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Benchmarks' Friday Members Webinar

Featuring Cindy Ehlers-Trillium & Karen McLeod-Benchmarks

February 16, 2024

PHD Laboratory/Benchmarks Webinar

February 22, 2024

Clinical Consolidation Communication Bulletin 15

When submitting a tar, please mark/ fill in the Locus and Calocus required boxes with the number 1.



Trillium is working to get this updated in TBS as no longer a required element.

All questions related to this Non-Covered Medicaid Benefit under EPSDT can be sent to [email protected]. Questions will be responded to as quickly as possible. We are working to address other questions and concerns as quickly as possible. Thank you for your patience while we transition. 

Clinical Consolidation Communication Bulletin 16

This communication serves as a reminder of the transition of benefits from B3 services to 1915i services under NC Demonstration 1115. Trillium wants to ensure all stakeholders know where to ask questions or seek answers on the transition. Trillium is posting an internal FAQ.   

Please use this SmartSheet to send questions to Trillium Health Resources. This will help us build a list of FAQs to share.

Division of Health Benefits also publishes a Fact Sheet with FAQ on this transition.

The excerpt below is from the NC Medicaid Fact Sheet. 

“Home and community-based services (HCBS) provide opportunities for community integration, enabling Medicaid enrollees to obtain services in their community. North Carolina’s local management entities/managed care organizations (LME/MCOs) provide 1915(b) (3) services, which offer a critical set of HCBS to Medicaid enrollees with significant behavioral health needs and intellectual/developmental disabilities (I/DD). Because Behavioral Health I/DD Tailored Plans will be operating under North Carolina’s 1115 demonstration, they will no longer be able to provide services under the 1915(b) (3) authority. To ensure that individuals maintain access to these critical services when Tailored Plans launch, North Carolina is transitioning 1915(b) (3) services to 1915(i) service.

Federal rules require that to obtain 1915(i) benefits, an individual must obtain an independent assessment to determine eligibility for 1915(i) services and to be used to develop a service plan, called a Care Plan for individuals with behavioral health needs or an Individual Support Plan (ISP) for individuals with an I/DD or traumatic brain injury (TBI) in North Carolina. This FAQ provides answers to common questions about North Carolina’s transition from 1915(b) (3) to 1915(i) services.”

In response to the COVID-19 public health emergency (PHE) in March 2020, the Centers for Medicare & Medicaid (CMS) approved several flexibilities to the Innovations Waiver to support waiver members to ensure they remain safe in their communities during the PHE. While some of the flexibilities have been added to the Waiver, other flexibilities will end effective Feb. 29, 2024.  

To support Innovations Waiver members, families, and providers in sunsetting flexibilities and amendment changes, the guidance below outlines the flexibilities and amendment changes.

See Document Here

Additional communications around the sunsetting of Innovations Waiver Appendix K Flexibilities & Innovations Waiver Amendment Changes, please see Network Communication Bulletins #332, #333, #335, #336, #337, and other previous Network Communication Bulletins for more information.

Any questions about this Communication Bulletin may be sent to the following email: 

[email protected]

Register Now: All Provider Meeting

Feb 27, 2024 09:42 am

The next All Provider Meeting will be held virtually on Wednesday, March 13, 2024 from 1:00 PM -3:00 PM. Please join us for updates on the public health system and Alliance-specific announcements. Participants must pre-register using this link.

The post Register Now: All Provider Meeting appeared first on Alliance Health.

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SR-AHEC Training Announcement: The Family Dynamics of Addiction

Feb 27, 2024 09:23 am

Twenty percent of children in the United States live with someone with a substance use issue. Yet, those children are often misunderstood and often dismissed as resilient. This presentation on March 12 from 9:00 AM – 12:15 PM will take

The post SR-AHEC Training Announcement: The Family Dynamics of Addiction appeared first on Alliance Health.

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Clarification on B3 Code Changes

Feb 26, 2024 04:19 pm

Clarification on B3 code changes Effective July 1, 2023, there were changes to some B3 Service Codes. Please see the Grid below that outlines these changes. B3 Code End Dated 6/30/2023 Service Description B3 Code Beginning 7/1/2023 Service Description H0045

The post Clarification on B3 Code Changes appeared first on Alliance Health.

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Recent Posts:

Save the Date: All Provider Meeting

NC Medicaid Webinars and Provider Fact Sheet – Direct Care Worker Wage Increase Initiative

Sunsetting of Appendix K Flexibilities for NC 1915 (c) Innovations Waiver and Traumatic Brain Injury (TBI) Waiver

SR-AHEC Training Announcement: Preventing and Planning for Mental Health Crisis with People with IDD

Billing and Enrollment Provider Training

Utilization Management Update:

Attention 1915(i) Providers and Tailored Care Management Agencies

Partners Utilization Management (UM) is aware providers have experienced difficulty requesting multiple authorizations for the 1915(i) Community Living and Supports (CLS) service codes. To simplify the process, Partners has created an “ALL” code for these authorizations.

What is happening?

Partners has created an “ALL” code for 1915(i) CLS so providers can submit multiple 1915(i) service codes on one authorization. Partners will apply used units to the authorization for T2013TFU4 1915(i) CLS.

What action is Partners taking?

Partners UM is combining 1915(i) CLS authorizations for members already authorized for more than one 1915(i) CLS service code. (For example, T2013TFU4 and T2012U4.) Partners will change these authorizations to the “ALL” code.

What do providers need to do?

Providers should submit new authorizations for any 1915(i) CLS service by requesting the base code T2013TFU4 with Treatment Type “1915(i) CLS.” Units should be bundled. Providers do not need to submit separate authorizations for other 1915(i) CLS service codes, including T2012U4, T2012GCU4 and T2013TFHQU4.

Providers should review their contracts and confirm the 1915(i) CLS base code T2013TFU4 is in their contract for all sites where any 1915(i) CLS service is provided. Authorizations can only be generated for sites associated with service code T2013TFU4.

Provider Communication Bulletin #149

Click below to read articles in this month's bulletin.

• Relative as Direct Support Employee (RASDE) Update
• Weekly State-Funded Services Waitlist Submission Requirement
• NC-TOPPS Information
• Claims Information
• Utilization Management Updates
• State News and Updates
• Training Resource and Collaborative (TRAC)
• Community Training
• Additional Events and Training  

Download and Print

Issue 39

Feb 22 2024

IN THIS ISSUE: Provider Touchpoint | New Launch Date: Healthy Opportunities Pilot | Draft Olmstead Plan Available for Public Comment Through March 7 | Share Your Thoughts! Vaya 2024 Provider Satisfaction Survey | 1915(i) Authorization Guidelines Posted | NC Launches Additional Phone Support for People with Behavioral Health Needs | Update: Standardized NC CORE Payment Model for IPS-SE | 1115 Substance Use Demonstration Waiver Update | NC Innovations Waiver Amendment: Relative as Direct Support Employee (RADSE) Update | Scholarship Opportunity for Individuals Interested in Pursuing Their Clinical License

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Issue 40

Feb 26 2024

IN THIS ISSUE: Direct Care Worker Wage Increase Initiative: NC Medicaid Fact Sheet | NC Innovations Waiver DCW Rate Increase: A Webinar for Providers | NC Medicaid Community Partners Webinar: An Update on Medicaid | Now Open: Vaya 2024 Provider Satisfaction Survey

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Issue 41

Feb 29 2024

IN THIS ISSUE: Provider Touchpoint | Quick Fix: Provider Portal Login Issue | Public Comment Open through April 7: 1115 Substance Use Demonstration Waiver Policies | Funding Available: Nicotine Replacement Therapy for Uninsured Individuals Receiving Substance Use Treatment | Supporting Dually Diagnosed Youth and Families: Two-Part Workshop

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In The Know with BPCI Advanced February 14, 2024 Edition

We are excited to share that we have made changes to the BPCI Advanced existing webpages to improve their look and function. If you haven’t already checked our webpage, we want to remind you of the many resources available there. The homepage highlights values and goals of the model, and also contains links to important documents, such as our evaluation reports, technical documents, and physician focused materials.

The Participant Resources page is also linked from the home page, and has more in depth resources for model Participants. Additionally, information about BPCI Advanced quality measures can be found on the BPCI Advanced Quality Measures page, also linked on the home page.

Our revamped website hopes to assist Participants, value-based care stakeholders, researchers, and Medicare enthusiasts to follow the happenings of BPCI Advanced and our journey in testing value-based care in the healthcare marketplace.

In addition to the resources described above, the BPCI Advanced webpage also offers an interactive map that can show BPCI Advanced Participants at the state level. Each blue dot represents healthcare facilities where BPCI Advanced is being tested. This map is available for all Innovation Center models. It allows for beneficiaries and Medicare providers to pinpoint organizations that are involved in value-based care testing. We hope this map can bring forth transparency and community among providers and beneficiaries.

Value Based Care Trivia!

Let’s test our knowledge of value-based care!

Have you heard the term “benchmark” used in models at the Innovation Center? We use the term benchmark in BPCI Advanced. But what does it mean?

Within CMS Innovation Center models, financial benchmarks are used to calculate a price for health care services such as lab testing and diagnostic care, preventive care such as screenings, as well as therapies, treatments, durable medical equipment and medical procedures.

Several CMS Innovation Center models use financial benchmarks to calculate a price for multiple services bundled together or the total cost of care – across doctors and treatments – during a particular health episode.

The CMS Innovation Center typically sets financial benchmarks for a model test based on 

• How much CMS has historically paid for the related health care service(s)
• How payments might change during the testing of the model 
• The characteristics and health of the patients served by the model

In some CMS Innovation Center models, model participants, such as doctors and hospitals, use these benchmarks to measure whether they can improve quality of care while decreasing or not increasing costs. CMS may make incentive payments to model participants who maintain or improve the quality of care while keeping costs below the benchmark by making improvements such as better care coordination.

Licensure Complexities Related to Using Telehealth Across State Lines

Two new reports have recently been released discussing states with licensure exemptions or registration processes specific to the use of telehealth by out-of-state providers. One report, titled, In 30 states you can’t use telehealth with out-of-state doctors, was released by the Pacific Legal Foundation (PLF), which also is the organization that filed the lawsuit alleging New Jersey’s licensure laws are unconstitutional which CCHP discussed in detail within its January 23^rd Newsletter. Additionally, a second report, issued by the Cicero Institute titled, The third annual telehealth innovation report, highlights 27 states that have barriers to cross-state-line telehealth. The discrepancies between the two reports are largely based on different definitions and interpretations of existing laws, demonstrating how confusing navigating telehealth across state lines can be for both providers and patients. In addition, the differences present the importance of reviewing each law directly in order to truly understand what the policies both require and allow in the various circumstances that arise in terms of virtual medical care.

The PLF article acknowledges that while 30 states do not have general out-of-state provider telehealth allowances, there are limited exceptions in those states that still may apply to certain situations. For example, Alabama has an exception from in-state licensure for “irregular or infrequent” visits, and Alaska, Illinois, and Washington allow exceptions if the provider already has an established relationship with the patient. Utilizing information tracked for each state in CCHP’s Policy Finder, we find that 24 states have some kind of licensure exception – though the exceptions vary widely and often are limited. Additionally, 17 jurisdictions have telehealth registration processes, or something similar, in place – although they sometimes only apply to certain providers. Some states have both licensure exceptions and registration processes, including Arizona, Delaware, Florida, and Oregon. According to CCHP’s Policy Finder, 12 jurisdictions do not currently have specific licensure exceptions or telehealth registration processes, however 9 of those jurisdictions are members of various licensure compacts, which technically also offer another route for out-of-state providers to address the licensure issue.

The Cicero report covers a variety of issues outside of licensure that may complicate and limit the use of telehealth. For instance, whether state laws are modality neutral and allow for the use of technology broadly, including audio-only and store-and-forward modalities. In addition, the report assessed laws that may limit the ability to establish a provider-patient relationship via certain types of technology. While the report found licensure to be the main policy area with barriers, providers should be aware that practicing across state lines via telehealth requires providers to abide by all state laws where the patient is located, including those that may place limitations on the modalities used (as well as federal laws such as those related to prescribing controlled substances) or require consent before telehealth is used.

The major takeaway from both reports is that it is indeed complex to navigate and apply each state’s requirements to the provision of care via telehealth across state lines. As pointed out in the PLF article, the “simplest” way for providers to ensure they can provide care in all instances is getting licensed in all states, however that is not feasible for most. The article states the upfront costs would be more than $90,000, not to mention the annual renewal fees would be over $11,000. Therefore, the providers best able to navigate such requirements are larger corporate providers, not individual providers, especially those that may have specific expertise needed by patients with specialty care needs. Both the PLF article and Cicero Institute report seem to favor states instituting a process for interstate telehealth registration in order to address licensure limitations to telehealth. Nevertheless, most state telehealth registration processes still require upfront costs and fees in order to receive board approval. At this point, more states seem to be willing to pass limited exceptions or enter into licensure compacts as a way of addressing the licensure issue. A recent JAMA Network article also discussed advantages of licensure exceptions to increase telehealth access, though they may be limited and difficult for providers to be aware of and comply with. The article discusses the potential of adopting uniform exception language across states, which has been developed by various groups, however that would require coordination by states.

In some cases, it is possible that the laws haven’t been updated to accommodate telehealth and address these instances directly. There have been many new laws and exceptions passed since the pandemic highlighted licensure barriers though, and there are likely many more to come as well – especially pending the outcome of the aforementioned lawsuit challenging New Jersey’s licensing laws. Another new study in JAMA Network Open reveals how utilization of out of state telemedicine surged during the COVID-19 emergency in light of the licensing waivers (though the extent of waivers varied by state). However, once the waivers expired instead of switching to in-person care, patients tended to simply stop seeing their physician altogether. This phenomenon raises concerns for patient continuity of care and demonstrates how changes in policy can have significant impacts on both providers and patients.

For more information on the PLF report, please review the article discussing state telehealth rules, and the Cicero Institute report can be viewed on their website. To review all laws and policies impacting telehealth by state, and federally, please access CCHP’s Policy Finder. 

To Support Kinship Caregivers, Systems Serving Children and Families Must Collaborate on Delivering Services

In 2022, more than 2.5 million children were being raised in kinship care (i.e., by a grandparent, other relative, or close family friend). While children whose parents are unable to care for them do better when cared for by kin than by non-kin, the additional responsibility and changing family relationships can create challenges for kinship caregivers that may threaten their health and restrict their ability to provide optimal care to their relative children. However, when systems work together to provide supports (see Figure), kinship caregivers can provide safe, stable, and loving homes to the children in their care. This blog describes challenges faced by kinship caregivers and their children and offers suggestions for how systems can work together to provide a safety net.

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The National Center on Substance Abuse and Child Welfare (NCSACW) is excited to share our latest series—Building Hope for Families Affected by Substance Use and Mental Health Disorders: A Blueprint for an Effective System of Care to Promote Lasting Recovery and Family Well-Being.

Access the Building Hope for Families blueprints and webinar to learn more.

Prevention Matters Podcast: The official podcast of the

National Prevention Science Coalition to Improve Lives

Anthony Petrosino

Director

Justice & Prevention Research Center at WestEd

Expert Bio

On Episode 8 of the Prevention Matters podcast, our host Dr. Robert LaChausse, talks with Anthony Petrosino from the Justice & Prevention Research Center at WestEd. In his role, he focuses on high-quality research to identify solutions that promote positive community and school environments. Anthony talks about his career studying violence prevention, the effectiveness of Scared Straight programs, how to best prevent youth violence and his favorite cop movie. 

Play Episode 8

Kahoot! Quiz on Underage Drinking

How does alcohol affect a teen’s health? Test your knowledge about underage drinking with an online quiz, now available from Kahoot! The National Institutes of Health (NIH) has partnered with Kahoot!, an online learning platform, to provide free interactive quizzes and games for educators and learners. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is excited to have content available in NIH’s Kahoot! quiz collection.

High schoolers, whether at home or in the classroom, can take NIAAA’s Kahoot! quiz about underage drinking to learn how alcohol affects their brain and body. The quiz is designed to help students have a better understanding of underage drinking, the negative health consequences associated with drinking, the signs of an alcohol problem, and how they can find support for friends, family, or themselves.

Explore NIAAA’s other resources for students, educators, and parents about underage drinking, including the new website Facts About Teen Drinking. This resource, designed for teens, contains more in-depth information about how alcohol affects health–both short and long term–how to identify signs of a problem, and how to get help.

You can visit NIH’s Kahoot! profile page for quiz content from other NIH components. Topics include teen depression, superbugs, health literacy, lung health, and more.

Learn More

Navigating the Future: How Artificial Intelligence is Reshaping Health Care

Despite AI’s promising ability to improve health outcomes and transform medicine, there is a potential to disrupt care and introduce risks resulting in harmful and inequitable outcomes. Health care stakeholders are beginning to explore the role of regulatory bodies and their approach to AI in the health care sector.

Watch our recent webinar to hear experts provide valuable insights on artificial intelligence and its implications for the health care system. In this webinar panelists discussed:

• Separating myths from tangible advancements to help understand the challenges and limitations of AI. 
• Real-world cases where AI is transforming patient care and empowering clinicians.
• Ethical and legal challenges associated with integrating AI into health care.

View Recording and Panelist Slides

Some lawmakers call for review of decades-old law that governs hospital authorities

By Michell Crouch, NC Health News/ Charlotte Ledger

Three North Carolina legislators said they are interested in revisiting the state law that gives special privileges to hospital authorities such as Atrium Health, noting that today’s multibillion-dollar hospital systems are nothing like the ones lawmakers had in mind when the law was written.

The hospital authorities act was written in 1943, “when a lot of county-owned hospitals were struggling to keep their doors open,” said Rep. Donny Lambeth (R-Winston-Salem), a former hospital administrator who is a co-chair of the House Health Committee in the state legislature. 

“It’s different today when they’re making billions.”

Rep. Larry Potts (R-Lexington) and Sen. Jim Burgin (R-Angier) told The Ledger/NC Health News that they, too, have concerns about the law.

Read more...

NC: Revival of Angel's Watch Program provides a lifeline for Western North Carolina families (Includes video)

WLOS - February 20, 2024

A program to help families that are in crisis is relaunching in Western North Carolina. The Angel's Watch Program is made possible through the nonprofits Caring for Children and Eckerd Connects. It's a voluntary program dedicated to supporting children up to 10 years old during family crises and finding temporary placement for them in licensed host homes for up to 90 days. The program was in effect until 2018, when it, unfortunately, lost funding. But, now it's back.

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