DECEMBER 31, 2020 | COMMUNICATION BULLETIN ISSUE 45 IN THIS ISSUE: Q&A Webinar for Vaya Health Network Providers | CLARIFICATION: Medicaid Managed Care Final Rule | COVID-19 Vaccination Update | COVID-19 Community Readiness Toolkit
So Long, Farewell 2020 We are less than 24 hours from a “new beginning” as we bid an enthusiastic farewell to 2020 and embrace a fresh, new start in 2021. From all of us at Vaya Health, have a safe, healthy and very happy New Year !
Q&A Webinar for Vaya Health Network Providers Friday, Jan. 8, 2021, 11 a.m. – 12 p.m. This webinar will cover CARES Act funding reimbursement deadlines, Appendix K flexibilities updates and state funding extensions. Q&A Webinars for Vaya Network Providers take place every two weeks and are an important source of the most up-to-date information. Registration is not required. All Vaya network providers are encouraged to join. Q&A WEBINAR FOR VAYA NETWORK PROVIDERS
CLARIFICATION: Medicaid Managed Care Final Rule The Dec. 10 Provider Communication Bulletin (Issue 41) contained some information that needs clarification about its impact to Vaya providers. See below for the revised summary. 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 took 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 of a member may submit oral or written requests for the appeal as long as the member or LRP provides written consent authorizing them to file the appeal on their behalf. Questions? Contact Vaya's Member Appeals Team at 1-800-893-6246, ext. 1400.
COVID-19 NEWS AND UPDATES COVID-19 Vaccination Update N.C. DHHS revised and simplified their vaccination prioritization plan to align with federal recommendations issued by the CDC’s Advisory Committee on Immunization Practices. See below for the updated vaccination schedule: Phase 1a (current) : Healthcare workers fighting COVID-19 and Long-Term Care staff and residents Phase 1b : Adults 75 years or older and frontline essential workers. There is not enough vaccine for everyone in Phase 1b to be vaccinated at the same time. Three groups will receive vaccinations in this phase, described in the NCDHHS infographic. Phase 2 : Adults at high risk for exposure and increased risk of severe illness. Four groups will receive vaccinations in this phase, also described in the infographic. Phase 3 : Students (college, university and K-12 students age 16 and over) Phase 4 : Everyone who wants a COVID-19 vaccination Click here for more information about the revised vaccination schedule.
COVID-19 Community Readiness Toolkit The toolkit is designed to help meet the unique needs of individuals living with behavioral health issues, intellectual/developmental disabilities and traumatic brain injuries during the pandemic. COVID Readiness Toolkit for Community Stakeholders
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