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Upcoming Benchmarks' Webinars
Benchmarks' Friday Membership Webinar
Date: Friday, January 22, 2021
Time: 8:30 am thru 9:30 am
Benchmarks' and i2i Partnership
The Bridge Between System of Care and Medicaid Managed Care: Looking at the Value Proposition
Date: Tuesday, January 26, 2021
Time: 1:00 pm thru 2:00 pm
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FREE WEBINAR
The Bridge Between System of Care and Medicaid Managed Care: Looking at the Value Proposition
Tuesday, January 26, 2021
1:00 - 2:00 p.m.
The BH/IDD Tailored Plan RFA incorporates System of Care as a part of the vision for Medicaid managed care.
This is an important and timely webinar to help you incorporate System of Care into your services under Tailored Plans. System of Care is a national set of guiding principles to address the multiple needs of children and their families. The principles of interagency collaboration, individualized strengths-based care, cultural competence, family and youth involvement, community-based services and accountability align well with the vision for integrated, whole person care in North Carolina. In fact, these principles drive our system toward value-based care by focusing on a collaborative, integrated approach to services and supports.
This webinar offers providers an exciting opportunity to hear how System of Care for children and their families can support your organization in the provision of value-based care.
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| | Kody Kinsley
Deputy Secretary for BH and IDD NC DHHS | |
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| | Liz Manley
Clinical Instructor for Health & Behavioral Health Policy
The Institute for Innovation and Implementation | |
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| Saarah Waleed
Community Mental Health Section Chief NC Division of MH/IDD/SAS |
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COVID-19 Vaccination Update:
Part of this is a repeat from Friday's Update, but includes new information received this morning
Our goal is to vaccinate as many people as quickly as possible given the limited supply of vaccines. Today, we shared that vaccine providers that are ready to expand may vaccinate all health care workers and anyone 65 years and older.
North Carolina moves through vaccination phases by aligning to federal priorities while empowering local health departments and hospitals with flexibility to move to the next priority group as they complete phases and have vaccines available. It is the responsibility of all vaccine providers to ensure equitable access to vaccines. This will mean taking intentional actions to reach and engage historically marginalized communities.
As always, we rely on you as a trusted messenger to help people make informed decisions and take action. NC DHHS has created a suite of communications materials to help you be a spot for accurate information.
You can use these resources to keep your networks and communities informed about the safety and effectiveness of the vaccines, as well as direct them to information that will help them find local vaccination sites. Available in both English and Spanish, the materials include general information about COVID-19 vaccinations and North Carolina's ongoing rollout that can help you inform people of all ages.
In addition, we now have video testimonials that we hope you will use and share!
Our website, YourSpotYourShot.nc.gov, has flyers, fact sheets, postcards in English and Spanish that we ask you to post, print and handout in places where people visit, and share in newsletters. Check the website often for new materials.
UPDATED VACCINE RESOURCES
PRESS RELEASES since the last update include:
Updated REPORTS include:
HCBS Stakeholder Quarterly Update: January 2021
Thank you for your ongoing support. Below, you will find updates and pertinent HCBS-related information:
Stakeholder Meetings:
- Reminder: HCBS updates will be provided via email and the DHHS HCBS Internal Team will schedule face-to-face meetings (conference/virtual calls) as needed.
HCBS Validation
- On July 14, 2020, the Center for Medicare and Medicaid Services (CMS) announced an extended timeframe for states to demonstrate compliance with HCBS settings requirements. This extension allows states an additional year, through March 17, 2023, to demonstrate that their existing HCBS settings comply with the settings rule.
- Joint Communication Bulletin #383 providing details on North Carolinas projected dates for completion of the HCBS settings comply with CMS settings rule was released on December 4, 2020. Please review this information as it relates to our plans regarding moving forward with HCBS Validation processes.
- 4th quarter Validation Quarterly Reports were reconciled by DHHS HCBS Internal Team and will be returned to the LME/MCO's this week.
- The DHHS internal look-behind process was completed for 1st and 2nd quarters.
- The DHHS Internal Team is currently completing reviews on 3rd quarter look-behind sites and will request 4th quarter documentation once 4th quarter Validation Quarterly Reports have been reviewed by the LME/MCOs.
HCBS Database
- The HCBS Database uplift roll-out was completed on October 23, 2020.
- Following feedback from our HCBS Stakeholders and LME-MCOs, DHHS IT worked and resolved reported issues from users including missing options at the end of the assessment and troubleshooting when there are still pending questions not completed by the provider.
If you would like to be removed from this listserv, please reply to this email. Thank you for your continued support of Home and Community Based Services.
IDD/TBI: OPPORTUNITIES FOR INPUT
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Should I Consent to My Ward/Loved One Getting Vaccinated?
Remember that you are obligated to consult your ward and apply the substituted judgment standard; that means making the decision based on their previously expressed wishes and values, not what you or their physician thinks is best for them. If your ward is capable of being involved in the decision-making process, then you must consult them and give them a simple plain language explanation of the risks and benefits. If you do not know your ward's wishes regarding vaccines, you should consider their values and thoughts on medical intervention generally.
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CCHP Releases Report on Private Payer Telehealth Coverage During the Public Health Emergency (PHE)
The COVID-19 pandemic has placed renewed focus on the United States' insurance-based health care system. In March 2020, the largest U.S. health insurers announced that they would waive cost-sharing obligations for COVID-19 tests and treatment, including for telehealth visits. This signaled a different approach from America's health insurance industry in combating the spread of the virus. What followed was a series of temporary and, in some cases, permanent changes to payer's telehealth coverage policies. CCHP staff analyzed coverage policies and bulletins for the largest U.S. private payers and summarized the findings in a new report, Private Payer Telehealth Coverage During the COVID-19 Pandemic.
The report builds on CCHP's COVID-19 research and resources by detailing the efforts that major U.S. health insurance carriers took to expand telehealth access in response to the pandemic. The eligibility windows for these policy changes ranged from March 2020 through the end of the public health emergency (PHE). We focused our analysis on private payer policies that were implemented prior to November 25, 2020. The report provides an overview of the key findings from our analysis and discusses their implications. Among those findings, five stood out:
- All of the national insurance carriers voluntarily expanded telehealth coverage for their commercial health plans on a temporary basis during the PHE.
- Nearly all major insurers (6 of 7) waived cost-sharing for COVID-19 telehealth treatment services and also for non-COVID primary or urgent care telehealth visits.
- Four major insurers agreed to cover limited out-of-network telehealth services, with at least 1 major payer (Anthem Blue Cross Blue Shield) waiving cost share obligations for out-of-network telemedicine visits through Spring 2020.
- Six major payers agreed to reimburse providers at the in-person rate, including for audio-only services.
- The majority of these expansions expired by the end of 2020, while a limited number of payers aligned expiration with the end of the PHE.
It is important to point out that because we conducted our analysis in Fall 2020, we anticipate that many of the coverage policies discussed here may have not been extended by payers and will have expired by the time this report is published. Still, these changes represent a seismic shift from business as usual in private payer telehealth coverage. While many of the more expansive changes have expired, some payers have extended their temporary coverage into 2021 and a few will become permanent.
In particular, the Centers for Medicare & Medicaid Services (CMS) recommendations around audio-only coverage and expanding the originating site to include the home, are likely to become a fixture of major private payer telehealth policies in 2021 and beyond. At least 1 large national carrier has already added several common telehealth services covered during the PHE to their 2021 reimbursement policy. These developments have presented private payers with a unique opportunity to reassess their telehealth coverage policies in light of utilization trends and consumer preferences prompted by COVID-19.
Factsheet on the Consolidated Appropriations Act, 2021 Now Available
The combined relief-spending bill (HR 133) passed by Congress in late December 2020 included several telehealth-related provisions. Chief among them are the addition of a new Medicare payment designation, new flexibilities for rural hospitals, and significant funding for broadband access efforts. Several other notable telehealth-related provisions were tucked into the bill and CCHP has developed a factsheet summarizing what you need to know.
View the Full Fact Sheet.
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Welcome to the redesigned data.cms.gov/beta
Today, the Centers for Medicare & Medicaid Services (CMS) is announcing the beta release of the redesigned data.cms.gov website. The goal of the website redesign is to make it easier for users to discover, access, and understand CMS data. CMS is publicly releasing https://data.cms.gov/beta/ for testing and feedback, so we'd love to hear from you!
View Site Here
CMS releases 2022 Medicare Advantage and Part D Rate Announcement
Today, the Centers for Medicare & Medicaid Services (CMS) announced 2022 Medicare Advantage (MA) and Part D rates three months earlier than usual providing Medicare health and prescription drug plans more time to consider this information as they prepare and finalize their bids for 2022, which are due June 7, 2021. Today's announcement follows the release of the Contract Year 2022 MA and Part D Final rule on January 15, 2021 that includes additional policies applicable to coverage for the 2022 plan year and will potentially lower beneficiary cost sharing on some of the most expensive prescription drugs. This earlier release of the Rate Announcement, along with the policies announced in the 2022 MA and Part D Final Rule, will help Medicare Advantage and Part D plans better plan for 2022 plan costs, in light of the uncertainty associated with the COVID-19 pandemic.
For the past four years, CMS has prioritized flexibility and competition in Medicare Advantage and Part D to spectacular effect. Since 2017, Medicare Advantage premiums have plunged 34 percent, and Part D premiums are down 12 percent. Crucially, these premium reductions have come with new and better benefits, as beneficiaries also enjoy more plan options.
"The vindication of our fresh approach to healthcare policy, one that discards the consensus of the last several decades - prescriptiveness, overregulation, and micromanagement from Washington D.C. at every turn - is complete and undeniable, " said CMS Administrator Seema Verma "CMS's efforts to lower prices and improve benefits has delivered historic results."
Every year, CMS adopts certain payment policies for Medicare Advantage and Part D after considering comments submitted on the Advance Notice. The final policies described in today's Rate Announcement are expected to increase per-capita plan payments by 4.08 percent on average.
The Rate Announcement also: includes the date by which plans must submit requests for changes to the appeals and complaints measures data for Star Ratings; lists the measures included in the Part C and D Improvement measures and the Categorical Adjustment Index for the 2022 Star Ratings; and lists the states and territories with Individual Assistance designations from the FEMA major disaster declarations used in the definition of an affected contract for the 2022 Star Ratings extreme and uncontrollable circumstances policy.
CMS continues to review different measurement concepts provided in response to the Advance Notice, including those for Provider Directory Accuracy (Part C) and COVID-19 Vaccination (Part C). CMS will take the feedback received into consideration as we continue to explore the feasibility of developing measures in these areas.
Today's Rate Announcement also includes final policies on risk adjustment for 2022. Due to requirements in the 21st Century Cures Act, CMS is finalizing the full phase-in of the Part C CMS-Hierarchical Condition Categories (HCC) risk adjustment model that was first implemented in 2020. This risk adjustment model includes variables that count the number of conditions a beneficiary has among those in the risk adjustment model and additional conditions for mental health, substance use disorder, and chronic kidney disease. With the full phase-in of this 21st Century Cures CMS-HCC risk adjustment model, which is designed to calculate risk scores using diagnoses from encounter data submissions, the Part C risk score used for payment in 2022 will rely entirely on diagnoses from MA encounter data and FFS claims as the sources of diagnoses.
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Completely unrelated news for Tiger King peeps and animal lovers everywhere:
Jeffrey Lowe and Tiger King LLC Ordered to Relinquish Big Cat Cubs to United States for Placement in Suitable Facilities
On Jan. 15, 2021, a federal court issued a preliminary injunction in favor of the United States and against Jeffrey and Lauren Lowe, Greater Wynnewood Exotic Animal Park LLC, and Tiger King LLC based on claimed violations of the Endangered Species Act and the Animal Welfare Act.
U.S. District Court Judge John F. Heil III ordered the Lowes to immediately surrender all Big Cat cubs under the age of one year and their mothers to the government for the pendency of the injunction. The court also ordered the defendants to retain an attending veterinarian and to provide records accounting for all animals acquired and disposed of since June 2020. The court further ordered the defendants and anyone acting on their behalf, including Eric Yano and Stephens Lane LLC, to cease exhibiting animals without a valid U.S. Department of Agriculture (USDA) license. "The Lowes have showed a shocking disregard for both the health and welfare of their animals, as well as the law," said Acting Assistant Attorney General Jonathan D. Brightbill of the Justice Department's Environment and Natural Resources Division. "We are gratified the court agrees and ordered Mr. Lowe to stop ignoring his obligations under the Animal Welfare Act and the Endangered Species Act." "This decision sends a clear message to both licensed and unlicensed exhibitors of the Animal Welfare Act's reach," said USDA Acting General Counsel Tyler S. Clarkson. "USDA looks forward to continuing its close partnership with the Justice Department to litigate these cases and enforce the Animal Welfare Act." The court found that the Lowes' failure to provide safe conditions, proper nutrition, and timely veterinary care resulted in harm to a number of animals, including the death of two tiger cubs less than a week apart. Such evidence indicated that the defendants' remaining Endangered Species Act protected animals are at risk of harm and convinced the court to grant the government's motion for temporary restraining order and motion for preliminary injunction. The court also found that the defendants' pattern and practice of providing substandard care and their failure to employ a qualified attending veterinarian placed the health of the defendants' animals in serious danger under the Animal Welfare Act, requiring injunctive relief. Although long authorized by statute, this case marks the first time that the government sought civil judicial injunctive relief under the Animal Welfare Act. The court was not persuaded by the defendants' argument that they were not "exhibitors" under the Animal Welfare Act because the zoo was still under construction. The court found that the Lowes' prior licensure and exhibition of animals, promoting Tiger King Park's grand opening, making their animals available to the public through online platforms for compensation, and allowing camera crews onto the property to film for a show to appear on Netflix constituted "exhibiting" as contemplated by the Animal Welfare Act. Trial attorneys from the Environment and Natural Resources Division's Wildlife and Marine Resources are handling the case. They are assisted by attorneys from the Civil Division of the U.S. Attorney's Office for the Eastern District of Oklahoma. The case is being investigated by USDA's Animal Plant and Health Inspection Service and the Department of the Interior's Fish and Wildlife Service. Read Here
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Upcoming Events
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Tuesday, January 19, 2021
Using Innovative and Alternative Approaches for De-Escalating Individuals in Crisis Situations
Time: 2:00 pm thru 3:00 pm
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Thursday, January 21, 2021
Clinical Quality Webinar Series-Diabetes
Time: 5:30 pm thru 6:30 pm
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New: Thursday, January 21, 2021
PROPOSED I/DD & TBI STATE-FUNDED SERVICE UPDATE
Time: 6:00 pm thru 7:00 pm
Call-in: +1-415-655-0003
Access Code: 178 820 9354
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Friday, January 22, 2021
Benchmarks' Friday Membership Webinar
Time: 8:30 am thru 9:30 am
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Friday, January 22, 2021
SESSION 2: Provider Engagement and Education (NC's Dr. Shannon Dowler will be presenting)
Time: 2:00 pm thru 3:30 pm
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Tuesday, January 26, 2021
The Bridge Between System of Care and Medicaid Managed Care: Looking at the Value Proposition
Time: 1:00 pm thru 2:00 pm
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Wednesday, January 27, 2021
Session 2
Post-Acute Care and Long Term Care Facility Pandemic Response Best Practices and Lessons Learned
Time: 2:00 pm thru 3:00 pm
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Wednesday, January 27, 2021
NC Medicaid Transition to Managed Care
Time: 3:00 pm
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Thursday, January 28, 2021
Tips for Keeping Kids Safe Online
Time: 10:00 am thru 11:30 am
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Thursday, January 28, 2021
Time: 1:00 pm thru 2:00 pm
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Friday, January 29, 2021
SESSION 3: Patient Engagement and Education
Time: 2:00 pm thru 3:30 pm
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Tuesday, February 2, 2021
Medicaid Managed Care Organization (MCO) Learning Hub - Webinar on MCO Investments in Affordable Housing
Time: 2:00 pm thru 3:00 pm
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Thursday, February 4, 2021
Medicaid Managed Care Fireside Chat Series: Value-Based Payment/Advanced Payment Models & Quality
Time: 5:30 pm thru 6:30 pm
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Friday, February 5, 2021
SESSION 4: What's Next? A Roadmap for Telehealth Policy Beyond the Pandemic
Time: 2:00 pm thru 3:30 pm
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Thursday, February 11, 2020
Save The Date: A State-Wide Convening on the Direct Care Workforce
Time: 9:00 am thru 12:00 pm
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Thursday, February 11, 2021
Time: 10:00 am thru 12:00 pm
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Friday, February 12, 2020
Save The Date: A State-Wide Convening on the Direct Care Workforce
Time: 9:00 am thru 12:00 pm
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Thursday, February 18, 2021
Clinical Quality Webinar Series-TBD
Time: 5:30 pm thru 6:30 pm
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Tuesday and Wednesday, March 2 & 3, 2020
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Thursday, March 4, 2021
Medicaid Managed Care Fireside Chat Series: Policy Approvals, Process Changes and Appeals
Time: 5:30 pm thru 6:30 pm
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Please click on each of the following links to view details sent out from each LME/MCO.
Benchmarks' wants to be sure to make the following list handy for our members to visit and suggests a peek at least once per week to find information that may be pertinent to your agency and contracts.
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