Q&A Webinar for Vaya Health Network Providers Friday, December 4, 2020
Good Morning and Welcome! o This is a live broadcast. Attendees are seeing the broadcast on a 30 second delay. o All attendees are muted throughout the broadcast. o Attendees may ask questions at any time during the broadcast through the Q&A feature o Questions can be seen by all attendees after they are published by the moderator. Submitted questions will be addressed at the end of the webinar.
The moderated Q&A is available in the controls bar on your screen. Look for the bubble with the question mark.
Today’s Vaya Participants Kimberly Wilson, Substance Use Provider Network Manager (Host) Donald Reuss, Sr. Vice President, Provider Network Operations Sabra Ball, IDD Utilization Management Director Michael Beveridge, Provider Network Manager Lead Justine Tullos, Provider Network Operations (Q&A Moderator)
Sarah Pfau NC Providers Council ncproviderscouncil.org
Where Can I Find: Provider Communication Bulletins
• Currently distributed every Tuesday and Thursday • Sign Up: Provider Central –> Learning Lab –> Communication Bulletins • Archive: Provider Central –> Learning Lab –> Communication Bulletins Archive
Where Can I Find: Q&A Webinar Recordings and Resources
Provider Central –> Learning Lab –> Provider Webinars
• 2-hours of your time that could help save a life
Question, Persuade, Refer (QPR) Suicide Prevention Training
• Free to attend • Open to all Vaya stakeholders • 30 participant max per class • Multiple dates through July 2021 • All trainings are now listed on the Vaya website calendar of events • For more information and to register: melissa.ledbetter@vayahealth.com
Permanent Supported Housing Training for CST Providers
Dec. 8, 9, 15 and 16, 2020 8:30 a.m. – 1:00 p.m. • CST staff must complete 15 hours of Tenancy Support Training within 90 days of hire. • Registration is required. • For more information and to register: vayahealth.com/calendar/
Medication Administration Record (MAR) Training • When scheduling a member’s annual Health Risk Assessment (HRA) interview, a Vaya care manager will request the member’s MAR.
• If you have questions about Vaya’s MAR requirements or an individual member’s MAR, please contact the member’s care manager.
• Vaya providers will have five business days from receipt of the request to send the requested MAR to Vaya via secure fax or email.
• A short training module is also available: Provider Central -> Learning Lab -> Medication Administration Record Training
Provider Updates Sarah Pfau, JD, MPH Senior Policy & Regulatory Affairs Specialist Cansler Collaborative Resources, Inc.
Federal Agency Updates December 4, 2020
CMS Stark Law
Section 1877 of the Social Security Act (42 U.S.C. 1395nn), also known as the physician self-referral law and commonly referred to as the “Stark Law�: Prohibits physicians from making referrals for designated health services payable by Medicare to an entity with which they (or an immediate family member) have a financial relationship (ownership, investment, or compensation), unless an exception applies. Prohibits the entity from filing claims with Medicare (or billing another individual, entity, or third-party payer) for those referred services. Establishes specific exceptions and grants the [HHS] Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse.
Designated Health Services:
1. Clinical laboratory services. 2. Physical therapy services. 3. Occupational therapy services. 4. Outpatient speech-language pathology services. 5. Radiology and certain other imaging services. 6. Radiation therapy services and supplies. 7. Durable medical equipment and supplies. 8. Parenteral and enteral nutrients, equipment, and supplies. 9. Prosthetics, orthotics, and prosthetic devices and supplies. 10. Home health services. 11. Outpatient prescription drugs. 12. Inpatient and outpatient hospital services.
CMS Stark Law Final Rule • Final Rule with 1/19/2021 Effective Date • CMS Final Rule Fact Sheet • Rule changes will offer flexibilities that will better align with care coordination and value-based contracting
COVID-19 Updates December 4, 2020
COVID Vaccination Distribution Plans North Carolina Federal (CDC) Advisory Committee on Immunization Practices develops recommendations on how to use vaccines to control disease in the U.S. CDC’s Director and U.S. DHHS approve ACIP recommendations and then publish them in the MMWR. 12/3/2020 MMWR with COVID-19 Recs During a 12/1 meeting, ACIP voted to adopt the following recommendation: “when a COVID-19 vaccine is authorized by FDA and recommended by ACIP, both 1) health care personnel and 2) residents of long-term care facilities be offered COVID-19 vaccine in the initial phase of the vaccination program [1a]." NOTE: This recommendation is not binding on CDC or the states. Secretary Azar has indicated that states will have discretion in distributing vaccines among their residents per State plans.
(DHHS & Div. of Emergency Management) • Full Plan (148 pages) • NC considered Guidance from the CDC’s ACIP, the National Academy of Medicine, Johns Hopkins University, and WHO. NC leadership drafted a proposed prioritization, and the NCIOM convened a COVID-19 External Advisory Committee. • Guiding principles for allocation proposed by ACIP: • •
Distribute vaccines efficiently and equitably Avoid exacerbating inequities and disparities
NC Vaccine Plan Highlights of Interest Phase 1a
Phase 1b
• Vaccinate approx. 140,000 - 161,000 individuals.
• Vaccinate approx. 727,000 – 951,000 individuals.
• Will include healthcare workers and medical first responders who are at high risk of exposure based on work duties [caring for COVID patients or deceased people, cleaning those areas] or who are vital to the initial COVID-19 vaccine distribution.
• Will include residents in LTC settings: SNF, ACH, family care homes, group homes, and homes serving individuals with IDD.
• Will include staff in long-term care settings.
• Will include people who have two or more chronic conditions identified by ACIP/CDC as increased risk of COVID disease severity; people > 65 years of age who live in congregate settings (i.e., migrant farm camps, prisons/jails, homeless shelters); and staff of congregate living settings.
NC Vaccine Plan Highlights of Interest Phase 2
• Migrant farm/fishery workers living in congregate settings • Incarcerated Individuals without > 2 chronic conditions • Homeless shelter residents without > 2 chronic conditions • Frontline workers at high or moderate risk of exposure without > 2 Chronic Conditions • All other Healthcare Workers not included in Phases 1a or 1b • Teachers and school staff • Other adults ages 18 - 64 with 1 chronic condition • > 65 years of age with < 1 chronic condition
Phase 3
• Workers in industries critical to the functioning of society and at increased risk of exposure who are not included in Phase 1 or Phase 2 • K-12 and college students
Phase 4
• “Remaining Population”
COVID-19 Vaccination: Voluntary or Compulsory? ยง 130A-485. Vaccination program established; definitions. (a) The Department and local health departments shall offer a vaccination program for first responders who may be exposed to infectious diseases when deployed to disaster locations. The vaccinations shall include, but are not limited to, hepatitis A vaccination, hepatitis B vaccination, diphtheria-tetanus vaccination, influenza vaccination, pneumococcal vaccination, and other vaccinations when recommended by the United States Public Health Service and in accordance with Federal Emergency Management Directors Policy. Immune globulin will be made available when necessary, as determined by the State Health Director. (b) Participation in the vaccination program is voluntary by the first responders, except for first responders who are classified as having "occupational exposure" to bloodborne pathogens as defined by the Occupational Safety and Health Administration Standard contained at 29 C.F.R. ยง 1910.10300 who shall be required to take the designated vaccinations or otherwise required by law. (c) Nothing in this section shall require first responders, except first responders for whom the vaccination program is not voluntary as set forth in subsection (b) of this section, who present a written statement from a licensed physician indicating that a vaccine is medically contraindicated for the first responder or who sign a written statement that the administration of a vaccination conflicts with the first responder's religious tenets, to receive a vaccine. (d) In the event of a vaccine shortage, the State Public Health Director, in consultation with the Centers for Disease Control and Prevention, shall give priority for vaccination to first responders deployed to a disaster location. (e) The Department shall notify first responders of the availability of the vaccination program and shall provide educational materials on ways to prevent exposure to infectious diseases. (f) As used in this section, unless the context clearly requires otherwise, the term: . . .(3) "First responders" means State and local law enforcement personnel, fire department personnel, and emergency medical personnel who will be deployed to bioterrorism attacks, terrorist attacks, catastrophic or natural disasters, or emergencies.
COVID-19 Vaccination: Voluntary or Compulsory? • § 130A-152. Immunization required. “Every child present in this State shall be immunized against diphtheria, tetanus, whooping cough, poliomyelitis, red measles (rubeola) and rubella. In addition, every child present in this State shall be immunized against any other disease upon a determination by the Commission that the immunization is in the interest of the public health. . .” • § 130A-153. Obtaining immunization; reporting by local health departments; access to immunization information in patient records; immunization of minors. (d) A physician or local health department may immunize a minor with the consent of a parent, guardian, or person standing in loco parentis to the minor. A physician or local health department may also immunize a minor who is presented for immunization by an adult who signs a statement that he or she is authorized by a parent, guardian, or person standing in loco parentis to the minor to obtain the immunization for the minor.
COVID-19 Vaccination: Voluntary or Compulsory? ยง 130A-155. Submission of certificate to childcare facility, preschool and school authorities; record maintenance; reporting. (a) No child shall attend a school (pre K-12), whether public, private or religious, a childcare facility as defined in G.S. 110-86(3), unless a certificate of immunization indicating that the child has received the immunizations required by G.S. 130A-152 is presented to the school or facility. The parent, guardian, or responsible person must present a certificate of immunization on the child's first day of attendance to the principal of the school or operator of the facility, as defined in G.S. 110-86(7). If a certificate of immunization is not presented on the first day, the principal or operator shall present a notice of deficiency to the parent, guardian or responsible person. The parent, guardian or responsible person shall have 30 calendar days from the first day of attendance to obtain the required immunization for the child. If the administration of vaccine in a series of doses given at medically approved intervals requires a period in excess of 30 calendar days, additional days upon certification by a physician may be allowed to obtain the required immunization. Upon termination of 30 calendar days or the extended period, the principal or operator shall not permit the child to attend the school or facility unless the required immunization has been obtained.
COVID-19 Vaccination: Voluntary or Compulsory? ยง 130A-156. Medical exemption. The Commission for Public Health shall adopt by rule medical contraindications to immunizations required by G.S. 130A-152. If a physician licensed to practice medicine in this State certifies that a required immunization is or may be detrimental to a person's health due to the presence of one of the contraindications adopted by the Commission, the person is not required to receive the specified immunization as long as the contraindication persists. The State Health Director may, upon request by a physician licensed to practice medicine in this State, grant a medical exemption to a required immunization for a contraindication not on the list adopted by the Commission. ยง 130A-157. Religious exemption. If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements contained in this Chapter, the adult or the child shall be exempt from the requirements. Upon submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements, the person may attend the college, university, school or facility without presenting a certificate of immunization. (1957, c. 1357, s. 1; 1959, c. 177; 1965, c. 652; 1971, c. 191; 1979, c. 56, s. 1; 1983, c. 891, s. 2; 1985, c. 692, s. 2; 2002-179, s. 17.)
MH-SUD Updates December 4, 2020
NC Injury and Violence Prevention Branch, DHHS
NC Injury and Violence Prevention Branch, DHHS
EHR and Telehealth Considerations: Data Privacy and Confidentiality HIPAA Privacy Rule*
42 C.F.R. Part 2*
U.S. DHHS, Office for Civil Rights
U.S. DHHS, SAMHSA
Ensures the confidentiality of “protected health information” among “Covered Entities” (providers, Plans, and healthcare clearinghouses) and “Business Associates” (contractors)
PHI: transmitted and/or maintained electronically, can include partial or full name, geographical identifiers, age, Soc. Sec. #, medical plan enrollment status, medical record number, etc.
Most substance use disorder treatment programs are subject to the HIPAA Privacy Rule and 42 C.F.R. Part 2.
(*P.L. 104-191 enacted 1996; last amended 2002)
Ensures the confidentiality of patient records created by federally assisted programs for the treatment of substance use disorders Eligible provider “holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment or referral for treatment” (42 CFR § 2.11). Provider “federally assisted” if it is: 1) authorized, licensed, certified, or registered by the federal government; 2) receives federal funds in any form, even if the funds do not directly pay for the alcohol or drug abuse services; or 3) is assisted by the IRS through a grant of tax-exempt status or allowance of tax deductions for contributions; or 4) is authorized to conduct business by the federal government (e.g., certified as a Medicare provider, authorized to conduct methadone maintenance treatment, or registered with the Drug Enforcement Agency (DEA) to dispense a controlled substance used in the treatment of alcohol or drug abuse); or 5) is conducted directly by the federal government. (*42 C.F.R. Part 2; Final Rule amendments effective August 14, 2020) 27
EHR and Telehealth Considerations: Data Privacy and Confidentiality HIPAA Patient Consent • Notice of Privacy Practices required • No written consent required for many types of disclosure, but written consent is required for circumstances outside of those • Written consent is required for disclosure of psychotherapy service notes •
Applies only when provider keeps notes separate from the medical record
•
Disclosure exception: “duty to warn or report abuse or neglect”
•
Disclosure protection extends after death of the patient
42 C.F.R. Part 2 Patient Consent • Written consent required – no known exceptions during COVID-19 pandemic, other than electronic signature is acceptable
• An SUD patient may consent to disclosure of the patient’s Part 2 treatment records to a specific entity [treating provider] or use a “general designation” without naming a specific recipient for the disclosure. •
Patients with general designation consent have the right to request a list of all entities to whom data are disclosed and receive the recipient, date of disclosure, and content description within 30 days.
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EHR and Telehealth Considerations: Data Privacy and Confidentiality HIPAA Disclosures Covered entity use or disclosure to Business Associates is authorized without consent for “payment and healthcare operations”: •
Payment (e.g., prior authorization and claims processing)
•
Treatment (including coordinated care)
•
Healthcare Operations (including appeal hearings)
•
Other Circumstances (e.g., subpoenas, Worker’s Compensation, law enforcement purposes)
42 C.F.R. Part 2 Disclosures •
Disclosures for the purpose of “payment and healthcare operations” – including care coordination and case management –are permitted with written consent.
•
42 C.F.R. Part 2 data are currently exempt from transmission under NC law controlling HIE connectivity, but federal regulations do not prohibit transmission.
•
NEW treatment records created by non-Part 2 providers based on their own patient encounters are explicitly exempt from Part 2, unless any SUD records previously received from a Part 2 program are incorporated into such records.
•
Disclosure exempt from consent requirement: Declared emergencies resulting from natural disasters that disrupt treatment facilities and services are considered a “bona fide medical emergency,” for the purpose of disclosing SUD records without patient consent under Part 2.
*Individuals do have the right to request restrictions on PHI disclosure.
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Medicaid Transformation- Timeline • November 13, 2020: Tailored Plan Request for Application (RFA) Released • February 2, 2021: Deadline to submit Applications • November 13, 2020 - February 02, 2021: Quiet Period • February 2 - June 10, 2021: NC DHHS Application Review Period • March - April 2021: Medicaid Open Enrollment Period for Standard Plans
Medicaid Transformation- Timeline • June 11, 2021: Contract Award • July 01, 2021: Go-Live for Standard Plans • July 01, 2022: Go-Live for Tailored Plans
Joint NC DMHDDSAS and DHB COVID 19 Update for NC Providers Thursday, December 10, 2020, 3:00 p.m. • Registration is available on the NCDHHS COVID-19 page
Agenda: • Policy updates from DMHDDSAS and DHB representatives • Q&A session • NC Start - Identifying and coping with stress, depression and other issues in individuals with IDD • Division of Public Health - Tobacco Free policies as they relate to Medicaid.
HHAeXchange Q&A Friday, December 18, 2020 11:00 a.m. – 12:00 p.m. • As part of our bi-weekly Q&A webinars
• Send your questions in advance to: tommy.duncan@vayahealth.com • Please send all questions by Wednesday, December 16, 2020
Hardship Payments â&#x20AC;˘ Effective December 01, 2020 Began accepting Hardship Paym ents for dates of service Nov. 1-30, 2020. â&#x20AC;˘ To date, Vaya has provided $4,941,519 in Hardship Payments to contracted Vaya providers.
Coronavirus Relief Funding for Group Homes • Session Law 2020-80 Coronavirus Relief Funding for Group Homes • Group Homes licensed under 10A NCAC 27G .5601 are eligible for COVID Relief Group Home Funding • Providers must submit the Provider Attestation form per JCB #376 • Each group home is eligible to receive a payment of $791.98 per bed the home is licensed. There must be at least one active consumer residing in the home to receive this funding. • Funding shall be utilized to support the implementation of recommended CDC guidance for preventative measures to address the introduction and spread of COVID-19 among residents and staff of these facilities. • Additional details are available in Joint Communication Bulletin #376
COVID Flexibility End Dates-Expected Vaya Hardship Payments
December 11, 2020
Room and Board
December 30, 2020
State Funded ACTT and CST
December 30, 2020
COVID Service Definition Flexibilities
December 11, 2020
25% State Funded Residential Support Rate
10% Medicaid Residential Support Rate
December 30, 2020
December 11, 2020
Appendix K-Retainer Payments 90 day maximum
December 31, 2020
Appendix K-Retainer Payments
March 12, 2021
Appendix K-Service Flexibilities
March 12, 2021
October 16, 2020
November 5, 2020
November 25, 2020 December 15, 2020
January 4, 2021
January 24, 2021
February 13, 2021
March 5, 2021
March 25, 2021
Medicaid Managed Care Webinar Series for Providers Medicaid Managed Care Fireside Chat Webinar Series Every First Thursday of the Month From 5:30 To 6:30 P.M.
Clinical Quality Webinar Series
• 12/3/2020
Beneficiary Attribution
• 1/7/2021
Behavioral Health
• 12/17/2020
• 2/4/2021
Value Based Payment/Advanced Payment Models And Quality
Every third Thursday of the month from 5:30 to 6:30 p.m. Behavioral Health
Communication Bulletin Updates • Provider Operations Manual Available for Review- Deadline for Comments 12/19/20 (Issue 35) • Medicaid Managed Care Provider Update- PHP Provider Manuals Posted (Issue 35) • Executive Order No. 180- Nov. 25 Dec. 11= Extend Phase 3 Capacity limits, Tightens Mask Requirements (Issue 36) • NC DHHS Guidance on Holiday Visitation for Residential Settings(Issue 36)
Retainer Payment 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. • 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.
Retainer Payment Update â&#x20AC;˘ On Dec. 1, 2020, Vaya mailed 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 also received emails with a copy of this notice that specific member. â&#x20AC;˘ 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. â&#x20AC;˘ The 90 days is member specific and service specific.
We are always available to support you:
provider.info @vayahealth.com