FEB. 9, 2023 | COMMUNICATION BULLETIN 2022-23 ISSUE 39 IN THIS ISSUE: Provider Touchpoint | Tailored Plan Required “Overview of Medicaid Managed Care” Provider Training | Reminder: Vaya Provider Portal – Systems Access Administrator Designation | Vaya Tailored Plan Third-Party Vendors | Reminder: Utilization Management Community Support Team Services (CST) Comprehensive Clinical Assessment (CCA) Addendum Requirement | UPDATE: State-Funded Residential Supports (I/DD) Service and Supported Living Periodic (SLP) (I/DD & TBI) Service | Need for Daytime Respite (b)(3) Providers | Education for Members Residing in ICF/IID Homes and State Development Centers | Trainings Available from The Mediation Center
ALL NETWORK PROVIDERS Provider Touchpoint Feb. 17, 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. 17, 2023
Tailored Plan Required “Overview of Medicaid Managed Care” Provider Training The Behavioral Health and I/DD Tailored Plan required provider training “Overview of Medicaid Managed Care” is now available in the Vaya Learn Portal . This is one of three trainings required for all Vaya network providers. For more information about Vaya’s required trainings and educational resources, please see Provider Communication Bulletin 2022-23 Issue 37 (Jan. 26, 2023).
Reminder: Vaya Provider Portal – Systems Access Administrator
Designation The transition to the Vaya Provider Portal includes implementation of a hierarchical structure for organization logins. Each provider organization identifies one systems access administrator (SAA) within their agency. The SAA is responsible for managing the creation, support, and deactivation of user access to the Provider Portal for users within your organization. If you have not designated an SAA for your organization, please complete the Network Provider SAA Designation Form. Vaya issues SAA logins by email after receiving your organization’s SAA designation. How do SAAs issue logins to the staff in their organization? Once SAAs have their login, creating user accounts is a simple process. For assistance, reference the Provider Portal job aid for SAAs in the Vaya Learn Portal . What should I do if I need assistance? If you are the designated SAA for your organization, email ServiceDesk@vayahealth.com or call 1800-893-6246, ext. 1500. Otherwise, contact your assigned provider network contract manager, email provider.info@vayahealth.com, or call our Provider Support Service Line at 1-866-990-9712.
Vaya Tailored Plan Third-Party Vendors Starting April 1, 2023, Vaya will manage physical health and pharmacy services for Tailored Plan Medicaid members in addition to behavioral health, I/DD, and traumatic brain injury (TBI) services. (Please note that Vaya will not manage physical health or pharmacy services for Vaya NC Medicaid Direct PIHP members or Tailored Plan recipients of State-funded services.) Vaya has contracted with several vendors in specific service areas to assist in serving the Tailored Plan Medicaid population. In the next several Provider Communication Bulletins, we will provide additional information about and educational resources from these vendors. eviCore Healthcare: We have contracted with eviCore Healthcare to provide utilization management for radiology and cardiology services, specialized services (speech, physical, and occupational therapies), and durable medical equipment (non-Innovations Waiver requests). Learn more about eviCore Healthcare. eviCore is also offering a series of provider orientation opportunities. For registration and additional information, please see below: Durable Medical Equipment Cardiology, Radiology, and Specialized Therapies
BEHAVIORAL HEALTH, I/DD, AND TBI PROVIDERS Reminder: Utilization Management Community Support Team Services (CST) Comprehensive Clinical Assessment (CCA) Addendum Requirement As of Nov. 1, 2019, NCDHHS amended the Community Support Team (CST) service definition in NC Medicaid Clinical Coverage Policy 8A-6 to reflect the following change to documentation requirements for concurrent CST services beginning January 2020:
When it is medically necessary for CST services to be authorized for six months or more for a member, a new CCA or CCA Addendum to the original CCA must be completed and submitted with each re-authorization service request. The new CCA or CCA Addendum must be completed within 30days of the start date of the concurrent Service Authorization Request (SAR) that is being submitted.
Please note that the initial pass-through period is included in the six-month timeframe. If you have questions regarding this documentation amendment, please contact Vaya’s Utilization Management Team at UM@vayahealth.com or the Provider Support Service Line at 1-866-990-9712.
UPDATE: State-Funded Residential Supports (I/DD) Service and Supported Living Periodic (SLP) (I/DD & TBI) Service Effective June 1, 2022, the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (Division of MHDDSAS) has implemented two State-Funded service definitions under the I/DD benefit plan. Please review the updated memo below. Memo: UPDATE: State-Funded Residential Supports (I/DD) Service and Supported Living Periodic (SLP) (I/DD & TBI) Service (Feb. 9, 2023)
Need for Daytime Respite (b)(3) Providers Based on the work of the “Pathways to Permanency” project, a collaboration among Benchmarks, Vaya, and local Department of Social Services (DSS) agencies within Vaya’s region, Vaya is announcing a need for providers of daytime Respite (b)(3) services. Respite offers periodic support and relief to the primary caregiver(s) from the responsibility and stress of caring for children ages 3 to 21 with mental health, substance use disorder, and/or I/DD service needs. The service enables the primary caregiver(s) to participate in planned or emergency events or have planned time for themselves and/or family members. Vaya is seeking responses from child-placing agencies, residential childcare facilities, residential treatment providers, current (b)(3) Respite providers, and DSS agencies interested in providing periodic Respite services to Vaya Medicaid members (in particular, youth experiencing school suspension). Services may be provided in a group or family setting given that the provider remains within capacity requirements. Interested providers/agencies must be able to meet the immediate needs of youth and families needing Respite services, including: Providing next-day service Meeting capacity Offering the service in the youth’s community of residence Offering availability for a broad age range of youth Operating during standard school hours Providing lunch and other necessary food Managing therapeutic behaviors (if applicable) Assisting youth with classwork and school goals Assisting with transportation to appointments (if applicable) Providing written communication to caregivers about youth’s day Evaluating progress toward the agency’s identified goals and outcomes Interested providers can submit the following information via email to Ashley Parks, Child and Family Treatment Continuum Director, at ashley.parks@vayahealth.com : Provider name Contact person Contact number Description of current (b)(3) Respite program (if applicable) Summary of providers interest in collaborating with Vaya, Benchmarks, and DSS in this work Upon receipt, additional information may be requested Participating DSS agencies must become enrolled with NCTracks and Vaya to provide this service. Interested DSS agencies should reach out to Ashley Parks, Child and Family Treatment Continuum
Director, at ashley.parks@vayahealth.com for more information on the service and support with NCTracks and Vaya enrollment.
Education for Members Residing in in ICF/IID Homes and State Development Centers In preparation for Tailored Care Plan launch, Vaya is increasing efforts to provide education and support to members who receive care in institutional settings. These efforts are focused on members who reside in intermediate care facilities for individuals with intellectual disabilities (ICF/IID) homes and state developmental centers and whose Medicaid is managed through Vaya. These efforts are called in-reach. Members of the Vaya the I/DD In-Reach and Transition Team and are focused on several interconnected activities: In-reach provides education about home and community-based services (HCBS) that allow people to live the life they choose in the community of their choice. Vaya team members visit with and learn about members in institutional settings and attend their annual person-centered plan meetings. Members and legally responsible persons (LRPs) have access to team members as questions and concerns arise to ensure their understanding of the benefits of HCBS. In-reach team members work collaboratively with facility staff to ensure continuity of care and a smooth transition. The I/DD In-Reach and Transition Team also links with all ICF/IID homes where Vaya-supported members reside to establish relationships, exchange documentation, and accept invites to annual person-centered plan meetings. The team will continue efforts to connect with members in ICF/IID level of care settings and offer community choice following Tailored Plan implementation. Vaya’s goal is to educate all members and LRPs of the services and supports available in their communities.
LEARNING OPPORTUNITIES Trainings Available from The Mediation Center The Mediation Center has released its spring calendar of continuing education programs for mental health professionals in Western North Carolina. The Mediation Center staff will join the Feb. 17, 2023, Provider Touchpoint webinar to discuss additional training opportunities. For more information, contact the Mediation Center at training@mediatewnc.org.
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