NOVEMBER 25, 2020 | COMMUNICATION BULLETIN ISSUE 37 IN THIS ISSUE: N.C. Innovations Waiver Retainer Payments Update | Last Call: October 2020 COVID-19 Hardship Payment Request Deadline
N.C. Innovations Waiver Retainer Payments Update In accordance with LME-MCO Joint Communication Bulletin # 381 , issued Nov. 24, 2020, please note that effective Dec. 31, 2020, Appendix K retainer payments will stop for staff who have either utilized or exceeded the maximum number of retainer payments. BACKGROUND On Jan. 31, 2020, the U.S Department of Health and Human Services declared a public health emergency due to the COVID-19 pandemic. To help meet the needs of North Carolina Medicaid beneficiaries participating in a home and community-based services (HCBS) waiver such as the Innovations Waiver, the Department created an emergency planning document, known as Appendix K, to offer service flexibilities to providers during the public health emergency. That document was approved by the Centers for Medicare and Medicaid Services (CMS) effective March 13, 2020, and will expire on March 12, 2021, or upon the expiration of the public health emergency, whichever comes first. Initially, when Appendix K was approved, the maximum number of times a retainer payment agreement could be executed was not clearly described. In a formal FAQ document provided to states in July 2020, CMS provided specific guidance on the maximum number of times a retainer payment agreement could be executed. According to the CMS guidelines, retainer payments may only cover 30 billable days for up to a total of three separate approval periods. The approval of retainer payments may be granted in consecutive (or repeating) approval periods. Utilizing consecutive approval periods allows for payment to an essential worker (e.g., Direct Support Professional) for up to a maximum of 90 billable days of the first retainer payment agreement. NOTIFICATION On or before Dec. 1, 2020, Vaya will mail letters to members whose direct care staff have or will have utilized or exceeded the maximum number of utilization periods as of Dec. 31, 2020. Providers will also receive a copy of this notice via email. It is important to note that any payments made past the 90-day limit prior to Dec. 31, 2020, are not subject to recoupment. It is also important to note that members whose direct care staff have not yet fully utilized or exceeded the maximum number of utilization periods can continue to access the benefit until the maximum is reached. For more information, email provider.info@vayahealth.com. If you receive questions from members, please reach out to the member’s Vaya Care Manager.
Last Call: October 2020 COVID-19 Hardship Payment Request Deadline COVID-19 Provider Hardship Form submissions for October payments are due Monday, Nov. 30, 2020. Starting Tuesday, Dec. 1, Vaya will begin accepting hardship requests from providers that meet established criteria and are exhibiting a financial hardship for November dates of service as evidenced by their November billed claims. Vaya will allow hardship requests until the end of North Carolina’s Phase 3. Learn more: COVID-19 Provider Hardship Form
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