DECEMBER 10, 2020 | COMMUNICATION BULLETIN ISSUE 41 IN THIS ISSUE: Medicaid Managed Care Final Rule Changes | Continuation of Non-Medicaid/State Funds for ACT and CST | Effective Friday: North Carolina to Begin Modified Stay at Home Order to Slow COVID-19 Spread | COVID-19 Vaccine Messaging and Resources
Medicaid Managed Care Final Rule Changes On Nov. 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Regulations originally proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in areas including network adequacy, beneficiary protections, quality oversight, and rates and payment. For more information about these changes, review the CMS news release and fact sheet. Most of the new provisions take effect on Dec. 14, 2020. In alignment with these changes, effective Dec. 14, 2020, Vaya will no longer require members or legally responsible persons (LRPs) who submit an oral request for reconsideration of an adverse benefit determination (ABD) to follow that up with a written request. All ABD notices sent to the member or LRP will continue to include the DHHS-required Reconsideration Request Review Form. Assistance with completing the form is available by contacting Vaya’s Member Appeals Team at 1800-893-6246, ext. 1400. Providers requesting a reconsideration of an adverse decision on behalf of a member or LRP will still be required to provide oral or written proof of consent from the member or LRP to file all appeals, including requests for expedited appeals when the member is in an inpatient setting. Questions? Contact Vaya’s Member Appeals Team at 1-800-893-6246, ext. 1400.
Continuation of Non-Medicaid/State Funds for Assertive Community Treatment (ACT) and Community Support Team (CST) Vaya will continue to allow utilization of non-Medicaid/state funds for Assertive Community Treatment (ACT) and Community Support Team (CST) through March 30, 2021, to help better support uninsured members during the COVID-19 pandemic. Read more in the Vaya Provider Network memo dated Dec. 8, 2020: Non-Medicaid/State-funded Assertive Community Treatment and Community Support Team .
COVID-19 NEWS AND UPDATES Effective Friday: North Carolina to Begin Modified Stay at Home Order to Slow COVID-19 Spread Gov. Roy Cooper announced on Tuesday, Dec. 8, 2020, that North Carolina will begin a Modified Stay at Home Order after a rapid increase in the state’s key COVID-19 trends. Executive Order No. 181 requires people to stay at home between 10 p.m. and 5 a.m. until Jan. 8, 2021. Read more in a news release from the Governor’s Office . The order also includes provisions on wearing face coverings and other precautions designed to slow COVID-19 transmission. Vaya and the NC Providers Council encourage providers to carefully review the following provisions in the order: 3.7. Health care settings (page 17) 3.3. Childcare facilities (page 15) 3.4. Children's day or overnight camps (page 15) 3.15. Transportation (page 22) 2.4. Face covering exceptions (page 11) 2.8. Enforcement of face covering requirements (page 12) Local governments in North Carolina are permitted to impose more restrictive requirements; however, local requirements may not restrict state or federal government operations.
N.C. DHHS COVID-19 Vaccine Messaging and Resources N.C. DHHS is compiling messaging information and resources about COVID-19 vaccines on the department’s COVID-19 Vaccine Information webpage. The site includes valuable resources for communicating with patients, including a new COVID-19 Vaccine FAQ . For additional information, also see the DHHS COVID-19 Vaccine Distribution Prioritization Framework.
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