00 pm
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New: Friday, October 8, 2021
Tailored Care Management 101 Webinar Series
Includes October: 15, 22, & 29
November: 5 & 9
December: 3 & 10
Time: 12:00 pm thru 1:00 pm
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Friday, October 8, 2021
SESSION 4: Medicaid & Permanent COVID-19 Telehealth Policies
Time: 2:00 pm thru 3:30 pm
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Friday, October 8, 2021
FINAL SUPPORTED EMPLOYMENT DEFINITION I/DD & TBI
NC MEDICAID AND STATE-FUNDED SERVICE UPDATE
WEBINAR & Q/A
Time: 6:00 pm thru 7:00 pm
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Wednesday, October 13, 2021
National Council and AAGP – Webinar #4: Evaluation and Management of the Behavioral and Psychological Symptoms of Major and Mild Neurological Disorders in Older Adults
Time: 2:00 pm thru 3:00 pm
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Friday, October 15, 2021
Benchmarks' Friday Membership Webinar
Dave Richard Joins Karen McLeod
Time: 8:30 am thru 9:30 am
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Tuesday, October 19, 2021
Federal Level Advocacy
Time: 9:00 am thru 11:30 am
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New: Tuesday, October 19, 2021
How Should States Invest in the Direct Care Workforce?
Time: 2:00 pm thru 3:00 pm
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New: Wednesday, October 20, 2021
The Science of Scaling-Up High-Quality Early Childhood Programs
Time: 2:00 pm thru 3:00 pm
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Tuesday, November 2, 2021
NC Children with Complex Needs Training Series
Evidence-Based and Promising Practices to Support the Workforce and Partners Serving Individuals with Mental Illness and Intellectual and Developmental Disabilities
Session 3: Psychopharmacology for Children with Complex Needs: 1.5 Contact Hours
Time: 10:00 thru 11:30 am
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