Read More About Pretend to be a Time Traveller Day Here

Partners Now has a Welcome to Davidson County Website

(H/T Jacque Millican-Nazareth)

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Funding Opportunity: Department of Labor YouthBuild Grants

February 1. The federal grants go to organizations providing pre-apprenticeship services that support education, occupational skills training, and employment services for at-risk youth, ages 16 to 24, while performing meaningful work and service to their communities. The YouthBuild program model contains wrap-around services such as mentoring, trauma-informed care, personal counseling, transportation support, and employment. Applications from rural, urban, and Native American organizations are encouraged. Each of 75 grantees will receive up to $1.5 million. Last year’s YouthBuild grantees included 15 projects in rural areas. 

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Final Week to Apply: Making Care Primary (MCP) Model

Applications for the Making Care Primary (MCP) Model must be submitted via web portal no later than Thursday, December 14 at 11:59 p.m. EST.

The MCP application is non-binding and should take no more than 15 minutes to complete. Eligibility requirements and additional model details can be found in the Request for Applications (RFA). To support interested applicants in their decision-making, CMS has published an Example Revenue Factsheet which compares potential revenue under Medicare fee-for-service to potential revenue under MCP. Please visit the model webpage for additional resources.

MCP will launch July 1, 2024, in eight states: Colorado, North Carolina, New Jersey, New Mexico, Upstate New York, Minnesota, Massachusetts and Washington, and will operate over a 10.5-year period. This model aims to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, to drive improved chronic disease prevention, fewer emergency room visits, and better health outcomes.



For questions about the Making Care Primary Model, please reach out to MCP@cms.hhs.gov. To stay up to date on upcoming model announcements, events, and resources, sign up for the Making Care Primary Model listserv.

Comment Period for Proposed Rule on Information Blocking Disincentives

Because of its commitment to interoperability and information sharing, the NC HIEA closely monitors the 21st Century Cures Act information blocking regulations as outlined by the Office of the National Coordinator for Health Information Technology (ONC).

On October 30, 2023, the U.S. Department of Health and Human Services (HHS) proposed a new rule detailing its initial plans for holding health care providers accountable for information blocking under the Cures Act. The proposal outlines a set of disincentives for health care providers found to have been engaging in information blocking according to the HHS Office of the Inspector General (OIG).

A formal comment can be made on this proposed ruling on the Federal Register website. Instructions for submitting a comment or contacting the ONC are also found on that page. Written or electronic comments must be received no later than 5 p.m. on January 2, 2024, in order to be considered.

This proposed rule seeks to:

• Refer a health care provider (individual or entity) determined to have committed information blocking ‘‘to the appropriate agency to be subject to appropriate disincentives.”
• Establish disincentives for certain health care providers (as defined in 45 CFR 171.102) that are also Medicare-enrolled providers or suppliers.
• Establish a process by which information would be shared with the public about health care providers that OIG determines have committed information blocking.

The proposals would establish disincentives for certain health care providers through several existing CMS programs, consistent with the Cures Act’s requirement for the secretary to establish disincentives using applicable federal law. OIG enforcement, already in place for other actors as of September 1, 2023, would begin for providers upon finalization of this proposed rule.

We encourage your organization to review the information blocking rules and determine how best to comply with them, to the extent the rules apply to your organization.

NC HealthConnex will continue to facilitate, and not inhibit, participants’ exchange of electronic health information in compliance with information blocking prohibitions. The NC HIEA remains steadfast in its commitment to refrain from engaging in any practice that we know or should know is likely to interfere with, prevent or materially discourage access, exchange or use of electronic health information via NC HealthConnex unless we have a good-faith basis to believe an exception applies.

The NC HIEA will be participating with Civitas Networks for Health in providing comments. If any participating NC HealthConnex providers have comments, please send them to us by December 20, 2023 at hiea@nc.gov with the subject “Comments on Proposed Ruling.”

NEW Resources to Help Providers Educate Patients on Privacy and Security While Using Telehealth Services

Last month, the Office for Civil Rights (OCR) at HHS released new documents to help providers educate patients on the privacy and security of their protected health information (PHI) while using telehealth services. These new resources explain the risks to their PHI when using telehealth and steps to take to reduce these risks.

Providers are not required by HIPAA Rules to provide this education; however, it is helpful for supporting the ongoing use of telehealth services, especially for those who may have trouble accessing in-person services. Assuring patients that their PHI will be kept private and secure can make patients feel at ease and improve communication during telehealth visits.

The first resource to help providers is “Educating Patients about Privacy and Security Risks to Protected Health Information when Using Remote Communication Technologies for Telehealth.” 

The resource provides suggestions for discussing:

• Telehealth options offered
• Risks to PHI when using remote communications technologies
• Privacy and security practices of remote communication technology vendors
• Applicability of civil rights laws

The second resource provided by OCR, “Telehealth Privacy and Security Tips for Patients,” provides recommendations for patients to implement to protect their PHI, including:

• Conduct the telehealth appointment in a private location
• Turn on multi-factor authentication if available
• Use encryption when available
• Avoid public Wi-Fi networks

Additional guidance about the Privacy Rule, Security Rule, and Breach Notification Rules can be found on OCR’s website. You can also read more about the NC HIEA’s security and privacy policies regarding protecting health data.

On-Demand Webinar

The Behavioral Health AI Implementation Playbook

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Related To The Post Above: We Wanted To Share Links For Some Of The Latest Artificial Intelligence (AI) Apps

(May have waiting lists or require a subscription)

Are you ready to delve into the wild world of AI?

From virtual assistants to poetry-writing robots, there are a plethora of exciting tools out there that can help you accomplish all kinds of tasks with ease.

Whether you're a seasoned AI pro or a curious newbie, these AI apps are sure to get your creative gears turning! Have fun! :-)

• Pi: A personal AI assistant that can help with scheduling, research, and more.
• Pika: A fun and creative AI app that can generate poems, stories, and other creative content.
• Grok: An AI-powered tool for analyzing and understanding complex data sets.
• ChatGPT: A conversational AI chatbot that can answer questions and engage in conversations on a wide range of topics.
• Character.AI: A platform for creating and interacting with AI-powered characters.
• Jasper: An AI writing tool that can help with content creation for blogs, marketing copy, and product descriptions.
• You.com: A search engine that uses AI to deliver personalized and relevant search results.
• Bard: A conversational AI chatbot developed by Google.
• Replika: An AI chatbot designed to act as a virtual companion and friend.
• Poem AI: An AI-powered tool that can generate original poems and verse.
• Grammerly: An AI-powered writing assistant that helps improve grammar, spelling, and style in your writing.

Department of Labor Sues UnitedHealth TPA Over Claim Denials

The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis codes and allegedly failed to comply with the requirements of the Patient Protection and Affordable Care Act, as amended (“ACA”) and the DOL’s claims procedures regulation. What makes this lawsuit unusual is that the DOL has requested a nationwide injunction against UMR with respect to allegedly improperly denied claims.

Specifically, the DOL alleges that UMR violated ERISA by denying all urinary drug screenings from August 2015 to August 2018, rather than determining whether a claim was medically necessary.

The DOL also alleges that from August 2018 to the present, UMR allowed some urinary screenings that were done in an emergency setting but changed its denial code in October 2019. The DOL further alleges that the UMR “Explanation of Benefit” forms (“EOB”) also did not comply with the ACA. Specifically, the DOL alleges that after denying a patient emergency room claim, UMR sent an EOB to claimants that had insufficient information. 

The DOL’s lawsuit further alleges that the denied claims did not point to specific plan provisions or rules, did not apply the prudent person layperson standard, did not inform claimants of the informal approval process, and did not state whether there was a lack of documentation or additional information to explain the claims decision.

Finally, the DOL alleges that patients who had urinary drug screening payments denied were similarly given limited information as UMR allegedly did not reference plan provisions or provide a description and explanation of the denied urinary drug screening claims. Interestingly, in a press release regarding the lawsuit, the DOL asserts that:

“UMR’s alleged decision to deny claims violated its obligation as a fiduciary under its administrative service plan documents and the law.”

Third-party administrators and employers of self-funded plans should understand that the DOL is alleging that a systemic failure to address claims properly rises to the level of a breach of fiduciary duty that calls for a substantive remedy (in this case, an injunction). The DOL’s lawsuit against UMR should be monitored to see how this law regarding fiduciary breach develops. In our experience, this is relatively new tactic by the DOL and suggests that a plan’s or third-party administrator’s claims procedures can be important and may be subject to further scrutiny by the DOL and other stakeholders.

Telehealth Providers: HHS Issues HIPAA Best Practices

Recognizing the evolving landscape of care delivery and growth of telehealth, the U.S. Department of Health and Human Services (HHS) published a resource guide aimed at assisting telehealth providers in explaining the privacy and security risks to patients that engage in telehealth. The guide explains the risks in telehealth visits and ways to reduce these risks. Importantly, the guidance makes clear health care providers are not required by Health Insurance Portability and Accountability Act of 1996 (HIPAA) to provide this education. However, the goal is that the resource guide will help providers that would like to discuss potential risks with the patient.

HHS recognizes that ensuring the privacy and security of protected health information can help promote more effective communication between the provider and patient, which is important for quality care. Accordingly, HHS recommends that providers explain the following to patients before a telehealth session:

• The remote communication technologies that the provider will use in the telehealth session. This should include explaining what telehealth is and providingexamples of different types of telehealth services, such as having a health care appointment by telephone or through a video conferencing application.
• The importance of health information privacy and security. Providers should inform patients about the privacy and security protections of the remote communication technologies the provider offers.
• The possible risks to the patient’s information and how to mitigate the risks. Providers should explain that using remote communication technologies for telehealth can come with risks to the privacy and security of information. Some examples of risks that may be relevant to patients may include viruses and other malware, unauthorized access, and accidental disclosures of information. Mitigation measures include anti-malware solutions, patching software, and using headphones to avoid others overhearing the telehealth session.

To help patients protect their health information and avoid potential phishing emails or other scams, providers should ensure that the patient knows when and how they will be contacted by the provider, provider’s office, or the remote communication technology vendor. Information should also be provided about the privacy and security practices of any technology vendor(s) that are being used for the telehealth service.

HHS also released a resource guide targeted at patients, which provides recommendations that patients can independently implement to protect and secure their health information. HHS provides many specific recommendations for patients, including the following:

• Conduct telehealth appointments from private locations.
• Turn off any electronic devices that may overhear or record information, such as smart speakers or security cameras.
• Avoid public computers or mobile devices, if possible, including avoiding public wi-fi connections. 
• Install all security updates available on the electronic devices to be used for telehealth appointments.
• Use strong, unique passwords.
• Delete health information from computers or mobile devices when it is no longer needed.
• Turn on multi-factor authentication and use encryption tools when available.

The message from HHS is clear, privacy and security play an integral part in the healthcare experience. HHS is signaling to the telehealth provider community that privacy and security education should be considered part of the patient intake and onboarding experience. While these best practices are not required to be implemented by providers, the type of information that HHS suggests telehealth providers share with patients can often be addressed in the telehealth informed consent or other intake documentation provided to the patient. Telehealth providers should review their intake process and determine whether these best practices can be incorporated as part of the patient experience.

NC: Best Interest of the Child (May require subscription) (Includes audio)

Assembly & WBTV - December 05, 2023

As of September, 11,000 children were in state custody in North Carolina. On average, they'll stay in the state's care for one to two years. And despite federal and state laws requiring "reasonable efforts" to reunify families, most will never go home. Each year, North Carolina courts terminate the rights of nearly 1,200 parents, who are disproportionately Black and overwhelmingly poor. Only 30 percent of the 5,020 North Carolina children who left foster care in the 2022-23 fiscal year were reunited with their parents. Durham County has some of the state's bleakest statistics: Children stay in foster care for an average of 875 days, according to the N.C. Department of Health and Human Services. The county's reunification rate is just 22 percent-less than half of the national average. Of the 34 Durham parents who lost their rights in the 2021-22 fiscal year, only one was white. This three-part investigation from The Assembly and WBTV examines Durham County's child welfare system and why the county has become a hub of parental rights activism in recent years. Each installment explores the case of a parent who spent years fighting to regain custody of their children. Together, they show a system that sometimes fails to live up to the state's goal of "preventing the breakup of the family" where "desirable and possible."

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NC: Children sleep in offices as foster care falls short (Includes audio)

Blue Ridge Public Radio - December 01, 2023

Since the pandemic, fewer families have been signing up to become foster parents. In North Carolina, the number of licensed foster homes dropped 23% in one year to just 5,436 across the state in 2022, according to federal data. This decline has led to foster children sleeping at department of social services (DSS) facilities across the state. Experts say that they have been advocating for additional resources for children and families for years. The state budget included new health care funding for foster families, but will it be enough to make an impact? In September, a video circulating on TikTok called for donations to help foster children in Jackson County. "One of my closest friends is an investigator for Jackson County DSS. They currently have kids there who have been there since January - living at DSS," TikTok user Rebecca said in a video, becoming visibly emotional. "Sorry, had to take a minute. That takes me out." Community outrage on social media called for funding and support to keep children from having to sleep in office spaces.

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