Provider Updates Sarah Pfau, JD, MPH Senior Policy & Regulatory Affairs Specialist Cansler Collaborative Resources, Inc.
IDD Updates October 30, 2020
NC DHHS BH&IDD Tailored Plan 10/28 Updates
NC DHHS 10/28 TBI Waiver Update • 3-year grant from the federal Administration for Community Living (ACL) • Ends 4/30/2021 • Limited to Alliance catchment area (4 counties) only to date
• Only 37/107 slots currently filled • Two levels of care: 1) SNF; 2) Neurobehavioral • DHHS reviewing Plans of Care, service utilization data, claims data, stakeholder feedback, level of care, and risk & needs evaluation tools
NC DHHS 10/28 TBI Waiver Update Proposed Changes for Next CMS-Approved Waiver Cycle: • Lower eligibility age from 22 to 18 • Increase income eligibility from 100% of FPL to 300% of FPL like CAP/DA • Add Supportive Living as a service definition • Expand to statewide within 5 years • Expand into 1 additional LME/MCO Catchment Area via competitive RFA – release date TBD
Additional NC DHHS Updates NCDHHS Interim Guidance for Long-term Healthcare Facility Antigen Test Reporting (updated 10/6) • Related: Congressional Push for all states to have COVID-19 case reporting to CMS like SNFs to • NC DHHS dashboard of congregate settings: by county, facility type (SNF, Residential, Correctional). (updated 10/27) ------------------------------------------------------------------------------------------------------------------------------------------Guidance on Visitation and Communal Dining (updated 10/16) • Applicable to SNFs, ACHs, BH&IDD ICFs, and PRTFs with > 7 beds. Facilities with < 6 beds refer to “Guidance for Smaller Residential Settings Regarding Visitation, Communal Dining, Group and Outside Activities” here.
Federal Agency Updates October 30, 2020
CMS HCBS Recommended Measure Set RFI: New 11/18 Response Deadline
CMS RFI: Recommended Measure Set for MedicaidFunded Home and Community-Based Services • DRAFT set of recommended quality measures (MLTSS, FFS, NCI-AD, Quality of Life, PCP, etc.). • Requests stakeholder comment on the purpose and organization of the recommended measure set and the criteria used to select measures. • Requests feedback on the potential benefits and challenges that could result from a nationally available set of recommended quality measures for voluntary use by states, MCOs, and other entities engaged in the administration or delivery of HCBS. • The recommended measure set is intended as a resource and to create opportunities to have comparative quality data on HCBS programs and services, including for the purposes of value-based purchasing and alternative payment models. • The recommended measure set it is also intended to reduce some of the burden that states and others may experience in identifying and using HCBS quality measures. • Submit comments electronically to HCBSMeasuresRFI@cms.hhs.gov no later than November 18, 2020. Please note organization name and type (e.g., state agency, MCO, provider) in your response.
Phase 3 U.S. HHS CARES Act Provider Relief Funds Access the Application Here
$20B in NEW Funding (from CARES Act, Paycheck Protection Program, Health Care Enhancement Act) • One-time payment of 2% of annual revenue from patient care authorized from this OR previous phases • Additional, “equitable add-on payment” to factor in with this application: • Change in operating revenues • Change in operating expenses, including related to COVID EXPANDED provider eligibility categories • Healthcare providers who began practicing 1/1/2020 – 3/31/2020 • Medicare, Medicaid, CHIP, Dentists, Assisted Living Facilities, and BH providers • BH providers include addiction counseling centers, MH counselors, and Psychiatrists UPDATES: • 10/28 Amended U.S. HHS FAQs Released • Register for an 11/2 Technical Assistance Webinar
Provider Relief Fund FAQ Changes / Additions •
Use of Funds
HHS makes several additions as it relates to use of funds. They included more details on how the funds can be used for salaries and fringe benefits. It also states that "healthcare related expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, employees, and other healthcare related costs/expenses for the calendar year." The changes also state that the Provider Relief Fund permits reimbursement of marginal increased expenses related to coronavirus and provides examples of increased expenses. The changes also state that G&A expenses can include hiring additional security personnel, increased hazard pay, increased cost of utilities to operate temporary facilities, or similar items attributable to the coronavirus that were not normally incurred. •
Date to use funds
Changes the date that Provider Relief Funds must be used by from July 31, 2021 to June 30, 2021. Providers must return unused money to HHS. •
Transferring General Distribution Funding Across TINs
The FAQs addresses the issue of transferring PRF funding across TINs within one organization for funding received through the General Distribution. The FAQ states "HHS is revising its prior guidance and clarifying that, for General Distribution payments only, a subsidiary TIN can transfer its General Distribution payment to a parent TIN; this is true even if a subsidiary TIN initially attested to accepting a General Distribution payment. Consistent with other longstanding guidance, the parent TIN may use the money and/or allocate the money to other subsidiary TINs, as it deems appropriate." •
Defining Lost Revenues
The changes also include additional information on lost revenues. The changes include language that "lost revenues attributable to coronavirus are calculated based upon a calendar year comparison of 2019 to 2020 actual revenue/net charges from patient care (prior to netting with expenses). The amount of lost revenues eligible for reimbursement through the Provider Relief Fund is capped at the change in 2019 to 2020 actual revenue from patient care related sources, less the Provider Relief Fund amount used to cover healthcare expenses attributable to coronavirus not reimbursed by other sources." •
COVID-19 Vaccines
HHS specifies that PRF funds can be used to pay for COVID-19 vaccine distributions.
Federal and State COVID-19 Vaccines Update CMS Interim Final Rule Summary • • • •
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Target vaccinating Medicare seniors at no cost to enrollees as a high priority Pharmacies and schools will be eligible to be Medicareenrolled “Medicare mass immunizers.” Hospitals that treat COVID patients with innovative new products authorized to treat COVID will be eligible for “outlier payments” for excessive costs that they incur. CMS will provide a free vaccine, but providers (and Health Plans – whether private, Medicare, Medicare Advantage, or Medicaid) may not charge consumers for vaccine administration and may not charge any enrollee copayments. However, when the Public Health Emergency end date passes (currently late January 2021 but likely to be extended), Medicaid programs may need to do State Plan Amendments to continue waiving any beneficiary cost sharing requirements. Providers who immunize uninsured individuals are eligible for reimbursement through the Provider Relief Fund (but keep in mind that those payments are capped at 2% of annual revenue). CMS has new single dose and series dose vaccine administration rates for Medicare. In relation to a separate CMS Final Rule, price transparency for COVID testing is mandatory and providers in violation of posting cash prices online may be subject to civil monetary penalties.
NC DHHS Vaccination Plan and Task Force Report • On 10/16/2020, North Carolina DHHS submitted to CDC its COVID-19 Vaccination Plan. The goal of the plan is to immunize everyone who is eligible for and wants a COVID19 vaccine. North Carolina’s vaccine plan reflects five principles that guide the planning for and distribution of one or more COVID-19 vaccines in the state. The principles include: 1. All North Carolinians have equitable access to vaccines. 2. Vaccine planning and distribution is inclusive; actively engages state and local government, public and private partners; and draws upon the experience and expertise of leaders from historically marginalized populations. 3. Transparent, accurate, and frequent public communications is essential to building trust. 4. Data is used to promote equity, track progress and guide decision-making. 5. Appropriate stewardship of resources and continuous evaluation and improvement drive successful implementation. • Read the full press release.
Federal and State COVID-19 Vaccines Update Disability Rights North Carolina representatives participated on the NC DHHS Task Force and have reported the following: â&#x20AC;&#x153;While I/DD was not emphasized in the release of the plan, People with disabilities living in institutional settings or living and receiving HCBS in the community will be among the first to have access to the vaccine. Support workers caring for people with disabilities will also have the chance to be vaccinated before the general population. In many cases, staff will have the opportunity to be vaccinated before the people they serve because this may be the most efficient way to protect some people with disabilities when medical considerations about who will get the most immunity out of being vaccinated are considered. The Taskforce recognized that vaccinating people with disabilities is an important part of protecting people who are vulnerable to adverse outcomes from COVID-19 and North Carolina communities on the whole.â&#x20AC;?
Access the full report here. North Carolina COVID-19 Vaccination Planning Team. Publication Date 10/16/20.
MH-SUD Updates October 30, 2020
10/5 CMS Guidance: FFPSA and SUPPORT for Patients and Communities Act 1.
Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, (P.L. 115-271, 10/24/2018)
2.
Family First Prevention Services Act (FFPSA), Bipartisan Budget Act of 2018 (P.L. 115-123, 2/9/2018) NOTE: NC DHHS has deferred implementation until September 2021
Guidance Discusses: •
Existing opportunities and flexibilities under the Medicaid program, including Section 1115 and Section 1915 waivers, for states to receive FFP for the provision of SUD treatment for pregnant and postpartum women [including IMD exception as we have in the NC SUD waiver], parents and guardians and, to the extent applicable, their children, in family-focused residential treatment programs.
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How states can employ and coordinate Medicaid funding, title IV-E (Foster Care) program funding, and other HHS programs such as SAMHSA grants targeting pregnant and postpartum women, to support the provision of treatment and services provided by a family-focused residential treatment facility. •
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Beginning 10/1/2019, title IV-E agencies could claim optional title IV-E funding for time-limited (1 yr.) prevention services for mental health/substance use disorder and in-home parent skill-based programs for: 1) a child who is a candidate for foster care; 2) pregnant/parenting foster youth; and 3) the parents/kin caregivers of those children and youth
How states can implement and coordinate funding provided under Medicaid and title IV–E to support placing children with their parents in family focused residential treatment programs. This would include title IV-E foster care maintenance payments (FCMPs) for a child placed with a parent who is receiving SUD treatment services in a licensed residential family-based treatment facility for substance abuse pursuant to the FFPSA.
Direct Link to the 25-page Guidance