JAN. 26, 2023 | COMMUNICATION BULLETIN 2022-23 ISSUE 37 IN THIS ISSUE: Provider Touchpoint | New Update to Tailored Plan Provider Training Requirements | FAQ: Utilization Management Prior Authorization Pass-Through for Child Residential/TFC Providers | Vaya Continues Open Enrollment for Statewide Child Treatment Provider Network | Clarification on the Use of Research-Based Behavioral Health Treatment Codes | NCDHHS Community Partners Webinar featuring updates from NC Medicaid | 1915(i) Assessment Tool Training | IPRC Webinar Series – Care and Support of Adult Patients with TBI and Their Families Across the Treatment Continuum | Resilience and Brian Injury Webinar | Question, Persuade, Refer Training
Provider Touchpoint Feb. 3, 2023, 11 a.m.-12 p.m. Provider Touchpoint is your source for the latest information on topics that affect Vaya Health network providers. We encourage all network providers 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 the Provider Communication Bulletin.
PROVIDER TOUCHPOINT – FEB. 3, 2023
New Update to Tailored Plan Provider Training Requirements Vaya’s catalog of Behavioral Health and I/DD Tailored Plan provider trainings is available through the Learn Portal on our Provider Central website. Please review the memo linked below for updated information and new provider requirements, including: Required completion dates for providers joining the network after Feb. 1, 2023 Requirements for providers with an Out-of-Network (OON) Agreement Clarification of contract signatory or designee requirements Memo: New Update to Tailored Plan Provider Training Requirements (Jan. 26, 2023)
FAQ: Utilization Management Prior Authorization Pass-Through for Child Residential/TFC Providers Vaya encourages child residential/Therapeutic Foster Care (TFC) providers to review the FAQ in the
memo linked below for additional clarity on utilization management prior pass-through procedures. Memo: FAQ: Utilization Management Prior Authorization Pass-Through (Jan. 26, 2023)
Vaya Continues Open Enrollment for Statewide Child Treatment Provider Network North Carolina’s LME/MCOs are working to create statewide solutions to challenges in the service delivery system for youth in foster care through the NC Child and Family Improvement Initiative. The LME/MCOs continue to contract with a statewide network of child treatment providers to ensure youth have continuity of care without delay when moving from one area of North Carolina to another. The open enrollment period for all child treatment providers, originally offered from August through December 2022, has been extended. Vaya encourages providers of child Psychiatric Residential Treatment Facility (PRTF), Level IV, Level III, Level II group and family, and Facility-based Crisis (FBC) services to submit the Provider Contract Request Form available on the Provider Enrollment page of Vaya’s Provider Central website. Please note that enrollment with NCTracks is a prerequisite. Additionally, all LME/MCOs are offering Out-of-Network (OON) Agreements for community-based and non-hospital services. While NCDHHS directs reimbursement for these services to be 90% of the Medicaid rate, the LME/MCOs have agreed to pay at least 100% of the Medicaid rate for all OON services for the first 120 days and for OON child residential services in perpetuity. Through Nov. 30, 2022, the LME/MCOs received a total of network enrollment 1,301 applications from child services providers, an average of 325 applications per month. For more information, email provider.info@vayahealth.com or call our Provider Support Service Line at 1-866-990-9712.
Clarification on the Use of Research-Based Behavioral Health Treatment CPT Codes Research-Based Behavioral Health Treatment (RB-BHT) for autism spectrum disorder (ASD) is the NC Medicaid service that includes applied behavior analysis (ABA) and similar services for the treatment of children with autism. Please note: CPT 97155: Adaptive Behavior Treatment with Protocol Modification is the RB-BHT service in which the licensed qualified autism service professional (LQASP) or certified autism professional (C-QP) resolves one or more problems with the protocol. The professional administers adaptive behavior treatment face-to-face with the individual (and/or observes the behavior technician providing the treatment) and makes necessary modifications in the protocol and treatment techniques. Per Clinical Coverage Policy (CCP) 8F, 10% of all approved services should be observed by the professional. Any excess of 10% of observation must be clinically justified. Please note that 97155 is not intended for supervision of the assistant behavior analyst and behavior technician, such as treatment fidelity checks and feedback. As noted in the May 2019 NC Medicaid Bulletin, oversight and supervision of behavior technicians are required as clinically appropriate and in accordance with the Behavior Analyst Certification Board guidelines and ethics but are not billable. Vaya will routinely approve 97155 hours up to 10% of approved 97153 (Adaptive Behavior Treatment by Protocol) hours and will review any requests for more than 10% for medical necessity.
NCDHHS Community Partners Webinar featuring updates from NC Medicaid Monday, Jan. 30, 2023, 1-2 p.m. The NCDHHS Community Partners webinar series is designed to provide updates on NC Medicaid Managed Care and other key Medicaid initiatives. This webinar will include information on the federal
COVID-19 PHE, Tailored Plan launch, and the NC Health Choice move to Medicaid. Register online: Community Partners Webinar – Update on NC Medicaid Managed Care For more information, email Medicaid.NCEngagement@dhhs.nc.gov.
LEARNING OPPORTUNITIES 1915(i) Assessment Tool Training Feb. 3, 2023, 12-1 p.m. This training will be recorded and added to the NC AHEC Tailored Care Management Curriculum. Registration is not required. Join online: 1915(i) Assessment Tool Training
IPRC Webinar Series – Care and Support of Adult Patients with TBI and Their Families Across the Treatment Continuum Feb. 8, 2023, 12–12:30 p.m. The next UNC Injury Prevention Research Center (IPRC) webinar will feature a presentation from Tolu Oyesanya, who will share about care and support of adult traumatic brain injury (TBI) patients and their families. Register online.
Resilience and Brian Injury Webinar Feb. 8, 2023, 2 p.m. Hosted by the United States Brain Injury Alliance (USBIA), this webinar will address the “what, why, and how” of building resilience after brain injury. Registration in advance is required. After registering, you will receive a confirmation email with a link to join the meeting. Webinars are recorded, and all registrants will receive a link to the recording after the meeting. If you cannot attend the webinar in real time, please register to receive recording link.
Question, Persuade, Refer Suicide Prevention Training Question, Persuade, Refer (QPR) is an emergency response to someone in crisis. In this free, virtual training session, Vaya instructors will teach attendees how to ask the right questions about suicide, how to persuade a person to get help, and how to refer them to the right resources. Vaya will offer this training on multiple dates. Please check our Calendar of Events for upcoming sessions. Registration is required.
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