Healthy Opportunities Pilots Webinar: Human Service Organizations
Join us on Tuesday, Aug. 31, 2021, from 9:30-11:00 a.m. ET for a webinar on North Carolina’s Healthy Opportunities Pilots.
This webinar will provide an overview of the Pilot program, with a focus on the essential roles and responsibilities of human services organizations that will provide Pilot services to eligible Medicaid members. The webinar will also highlight important upcoming implementation milestones and next steps. The session will be geared towards human services organizations that are interested in providing Pilot services, but is open to the public. There will be time reserved at the end for Q&A.
The Pilots offer the unprecedented opportunity to evaluate the impact of providing evidence-based, non-medical interventions to a subset of high-risk eligible Medicaid members in select regions of the state. The federal government has authorized up to $650 million in state and federal Medicaid funding to cover the cost of providing select Pilot services related to housing, food, transportation and interpersonal safety that directly impact the health outcomes and health care costs of Medicaid members.
DHHS Update Call for BH/IDD Consumers, Family Members and Community Stakeholders
The Division of MH/DD/SAS and Division of Health Benefits (NC Medicaid) remain committed to working hard to assess service gaps, create and amend policies, and direct funding into service areas that will be impactful in preventing the interruption and delay of BH/IDD services during this challenging time. This recurring call will be the fourth Monday of each month in an attempt to help keep consumers, family members and community stakeholders informed and updated on policies and actions impacting service access and health outcomes for BH and IDD consumers, and perhaps more importantly – to hear directly from you about any questions or issues that have emerged since we last communicated. We hope that you can join us. To participate please click on the link below to register:
Participant Log-In Information ONLY (see panelist log-in details below):
After registering, you will receive a confirmation email containing information about joining the webinar.
From DSS: Resource Parent Curriculum (RPC) Staff Facilitator Opportunity
Please see the attached DCDL and attachments sent on behalf of Linda Waite.
Expedited Hardship Advances for Managed Care Providers
The North Carolina Department of Health and Human Services (DHHS) and prepaid health plans (PHPs) are committed to supporting providers during the transition to managed care. We stand by the Day One goal to ensure providers are paid for services they provide. DHHS and PHPs are aware of potentially delayed payments and increased claim denials during the transition period.
As DHHS, PHPs and providers address the various claim processing problems, providers who are at risk of not meeting financial obligations this month as a result of claim processing issues may request a hardship advance to offset the business cost due to pended or denied claims.
Updated Guidance for Non-Emergency Medical Transportation
NC Medicaid is committed to ensuring that beneficiaries are able to get rides to their medical appointments through Non-Emergency Medical Transportation (NEMT) providers. NC Medicaid is sharing updated recommendations for NEMT vendors and drivers related to COVID-19.
The best protection against COVID-19 is a vaccine. NC Medicaid strongly recommends that all employers direct employees to information and encourage them to get vaccinated. It is strongly recommended that businesses:
- Require employees to report vaccination status
- Require employees who are unvaccinated, or do not disclose vaccine status, participate in screening/testing programs.
Extension of Out of Network Provisions
In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to providers who have not yet contacted with a PHP through Nov. 30, 2021. These flexibilities were originally expected to sunset on Aug. 30, 2021.
Under this policy, the PHPs have agreed to:
- permit uncontracted, out of network providers enrolled in NC Medicaid to follow in network provider prior authorization rules and may continue to get a prior authorization retroactively (This exception does not apply to concurrent reviews for inpatient hospitalizations which should still occur during this time period);
- reimburse out of network providers at the in-network rate of 100% of the Medicaid fee schedule;
- delay implementation of the 90% rate reduction following good faith contracting provision;
- allow beneficiaries to change their Primary Care Provider for any reason; and
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extend flexibility for Non-Emergency Medical and Non-Emergency Ambulance Transportation providers through November 2021.
LME-MCO Joint Communication Bulletin #J399: American Society of Addiction Medicine (ASAM) Training Resources
There are four American Society of Addiction Medicine (ASAM) training resources that can now be utilized to meet the proposed training requirements in the ASAM criteria. These requirements were announced in previous bulletins related to changes taking place in preparation for the implementation of the CMS 1115(a) Substance Use Disorder (SUD) Demonstration Waiver.
The following four training resources will meet the training requirements included in Clinical Coverage Policies 8C Outpatient Behavioral Health Services Provided by Direct Enrolled Providers (which outlines the requirements for the Comprehensive Clinical Assessment) and 8A-5 Diagnostic Assessment.
1. UNC Behavioral Health Springboard: UNC will continue to coordinate with Train for Change to provide 2- Day ASAM Criteria Skill-Building Training live virtual sessions and to continue to offer The ASAM Criteria eLearning through The Change Companies for FY21/22. Copies of The ASAM Criteria manual are also available for the cost of shipping. Please refer to the UNC Behavioral Health Springboard website for forthcoming training dates and registration information. https://bhs.unc.edu/asam/dashboard
3. The Change Company offers registration for eLearning (ASAM Modules 1,2 and 3 must be completed to
fulfill the training requirement). Individual and group rates are available.
• Module 1 – “ASAM Multidimensional Assessment”
• Module 2 – “From Assessment to Service Planning and Level of Care”
• Module 3 – “Introduction to The ASAM Criteria”
4. ASAM Criteria Online foundations Course (eLearning Modules).
If you have any questions, please contact Howard Anthony at 919-741-3129 or
LME-MCO Joint Communication Bulletin #J400: To Reiterate Olmstead Obligations and Address Department's Current Initiatives and Planning
North Carolina has an obligation under Olmstead, the Americans with Disabilities Act, and the North
Carolina Persons with Disabilities Protection Act to provide appropriate opportunities for people with disabilities to become fully integrated into the community if they choose to do so. This is more than a legal obligation—it is a moral imperative.
The Americans with Disabilities Act and the Olmstead decision.
The year 2020 marked the 30th anniversary of the signing of the Americans with Disabilities Act (ADA) of 1990. The Act is a civil rights law that prohibits discrimination against people with
disabilities in all areas of public life, including jobs, schools, transportation and all public and private places that are open to the general public. The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else.
In 1999, the United States Supreme Court issued its landmark decision in Olmstead v. L.C., 527 U.S. 581 (1999). The Court found that the unjustified segregation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA) and its “integration mandate.” The integration mandate requires that all public entities, including the State of North
Carolina, “administer services, programs, and activities” for people with disabilities in the most integrated setting appropriate to the person’s needs. “Most integrated setting” has been defined as one
that enables people with disabilities to interact “to the fullest extent possible” with individuals that don’t have a disability.
Specifically, the case requires states to provide services in the community for eligible persons with disabilities when (a) such services are appropriate; (b) the affected persons do not
oppose community-based treatment; and (c) community-based services can be “reasonably accommodated.” Twenty-two years after the Supreme Court’s ruling, there are still far too many people who can – and want to – live in their communities.
Current planning at NC DHHS
NC DHHS is committed to the principle that people with disabilities should have access to the services and supports necessary to enjoy the same benefits of community life as do other North
Carolinians. Each day at NC DHHS, we are working to ensure that all people with disabilities have the opportunity to live, work and fully participate in their communities. We are looking forward to
working with people with disabilities, their families, and our networks and partners to seize the unprecedented opportunities before us and to realize the true promise of Olmstead.
Starting in the Fall of 2019, NC DHHS commenced planning to broaden its efforts under Olmstead and expand the reach of its community-based services. In the Spring of 2020, NC DHHS
organized a stakeholder advisory group comprised of people with disabilities, family members, advocacy groups, state agencies, Local Management Entities/Managed Care Organizations (LME/MCOs), providers and others. NC DHHS is being supported in these efforts by the Technical Assistance Collaborative (TAC), a national nonprofit organization based in Boston, Massachusetts.
The TAC is working closely with NC DHHS to ensure the development of an Olmstead plan that is data-driven, outcome-based, and person-centered. By the end of 2021, NC DHHS will have developed an Olmstead plan. The Olmstead plan will be built upon the foundation of the Department’s existing Olmstead work, such as Transitions to Community Living and Money Follows the Person (MFP) programs as well as the work being done under our four 1915 (c) waivers [Community Alternatives Program for Disabled Adults (CAP/DA), Community Alternatives Program for Children (CAP/C), NC Innovations, and the Traumatic Brain Injury (TBI) waiver], our 1915 (b)(3) services (Supported Employment, Respite, Individual Supports, Transitional Living Skills, and In Home Skill Building), and Intermediate Care Facility for Individual with Intellectual Disability (ICF IID) In Lieu of Services. There will be much to discuss as
the plan is being drafted, and much to share as we begin to work with our stakeholders and legislative leaders to implement these important systems changes in the coming years.
As these plans are being developed, we want to remind all stakeholders that the critical and affirmative obligation to provide for community-based alternatives to institutionalization remains central to our day-to-day work. LME/MCOs are reminded of the following:
