Provider Touchpoint Friday, June 3, 2022
How the live broadcast works • You are seeing the broadcast on a 30-second delay. • Your microphone is muted throughout the broadcast. • You may ask questions at any time during the broadcast through the Q&A feature. • Questions can be seen by all attendees after they are published by the moderators. • Questions submitted during the webinar will be addressed at the end of the webinar. Vaya Health | Provider Touchpoint
How the live broadcast works • If multiple similar questions are received, the Q&A moderators may combine the questions into one before posting. • If you need to ask a question that is specific to your agency or the services you provide, please include your name, agency, and email address with your question. • The Q&A feature will close at 11:50 a.m. to allow us to respond to all questions before the end of the webinar.
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The moderated Q&A is available in the controls bar on your screen. Look for the bubble with the question mark.
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Where can I find … Provider Touchpoint Recordings and Resources: Provider Central > Learning Lab > Provider Webinars
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Provider Communication Bulletin Sign-Up:
Provider Communication Bulletin Archive:
Provider Central > Learning Lab > Sign up for PCB
Provider Central > Learning Lab > Communication Bulletins
Today’s Vaya participants Alison McCall, Quality Management Brian Justice, Housing and Transition Cynthia Perry, Eligibility & Enrollment David Boyd, Provider Network Operations - Behavioral Health George Ingram, Provider Network Operations - Physical Health Lisa Vuchak, Quality Management Paul Tax, Finance Vaya Health | Provider Touchpoint
Today’s Vaya participants Breonna Martin, Provider Network Operations (Q&A moderator) George Cannella, Provider Network Operations - Behavioral Health (host) Lindsay Locklear, Provider Network Operations (producer) Tommy Duncan, Provider Network Operations (co-producer)
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Good morning and welcome
Today is National Donut Day
Follow-Up from our May 20 Provider Touchpoint • 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.
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Follow-Up from our May 20 Provider Touchpoint • 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.
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Follow-Up from our May 20 Provider Touchpoint • 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.
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Follow-Up from our May 20 Provider Touchpoint • 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 RBBHT is amended to reflect CMS approval for individuals > 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). Vaya Health | Provider Touchpoint
ON YOUR RADAR
Current Network Needs • • • • • • • • •
Adolescent Substance Use Services Child and Adolescent Day Treatment Emergency Respite (child and adolescent) Emergency Respite (adult IDD overnight) Financial Support Agency Psychological/Psychiatric Services Specific to IDD testing Psychosocial Rehabilitation (PSR) Research Based Behavioral Health Treatment Therapeutic Foster Care
All counties School system based All counties All counties All counties All counties Rural counties Rural counties All counties
For more information, please contact your Provider Network Manager, or provider.info@vayahealth.com Vaya Health | Provider Touchpoint
Due Dates for Non-UCR Payment Expenditures • Providers must submit invoices for actual non-UCR expenditures incurred through May 31, 2022, to Vaya’s Finance department by end of day on Friday, June 3, 2022. • Invoices for actual non-UCR expenditures incurred between June 1-7,2022, must be submitted to Vaya’s Finance department by end of day on Tuesday, June 7, 2022 • Actual non-UCR expenditures incurred between June 8-30, 2022, will be due July 15, 2022. Please note that NCDHHS does not allow submission of estimated or projected non-UCR expenditures. • Provider Communication Bulletin, Issue 63 (June 1, 2022) Vaya Health | Provider Touchpoint
Retroactive Therapeutic Foster Care Rate Increase • Effective retroactively to July 1, 2021, the standard rate for the S5145 code has increased from $97.22 to $175.00. • The new rate is intended to help providers support current TFC families and to plan for expansion of TFC homes. • If you plan to rebill previously paid claims at the new rate, please contact your designated Claims Specialist to coordinate voiding and replacing your claims and to avoid any timely filing denials. • Provider Communication Bulletin, Issue 62 (May 26, 2022) Vaya Health | Provider Touchpoint
Moratorium lifted: Initial State-funded supported employment and respite services • Effective May 26, 2022, Vaya Health is lifting the moratorium on new service authorization requests (SARs) for State-Funded I/DD Supported Employment (SE) and State-Funded I/DD Respite services. • Providers contracted with Vaya for these services may resume requests for the following: o YA389 Long-Term Vocational Supports (LTVS) o YA390 Supported Employment (SE) o YP010 Respite Individual o YP011 Respite Group I/DD Vaya Health | Provider Touchpoint
Moratorium lifted: Initial State-funded supported employment and respite services • Additionally, providers may submit SARs for consideration of retroactive approval. Please note the following: o Providers must request retroactive approval by 5 p.m. on May 31, 2022. o Providers must submit all retroactive billing to Vaya’s Claims department by 5 p.m. on June 12, 2022. o All initial requests will follow Vaya’s usual business processes and timeframes. Providers may submit these requests immediately.
• Provider Communication Bulletin, Issue 62 (May 26, 2022) Vaya Health | Provider Touchpoint
Sunsetting COVID-19 Rates
Vaya Health COVID PHE Rate Supplements sunset June 30, 2022 Vaya Health | Provider Touchpoint
Sunsetting COVID-19 Rates • All Vaya Health COVID/ Public Health Emergency (PHE) Rate Supplements in place currently will end date June 30, 2022 (date of service).
• CR (crisis response) and GTCR (telehealth crisis response) modifiers will also end-date June 30, 2022 in the Claims system. • GT (telehealth) modifier will continue
• Standard Rates Schedules for each Benefit Plan (Medicaid 1915 (b) and (b-3); Medicaid 1915(c) and Non-Medicaid) are maintained and are available on the Vaya website. Vaya Health | Q&A Webinar for Vaya Health Network Providers
COVID-19 Rate Extensions Provider Action Recommendations: > Remove the CR and GTCR Code options from your system as of 7/1/22. All claims using these modifiers on or after 7/1/22 will be denied (Service Code and/or Rates Not Available). > Expect reimbursements and payments to return to the non-PHE rates 7/1/22. > Follow up with your Claims Specialist and/or Provider Network Manager or staff with questions or concerns. claims@vayahealth.com and provider.info@vayahealth.com > Stay tuned to Vaya Provider Communications Bulletins and Touchpoints for future information on rates. Vaya Health | Provider Touchpoint
NC SNAP Requirements • 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. • If an NC-SNAP is no longer required, only the top section of the Summary Report and Supplemental Information Sheet will need to be completed. When finished, scan form(s) into AlphaMCS Clinical Docs and send an email confirmation to ncsnaps@vayahealth.com. Vaya Health | Provider Touchpoint
NC SNAP Requirements • To access the NC-SNAP form and Summary Report and Supplemental Information sheet, visit the NCDHHS NCSNAP webpage. • Provider Communication Bulletin, Issue 64 (June 2, 2022)
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Co-payments for Services to Medicaideligible Members • Under the 1915(b) Waiver, Network Providers are not permitted to charge a co-payment for services to Medicaid-eligible members. • Providers may not charge a Medicaid beneficiary for services delivered under contract with Vaya if authorization or reimbursement are denied. • If funds are collected from Medicaid beneficiaries for any services delivered under contract with Vaya, the provider must notify Vaya and return all funds received from the member or responsible party immediately. • Vaya Health Provider Operations Manual V.4.2 (section 5, page 52-53) Vaya Health | Q&A Webinar for Vaya Health Network Providers
BH I/DD TAILORED PLAN
Updating Provider Hours of Operation in NCTracks • Providers are responsible for ensuring their agency’s operating hours for each service location are current in NCTracks. • This information will be used in compiling the NC Medicaid and NC Health Choice Provider Directory, as well as the Health Plan LookUp Tool. • Vaya encourages providers to verify their information in NCTracks by June 10, 2022. Vaya Health | Provider Touchpoint
Provider and Tailored Plan Contract Deadlines • 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.
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Provider and Tailored Plan Contract Deadlines 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: o
July 16, 2022, for inclusion in the initial beneficiary choice period.
o
Sept. 15, 2022, for PCP inclusion in auto-assignment.
o
Sept. 30, 2022, for tailored care management inclusion in autoassignment.
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Provider and Tailored Plan Contract Deadlines • 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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Tailored Plan Contracting • TP mailing of contract stats as of 6/2: o Total number of TP contracts mailed=1,386 (100%) o Total of TP contracts counter-executed=985 (71.07%) BH=790 PH=195 o Total number of contracts unsigned=401(28.93%) Vaya Health | Provider Touchpoint
Tailored Plan Contracting • Hospital contracts and CIN contracts have been released. Physical Health contracts are continuing to go out daily based on requests and targeted recruitment. • Providers that have not signed their TP contracts are getting follow up calls. Please sign and return your TP contracts ASAP.
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Tailored Plan Resources for Providers • Tailored Plan Contracting Information (May 5, 2022) • Fact Sheet What Providers Need to Know: Part 3 – Before Tailored Plan Launch
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LEARNING AND PARTICIPATION OPPORTUNITIES
BreatheEasyNC: Becoming Tobacco Free
• Medical, behavioral health, and many IDD/TBI service agencies that contract with Standard or Tailored Medicaid managed care plans to provide services are required to have 100% tobacco-free facilities by December 1st, 2022. Type of Service
Required to have a 100% tobacco-free campus?
Medical
Yes
Behavioral Health
Yes
Non-residential IDD/TBI Services
Yes
Intermediate care facilities and residential services for people with IDD/TBI
No, but staff are required to be 100% tobaccofree on campus, and clients must have access to outdoor common areas free from tobacco products/use.
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BreatheEasyNC: Becoming Tobacco Free • Providers can visit BreatheEasyNC.org for technical assistance and training on tobacco-free policy implementation and evidence-based tobacco use treatment. • Upcoming trainings: • How to Support Clients and your Organization to Become Tobacco-Free • June 22, 2022, 9 a.m. - 12:30 p.m. or October 5, 2022: 9 am-12:30
• QuitlineNC & Live Vape Free: Your Clients Can Quit, We Can Help • July 20, 2022, 12 p.m.
• Register at: Register for Breathe Easy NC Trainings | Breathe Easy NC Vaya Health | Provider Touchpoint
ON YOUR RADAR
NC TOPPS Reporting • Vaya offers NC-TOPPS assistance to providers. Email nctopps@vayahealth.com to obtain a CNDS#, request NC-TOPPS transfers, resolve error messages and get answers to your questions. • Vaya offers a virtual NC-TOPPS training available on the "Online Trainings " page of our website • All Mental Health and Substance Use providers should have an active Superuser • NC-TOPPS Guidelines can be found NCDHHS NC-TOPPS Vaya Health | Provider Touchpoint
NC TOPPS Reporting • Interviews are designed to be conducted In-person with the member • Initial interview is due by the second treatment visit • 3-month, 6-month, 12 month and bi-annual interviews should be submitted within 2 weeks of due date • Providers should enter all information accurately, ensuring it matches the member's information in NCTracks • Vaya recommends staff use provider-issued emails Vaya Health | Provider Touchpoint
Q&A SESSION
Questions? Thoughts? Ideas?
Our next Provider Touchpoint Friday, June 17, 2022 11 a.m. – 12 p.m.