JUNE 2, 2022 | COMMUNICATION BULLETIN 2021-22 ISSUE 64 IN THIS ISSUE: Provider Touchpoint | Follow-Up from May 20 Provider Touchpoint | Reminder: NCSNAP Requirements | Provider and Tailored Plan Contract Deadlines for Inclusion in the Beneficiary Choice Period and Auto-Assignment
Provider Touchpoint Tomorrow, June 3, 2022, 11 a.m.-12 p.m. Provider Touchpoint is your source for the latest information on topics that affect Vaya 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 – JUNE 3, 2022
Follow-Up from May 20 Provider Touchpoint Vaya received two questions during the Provider Touchpoint on May 20, 2022, that required clarification from NCDHHS or Sarah Pfau, Health Policy Consultant with Cansler Collaborative Resources. QUESTION: [Submitted by a provider as written] In the NC Medicaid Innovations Policy 8-P Amended 5/1/22, the service definition for Day Supports, Group (T2021HQ) and Individual (T2021) and Developmental Day (T2027), Under exclusions – “Waiver funding is not available for vocational services delivered in facility based, sheltered settings or Adult Developmental Vocational Program.” Is this in effect or has this been paused due to the ADVP/CIE continuation? This was not in the previous service definition dated 3/15/2019.
RESPONSE FROM NC MEDICAID: Vocational services – e.g., paid work, should not occur through Innovations Day Supports. If a member is being supported at a job, then Supported Employment should be utilized. QUESTION: For clinical coverage policy 8F, providers aren’t clear regarding when they will be eligible to bill for RB-BHT services for individuals >21 years of age.
RESPONSE FROM SARAH PFAU: NC Medicaid coverage of RB-BHT services for individuals over 21 years of age has already been approved by CMS. Providers can review the December 2021 CMS approval letter with a retroactive effective date of July 1, 2021. Please also see the April 19, 2022, NC
Medicaid Provider Bulletin article Research-Based – Behavioral Health Treatment for Autism Spectrum Disorder that notes that until policy 8F for RB-BHT is amended to reflect CMS approval for individuals under 21 years of age, providers should request prior authorization through the LME/MCOs or the Standard Plans. Please note: For individuals enrolled in the EBCI Tribal Option, the current policy 8F instructs providers to request prior authorization via the Cherokee Indian Hospital Authority (CIHA).
Reminder: NC-SNAP Requirements Please remember that a North Carolina Support Needs Assessment Profile (NC-SNAP) is required for individuals receiving State-Funded I/DD Services. The NC-SNAP is administered annually and whenever there is a significant change in the individual’s needs. Providers must complete the NC-SNAP and the Summary Report and Supplemental Information sheet as instructed in the NC-SNAP Examiner’s Guide. When finished, scan both forms into AlphaMCS Clinical Docs and send an email confirmation to ncsnaps@vayahealth.com. To access the NC-SNAP form and Summary Report and Supplemental Information sheet, visit the NCDHHS NC-SNAP webpage . NC Innovations Waiver participants Please note that NC Innovations Waiver participants are no longer required to receive an NC-SNAP if they have received a Supports Intensity Scale® (SIS) assessment. To confirm a SIS has been completed, look in AlphaMCS Clinical Docs for the Summary Report and Supplemental Information sheet, which indicates whether a SIS was previously administered. If a completed Summary Report and Supplemental Information Sheet is not found, complete the top section of the of the Summary Report and Supplemental Information sheet, scan it into AlphaMCS Clinical Docs, and send an email confirmation to ncsnaps@vayahealth.com. Once the completed form is uploaded to AlphaMCS, the individual will be removed from the NC-SNAP database, and there is no need to complete any additional NC-SNAP forms for that individual.
Provider and Tailored Plan Contract Deadlines for Inclusion in the Beneficiary Choice Period and Auto-Assignment During the beneficiary choice period (Aug. 15 – Oct. 14, 2022) for Behavioral Health and I/DD Tailored Plan launch, Medicaid beneficiaries can choose a primary care provider (PCP) and tailored care management provider by contacting their Tailored Plan. Beneficiaries who do not make a choice will be automatically assigned a PCP and/or tailored care management provider. Providers who do not contract with Tailored Plans by the deadlines risk losing patients. To allow Tailored Plans time to process provider contracts and ensure provider records are loaded correctly and transmitted to NCDHHS, contracts must be signed and mailed to the Tailored Plan by: July 16, 2022, for inclusion in the initial beneficiary choice period. Sept. 15, 2022, for PCP inclusion in auto-assignment. Sept. 30, 2022, for tailored care management inclusion in auto-assignment. For more information, please review the NC Medicaid Provider Bulletin article Provider and Tailored Plan Contract Deadlines for Inclusion in Beneficiary Choice Period and Auto-Assignment (June 1, 2022). For information about contracting with the Vaya Tailored Plan, email TPContracting@vayahealth.com .
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