Q&A Webinar for Vaya Health Network Providers Friday, March 4, 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. • 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. Vaya Health | Q&A Webinar for Vaya Health Network Providers
The moderated Q&A is available in the controls bar on your screen. Look for the bubble with the question mark.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
Our Schedule for Today Questions specific to the Cardinal Innovation transition will be addressed at the end of the webinar as time allows. Providers may also send questions to provider.info@vayahealth.com or call our provider support line at 1-866-990-9712 ext. 1512. If you do have a transition question, please include your name, organization name, and email address so that we can reach out to you if we are not able to address all questions during the webinar.
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Vaya Health | Q&A Webinar for Vaya Health Network Providers
Today’s Vaya participants Chris Tyler, Management Information Systems David Boyd, Provider Network Operations (host) Donald Reuss, Provider Network Operations Jessica Moore, Provider Network Operations Justine Tullos, Provider Network Operations (Q&A moderator) Paul Tax, Finance Stephanie Justice, Utilization Management Tommy Duncan, Provider Network Operations (producer) Provider Training Team: Lindsay Locklear, Crystal McMillan Vaya Health | Q&A Webinar for Vaya Health Network Providers
GUEST PRESENTER
Sarah Pfau Health Policy Consultant, Cansler Collaborative Resources on behalf of NC Providers Council
ncproviderscouncil.org Vaya Health | Q&A Webinar for Vaya Health Network Providers
Good morning and welcome
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NCGA Updates 2021 SESSION
3/4/2022 10:37 AM
NCGA Updates • • •
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STILL have not adjourned Sine Die for the 2021 session Working on election map redistricting Joint Legislative Committee on Access to Healthcare and Medicaid Expansion meeting •
S.L. 2021-180 Section 5.13 provision mandated the Committee
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9 House Members, 9 Senate Members; Co-Chairs Rep. Donny Lambeth (R) and Sen. Joyce Krawiec (R)
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“The Committee may submit proposed legislation to the members of the Senate and the House of Representatives before the sine die adjournment of the 2021. . .”
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Two meetings to date; next meeting 3/15/2022
Dave Richard’s 3/1/2022 Presentation
3/4/2022 10:37 AM
NC Medicaid Expansion •
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S.L. 2021-180 DHB 9D.14. Requires DHHS to apply for CMS approval to maintain Medicaid eligibility for parents whose children are temporarily in the foster care system, as long as parents make reasonable efforts to comply with court-ordered reunification plans. S.L. 2021-180 DHB 9D.13. Expands Medicaid postpartum coverage for the MPW eligibility group from 60 days to 12 months but sunsets 3/21/2027. At Least 15 Million Projected To Lose Medicaid Coverage After COVID-19 Public Health Emergency Ends - OPEN MINDS o August 2021 Dear State Health Official letter re: 12 months to complete redeterminations after PHE terminates (currently 4/16 unless another federal extension)
3/4/2022 10:37 AM
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PHE SUNSET 4/16/2022 WAIVERS & POLICY FLEXIBILITIES
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Preparing for PHE Waivers to Sunset
Preparing for Flexibilities to Sunset
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3/3/2022 REPLACEMENT Medicaid COVID-19 Special Bulletin #234 for Sunsetting Policy Flexibilities
Flexibilities that have been or are being incorporated into permanent policy.
Temporary Flexibilities that will end on April 1, 2022 (i.e., sunsetting on March 31, 2022).
Temporary Flexibilities that will end at the end of the federal PHE.
3/4/2022 10:37 AM
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FEDERAL & STATE COVID-19 UPDATES Regulations and guidance
Federal Updates •
New CDC Mask Guidance Rubric: COVID-19 by County | CDC
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CDC Booster Schedule Guidance: COVID-19 Vaccine Booster Shots | CDC
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“community levels” calculated by cases and hospital admissions per 100,000 population 3/4/2022 10:37 AM
State Updates •
New DHHS Mask update: masks optional for State employees (but ‘vaccinate or test’ policy is still in place) as of 3/7/2022 but agencies may still mandate masks in certain high-risk settings (LTC facilities, health care facilities, homeless shelters, correctional facilities, or other) o EO #253 eff. 3/1/2022 through 5/5/2022
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Gov. Cooper recently vetoed the “Free The Smiles Act” o *Allow parents to opt their children out of face covering requirements in public school units. o *Repeal the requirement for monthly votes on face covering policies in public school units for the current school year.
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S.L. 2021-130 still good law: K-12 COVID-19 Provisions [Requires local school boards to vote monthly on mask (“face covering”) policies]
3/4/2022 10:37 AM
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Medicaid Updates WAIVERS, PROGRAMS, AND POLICIES
Medicaid Updates - Waivers •
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CAP/C Waiver extension approved by CMS; amendment process pending and extension period indefinite o S.L. 2021-180 DHB 9D.11. Adds a minimum of 114 CAP/DA waiver slots by 6/30/2022. o S.L. 2021-180 DHB 9D.12. Incrementally adds 1,000 new Innovations Waiver slots by 7/1/2022 with a proposed new slot allocation methodology and requisite SPA. DHB still awaiting CMS approval Legislation calls for March and July incremental slot addition Slot distribution in this order: 1. Per Capita at LME/MCO catchment level 2. Per Capita at county level within LME catchment 3. First come, first served based on time on the RUN 3/4/2022 10:37 AM
Medicaid Updates - Policy
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DMH/DD/SAS Administrative Rule Update: QP Rule Waiver o S.L. 2017-32 required the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services to amend existing rules governing QP qualifications; authorized counting years of full-time experience either after or before obtaining the required educational degree. 10A NCAC 27G .0104, Staff Definitions [HCBS settings] o 10A NCAC 28A .0102 Definitions [state-operated facilities settings] o
Temporary rules expired in 2019 and previous waiver expired 12/31/2021. o New Waiver request approved retroactive to 1/1/2022 through 12/31/2023. o
3/4/2022 10:37 AM
Medicaid Updates - Policy •
Home Health EVV update: stakeholder meetings have resumed • •
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Access 2/28/2022 webinar slides here Access provider and stakeholder updates here
Specialized Therapies (PT/OT/ST) in the home will be subject to EVV as of 1/1/2023 Statewide aggregator still Sandata o All LME/MCOs and four Standard Plans are contracted with HHAeXchange; Healthy Blue uses CareBridge
3/4/2022 10:37 AM
Medicaid Updates - Programs
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2/18/2022 Policy Paper: Children and Families Specialty Plan
NOTE: Today is the final day to submit public comments to DHB [Medicaid.NCEngagement@dhhs.nc.gov]
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Single, statewide Plan (“CFSP”) to increase access to physical health, behavioral health, pharmacy, LTSS and I/DD services, and unmet health-related resource needs = whole person, integrated care + SDOH • Only Standard Plans and LME/MCOs may apply
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Care management for each Plan member, with CFSP coordinating with State Division of DSS, County DSS offices, and EBCI Family Safety Program
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Cover children, youth, and families served by the child welfare system
3/4/2022 10:37 AM
CFSP Eligibility o
Exempt populations: Medicaid managed care carve-out populations; TRACK @ Murdoch Center clients; ICF-IID clients; Innovations and TBI Waiver enrollees; TCLI beneficiaries [Waiver & TCLI services available in TPs only]
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Eligible populations: children and youth in foster care or receiving adoption assistance; former foster care < 26 years of age; Medicaid and NC Health Choice-enrolled families of children and youth in foster care (parents, guardians, custodians, minor children siblings – Tribal definition recognized where applicable), Medicaid and NC Health Choice-enrolled children and families receiving Child Protective Services (CPS) In-Home Services (caregivers, minor children) or EBCI Family Safety Program equivalent
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NOTE: please see paper for detailed information about auto-enrolled versus opt-in
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3/4/2022 10:37 AM
CFSP Care Manager Responsibilities • • • • • • • • •
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Conduct comprehensive assessments – timing will vary for higher risk members Develop member care plans or individual support plans Convene members’ multidisciplinary care team at least semi-annually Meet “regularly” with Co. Child Welfare workers and obtain parental/guardian/custodian consent, when applicable, for treatment in accordance with NC General Statutes and EBCI Tribal Codes. Notify care team members of any change in health plan Assist members with selecting a new PCP Support members with pre- and post- discharge planning from hospitals & institutional settings; includes handoffs and medication management Provide in-reach, transition, and diversion services for eligible Plan members Collaborate with local DSS / Child Welfare workers to develop 90-day transition plan / transitional living plan for Plan members leaving the child welfare system o Develop a Health Passport (electronic + paper) for each member as part of the transition plan: medical records, prescribed medications, upcoming scheduled appointments For former foster youth aging out of the former foster youth categorical Medicaid eligibility group, educate members about alternative insurance options available (e.g., Marketplace/Qualified Health Plan (QHP) coverage, applicable EBCI tribal programs/funding options, etc.) and assist them in signing up if desired. 3/4/2022 10:37 AM
Relevant DSS Legislative Updates
DSS 9I.13. Requires DSS to incrementally (through 3/24) establish and staff 7 regions for regional supervision of child welfare and social services (2017 Rylan’s Law requirement)and establish a statewide CPS hotline.
DSS 9I.15. Requires DSS to resume deployment of the North Carolina Families Accessing Services through Technology (NC FAST) system, as it relates to case management functionality for child welfare, by 10/1/2022.
DSS 9I.11. Eff. 1/1/2022, increases the foster care and adoption assistance rates 8% -12% by age category ($514; $654; $698) and covers the county share of cost only in SFY2022.
DSS 9I.12. Requires DSS, in collaboration with DMH, to implement a two-year child welfare & behavioral health pilot for a trauma-informed, integrated health foster care model in Davie, Forsyth, Rockingham, & Stokes counties [NOTE: spans Vaya, Partners, Sandhills].
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3/4/2022 10:37 AM
ON YOUR RADAR
AlphaMCS Transition • As announced in the Vaya Health Provider Communication Bulletin 2021-22 Issue 41, published Jan. 25, 2022, Vaya will transition from a hosted version of AlphaMCS to an in-house version in late February as WellSky ends support for the AlphaMCS product. • The in-house AlphaMCS environment will be an exact duplicate of the current system. All data in the hosted version will remain available in the new system.
• New target date: Monday, April 4, 2022
Vaya Health | Q&A Webinar for Vaya Health Network Providers
Electronic Visit Verification (EVV) Rate Changes Electronic Visit Verification (EVV) rate changes are effective for dates of service beginning Feb. 1, 2022. • For all services that require EVV, a 10% increase has been applied to the base rate in the fee schedule. • The EVV rate increase will be in addition to the COVID-19/PHE supplement, which runs through March 31, 2022, and to the forthcoming direct care worker (DCW) rate increase. • PLEASE NOTE: To submit billing at the correct rate, providers must update their rates in their HHA Provider Portal. Please reference the Rate Management Job Aid for assistance. • For questions on services with EVV requirements, please email provider.info@vayahealth.com Vaya Health | Q&A Webinar for Vaya Health Network Providers
Electronic Visit Verification (EVV) Rate Changes Detailed Update in Vaya Provider Communication Bulletin Issue # 48 Electronic Visit Verification (EVV) rate changes are effective for dates of service beginning Feb. 1, 2022. Memo: Electronic Visit Verification (EVV) Rate Changes (Mar. 3, 2022) • PLEASE NOTE: To submit billing at the correct rate, providers must update their rates in their HHA Provider Portal. Please reference the Rate Management Job Aid for assistance. • For questions on services with EVV requirements, please email provider.info@vayahealth.com Vaya Health | Q&A Webinar for Vaya Health Network Providers
Direct Support Worker Bonuses • NC Medicaid will provide one-time bonus payments to non-licensed direct care workers (DCW) and support staff who provided services to Medicaid and NC Health Choice beneficiaries from Mar. 10, 2020, through Aug. 1, 2021. • Per NC Medicaid, each eligible DCW and support staff will receive a gross bonus amount of $1.946.34 (after subtracting allotments for the employer share of FICA). • This amount is based on the amount of funding allocated by the NC Operations Appropriations Act of 2021 and NC Medicaid’s review of eligible submissions. The gross bonus payment is also subject to state and federal payroll taxes for the employee. Vaya Health | Q&A Webinar for Vaya Health Network Providers
Direct Support Worker Bonuses • NC Medicaid plans to distribute bonus amounts to providers beginning this week and anticipates that employees should receive payment from their employer by mid-April. DSWs and support staff should direct any questions to their employer. • More information is available in the NC Medicaid SPECIAL BULLETIN COVID-19 #233: Direct Care Worker One-Time Bonus Payments and on the NC Medicaid Direct Care Worker Initiative webpage.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
Direct Care Worker (DCW) Rate Adjustments • Effective Mar. 1, 2022, NC Medicaid will implement the home and community-based services (HCBS) provider rate increases. • As described in NC Medicaid SPECIAL BULLETIN COVID-19 #214: Direct Care Worker HCBS Wage Increase these increases are intended to support providers in increasing DCW wages toward a minimum of $15 per hour. • The details of each of these COVID-19 and HCBS rate actions, as well as additional information, is listed in NC Medicaid SPECIAL BULLETIN COVID-19 #230: Update on Temporary Rate Increases and HCBS Rate Implementation. Vaya Health | Q&A Webinar for Vaya Health Network Providers
Direct Care Worker (DCW) Rate Adjustments • Vaya Health's rollout of Direct Care Worker (DCW) Rate Adjustments is described in Provider Communication Bulletin 2021-2022, issue #48. o Rates will be effective Mar. 1, 2022 o From Mar. 1, 2022 to Mar. 31, 2022, only the higher of the COVID Rate Adjustment and the DCW Rate Adjustment will apply o DCW Rate Adjustments will be a permanent part of the base rate o Table of services and rates will be published in an upcoming provider Communication Bulletin. • Memo: Direct Care Worker (DCW) Rate Adjustments (Mar. 3, 2022) Vaya Health | Q&A Webinar for Vaya Health Network Providers
Sunsetting COVID-19 Rates • All Vaya Health COVID/ Public Health Emergency (PHE) Rate Supplements in place currently will end date March 31, 2022 (date of service). • Standard Rates Schedules for each Benefit Plan (Medicaid 1915 (b) and (b-3); Medicaid 1915(c) and Non-Medicaid) are available on the Vaya website. • We will update the Standard Rates Schedules with cumulative service code and rates changes before April 1, 2022.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
COVID-19 FLEXIBILITIES UPDATE
Appendix K Flexibilities • Effective Jan. 1, 2022, the federal public health emergency was extended for another 90 days (through Apr. 16, 2022). • Appendix K flexibilities end 6 months after the end of the public health emergency (on or around Oct. 16, 2022) Some flexibilities were made permanent in Clinical Coverage Policy (CCP) 8P. Examples include: o Telehealth for certain Innovations and TBI waiver services o Allowable locations of provision of certain services o Provision of services when required, hands-on, crisis prevention or CPR training is not feasible due to COVID. Vaya Health | Q&A Webinar for Vaya Health Network Providers
Appendix K Flexibilities Other flexibilities are still under consideration for permanent status: o Addition of Home Delivered Meals o Ability to exceed 135K waiver limit on case-by-case basis For a comprehensive list of all flexibilities that have either been made permanent or are under review, visit https://medicaid.ncdhhs.gov/covid-234update-permanentchanges-made-phe-flexibilities030222/download?attachment.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
MH/SU Flexibilities • All temporary behavioral health policy flexibilities outlined in COVID-19 Special Bulletins that have not been made permanent will be end-dated Mar. 31, 2022. • Temporary behavioral health COVID-19 policy flexibilities found in the following NC DHHS COVID-19 Special Bulletins: #9, #19, #20, #35, #46, #59, #60, #76, and #108 will be end-dated Mar. 31, 2022 • Flexibilities to the State Plan Amendment (SPA) that were done through the Disaster SPA will continue until the end of the federal public health emergency.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
MH/SU Flexibilities
• Some flexibilities were made permanent in Clinical Coverage Policy (CCP) 8A-2 and 8C. Examples include: o Telehealth for certain MHSU services o Two-way, real-time audio & video contacts for certain MHSU & B-3 services • Other flexibilities are still being considered for permanent status: o Certain SU residential and detox service • For a comprehensive list of all flexibilities that have either been made permanent or are under review, visit https://medicaid.ncdhhs.gov/covid-234update-permanentchanges-made-phe-flexibilities030222/download?attachment. Vaya Health | Q&A Webinar for Vaya Health Network Providers
Q&A SESSION
Questions? Thoughts? Ideas?
OUR NEXT Q&A WEBINAR Friday, March 18, 2022 11 a.m. – 12 p.m.