JANUARY 13, 2022 | COMMUNICATION BULLETIN 2021-22 ISSUE 38 IN THIS ISSUE: Q&A Webinar for Vaya Network Providers | Office Hours Sessions for Legacy Cardinal Innovations Providers | Technical Assistance Sessions for Legacy Cardinal Innovations Providers | Extension of Deadline for Retroactive Authorization Request Submission | Extension of Deadline for Retroactive Authorization Request Submission | HHAeXchange Placements | Innovations Waiver Self-Review Tool | Helping Members to Move from Standard Plans to NC Medicaid Direct or the LME/MCO | Attention Legacy Cardinal Providers: Comprehensive Clinical Support and Case Support Services | NCDHHS Releases Olmstead Plan | Reminder: Regional Referral Form | AFL Site Reviews and Credentialing for Transitioning Cardinal Innovations Providers | CMS Vaccine Rule for Certain Medicaid Providers
Q&A Webinar for Vaya Health Network Providers Friday, Jan. 21, 2022, 11 a.m. – 12:15 p.m. Vaya’s Provider Q&A Webinars are an important source of the most up-to-date information on topics that affect Vaya network providers. Recently, much of this information has focused on Vaya’s consolidation with Cardinal Innovations. We will dedicate the first 30 minutes of next week’s webinar to general Q&A. The next 30 minutes will focus on legacy Cardinal Innovations providers. All network providers are encouraged to attend. Registration is not required. The link to each webinar is published both the week prior to and the week of the event in Vaya’s weekly Provider Communication Bulletin.
Q&A WEBINAR FOR VAYA PROVIDERS – JAN. 21, 2022
Office Hours Sessions for Legacy Cardinal Innovations Providers During January, Vaya will offer Provider Transition Office Hours sessions. These drop-in sessions will be staffed by Vaya subject matter experts who can help legacy Cardinal Innovations providers with any questions or issues they may have. Upcoming sessions will be announced in the Provider Communication Bulletin the week prior to the event. Please note: Because sessions use a drop-in format with the potential for multiple providers to be in the same session simultaneously, we will not be able to discuss member-specific issues during this time.
OFFICE HOURS: TUESDAY, JAN. 18, 9-11 A.M.
OFFICE HOURS: WEDNESDAY, JAN. 19, 1-3 P.M.
OFFICE HOURS: FRIDAY, JAN. 21, 2-4 P.M.
Technical Assistance Sessions for Legacy Cardinal Innovations Providers Vaya will offer 30-minute technical support sessions through Jan. 31, 2022, for legacy Cardinal Innovations providers who need additional assistance using AlphaMCS. Topics include navigating AlphaMCS, service authorization request (SAR) entry, claims entry, EDI enrollment, state-funded member enrollment, and login issues. Providers must review the AlphaMCS educational resources offered through the AlphaMCS Portal University before requesting a technical assistance session. To register for a session, complete the online request form.
Extension of Deadline for Retroactive Authorization Request Submission Vaya is extending the period for retroactive service authorization requests (SARs) for providers serving members in legacy Cardinal Innovations counties. These providers may now submit SARs for retroactive authorization on or before Feb. 15, 2022. The previous submission deadline was Jan. 16, 2022. Please direct any questions to Vaya’s Utilization Management team at UM@vayahealth.com or 1800-893-6246, ext. 1513.
HHAeXchange Placements On Jan. 12, 2022, Vaya created placements in HHAeXchange for services from legacy Cardinal Innovations providers. Although these placements are not yet associated with authorizations, this step will enable providers to log visits and bill for services through HHAeXchange, and claims can be adjudicated at this time without “looking” for an authorization. To connect affected services to the corresponding authorizations, these claims will be readjudicated once authorizations from Cardinal Innovations have been uploaded.
INNOVATIONS WAIVER SELF-REVIEW TOOL Beginning Jan. 1, 2022, providers serving NC Innovations Waiver participants in the nine legacy Cardinal Innovations counties will be responsible for completing Vaya’s Innovations Waiver Self-Review Tool. This tool, located on the Forms page of the Vaya Provider Central website, must be submitted quarterly for each member who participated in Innovations Waiver services during the quarter. Providers must email the completed tool to CCMProgramAssistants@vayahealth.com no later than the 10th of the month following the calendar quarter being reported. The next submission deadline will be April 10, 2022, for the third quarter of FY 2021-22. NCDHHS has approved this form and process. For more information, review our Self-Review of Innovations Member Record Job Aid . If you have questions, please email provider.info@vayahealth.com.
Helping Members to Move from Standard Plans to NC Medicaid Direct or the LME/MCO NC Medicaid Direct (formerly known as Fee-for-Service or traditional Medicaid) is the Medicaid program for people who do not receive their Medicaid services through a Prepaid Health Plan (Standard Plan or, effective Dec. 1, 2022, a Behavioral Health I/DD Tailored Plan). While physical health services are the same for all individuals with Medicaid, some services for people with an I/DD, mental illness, traumatic brain injury, or substance use disorder are only available in NC Medicaid Direct and/or through the LME/MCOs. It may benefit an individual to transition to NC Medicaid Direct and/or their LME/MCO if they need these services. Providers can help members who need these services move from a Standard Plan to NC Medicaid Direct and/or an LME/MCO by completing the Request to Move to NC Medicaid Direct (Fee for Service) or LME/MCO Beneficiary Form (Request to Move Form). Please follow all directions on the form and submit completed forms to the NC Enrollment Broker digitally at https://ncmedicaidplans.gov/submit-forms-online or by calling 833-870-5500 to request a downloadable form version that can be mailed or faxed. More information about the Request to Move process is available in this NC Medicaid Fact Sheet . If the Request to Move is approved, but a Service Authorization Request (SAR) Form is not attached, the member will transition to NC Medicaid Direct and/or the LME/MCO effective on the first day of the month following receipt of the request by the Enrollment Broker. If a member has an urgent need for a service that is only available through NC Medicaid Direct or an LME/MCO, the provider may submit the Request to Move Form and include a SAR Form and supporting documentation. If the request is approved, the Enrollment Broker will send the SAR and supporting documentation to Vaya for prior authorization review, and the member will transition to NC Medicaid Direct and/or the LME/MCO effective on the date the Request to Move Form was received. Please note that approval of the Request to Move does not mean the requested service is approved. To ensure Vaya’s Utilization Management (UM) team is able to review the service request, please include Vaya’s SAR Form and supporting documentation when submitting the Request to Move Form. All required fields on the SAR Form must be complete for UM to process the request. If you have Vaya-specific or member-specific questions related to this process, please email member.services@vayahealth.com . For more information about NC Medicaid health plans, benefits, services, or general information, visit ncmedicaidplans.gov .
Attention Legacy Cardinal Innovations Providers: Comprehensive Clinical Support and Case Support Services At this time, Vaya does not offer Comprehensive Clinical Support (G2021 CR) and Case Support (T1016 CR) as part of our Medicaid(b) benefit package. Vaya is actively seeking approval from NC Medicaid to add these “in lieu of” services (ILOS) to our Medicaid service array. In the meantime, we ask that all Vaya network providers who provided Comprehensive Clinical Support and/or Case Support as part of their Cardinal Innovations contracts delay billing for these two services for the next 30 days, or until Vaya receives final approval from NCDHHS. Upon approval by NC Medicaid, Vaya will notify providers in an official communication and load all codes into provider contracts. If you are providing either service to Vaya members who may need to transition to an existing Vaya service while approval is pending, please email us at provider.info@vayahealth.com to discuss transition options.
NCDHHS RELEASES OLMSTEAD PLAN
NCDHHS has published its Olmstead Plan. The plan serves as a blueprint for how NCDHHS, the Office of the Governor, and other governmental agencies will make decisions regarding services for people with disabilities who receive or who are eligible to receive publicly funded services. The Olmstead Plan was developed with stakeholders from across the state with the goal to divert people from entering institutions and to support individuals wishing to leave institutions. It outlines an approach to services and supports vital to community living where individuals with disabilities can reside alongside those without. Read more: North Carolina’s Olmstead Plan (Dec. 20, 2021)
Reminder: Regional Referral Form Hospitals and other providers that refer Vaya members to a state hospital must fax the Regional Referral Form to Vaya’s Member Services department at 1-877-917-9887. Please call Member Services at 1-800-849-6127 prior to faxing the form to alert us to the incoming fax.
AFL Site Reviews and Credentialing for Transitioning Cardinal Innovations Providers Vaya’s Site Review team is available to legacy Cardinal Innovations providers with any AFL questions. Vaya’s Site Review Specialists will contact transitioning providers to schedule an annual site review for transitioning homes. To notify Vaya of a new unlicensed AFL or any changes to an existing unlicensed AFL, submit the AFL Update Form , located on the Vaya Provider Central website Monitoring page. Notification is not necessary for sites and locations that are already credentialed with Cardinal Innovations. For more information, email AFL.Info@vayahealth.com. Site Review Information Vaya conducts annual reviews of unlicensed AFLs to monitor for member safety. Unlicensed AFLs must be reviewed before a member moves into the home and annually thereafter (every two years for State-funded homes). Please note: An HCBS Provider Self-Assessment is required for AFLs with members receiving Innovations Waiver services, with submission required prior to placing a member in the home. AFLs billing Long Term Community Support (LTCS) must scan the completed paper copy of the HCBS Provider Self-Assessment and return it to hcbs@vayahealth.com. Vaya cannot review a home until all HCBS requirements have been met. Upon approval of the HCBS survey, the provider must notify the site review team of any of the following using the AFL Update Form : AFL homes in need of review prior to a member being placed When a member moves out or is no longer receiving AFL services in the home Any other change, including changes in the provider, license, or member If an emergency placement is necessary, and Vaya’s Site Review team cannot be contacted, the provider agency QP may arrange for placement in an AFL home after completing and submitting the HCBS. Following an emergency placement, providers must complete and submit the AFL Update Form the next business day. Vaya will conduct a site review within five business days before the AFL will be considered a permanent placement. Homes must meet all HCBS and NCDHHS requirements outlined in the Unlicensed AFL Monitoring Tool available on the NCDHHS website. Proof of any correction is the responsibility of the agency and
should be sent to the Site Review Specialist within 30 calendar days from the initial date of the AFL review. As a reminder, AFL reviews are member-specific. Each member has specific skills and needs. A home approved for one member may not necessarily be approved for another.
CMS Vaccine Rule for Certain Medicaid Providers On Dec. 28, 2021, the Centers for Medicare & Medicaid Services (CMS) issued guidance for how it intends to enforce the Interim Final Rule mandating COVID-19 vaccinations for certain health care workers. CMS has also issued 14 provider-specific guidance documents that should be reviewed along with the general guidance. On Friday, Jan. 7, the U.S. Supreme Court heard oral arguments as to whether CMS exceeded its authority by issuing the vaccine mandate. News outlets are reporting that the Supreme Court issued a ruling today, in Biden v. Missouri , allowing the CMS vaccine mandate for workers at federally funded health care facilities to take effect nationwide. Our understanding is that employees, trainees, and volunteers in qualifying facilities must comply with the rule by Jan. 27 and Feb. 28 for first and second vaccines in two-part vaccinations, respectively. CMS is not requiring boosters at this time, and there is no testing alternative; only a vaccine mandate with the exception of qualifying religious or medical exemptions and corresponding documentation. We also understand that HCBS providers, group homes, physician offices, and certain other provider types are exempt from the rule. Vaya recommends that providers consult with their provider association and/or their legal counsel about whether the Interim Final Rule applies to them, and, if applicable, next steps for ensuring compliance with the rule by the CMS deadline.
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