Q&A Webinar for Vaya Health Network Providers Friday, April 22, 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
Today’s Vaya participants David Boyd, Provider Network Operations Donald Reuss, Provider Network Operations (host) George Ingram, Provider Network Operations Justine Tullos, Provider Network Operations (Q&A moderator) Lindsay Locklear, Provider Network Operations (producer) Paul Tax, Finance Tommy Duncan, Provider Network Operations (co-producer) 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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Provider Update APRIL 22, 2022
SARAH PFAU, JD, MPH SENIOR CONSULTANT, CCR CONSULTING
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NCGA Updates 2022 SHORT SESSION PLANNING
NCGA Updates Notable 2022 Activity Prior to Adjournment of The 2021 Long Session: •
S.L. 2022-6 AN ACT TO MAKE TECHNICAL, CLARIFYING, AND OTHER MODIFICATIONS TO THE CURRENT OPERATIONS APPROPRIATIONS ACT OF 2021 AND TO OTHER LEGISLATION [enacted 3/17] • • • •
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Clarifies administrative deadlines and criteria for filing civil actions in State and federal court for Special Education Due Process Hearings Adds health care partnership and accountability/reporting requirements for the $10M directed grant to Hope Alive, Inc. for SUD services in Robeson Co. [Eastpointe] Adds self-directed care direct care workers as eligible for the HCBS wage increases targeting $15/hr. Redirects ORH Veterans health care pilot funding to 1) Cumberland Co.[Alliance] clinical, lab, nursing assistant job training; and 2) SUD [MAT] services for uninsured via a directed grant to Community -Based Developmental Services, Inc. [also Cumberland Co. / Alliance]
S.L. 2021-130 still good law: K-12 COVID-19 Provisions [Requires local school boards to vote monthly on mask (“face covering”) policies] •
In March 2022 , SB173 – Free The Smiles Act – was ratified but Gov. Cooper VETOED it.
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NCGA Updates •
Members will reconvene on May 18
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Limitation to eligible bills during a short session year (even numbered years)
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Key health care topics under consideration: •
Medicaid Expansion
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Certificate of Need (CON) repeal
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2021 SAVE Act / Scope of Practice
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2021 NC Compassionate Care Act / Medical Marijuana
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Opioid Settlement fund administration and distribution •
Two multi-state Settlement Agreements to Manage over many years: $573M and $26B ($750M to NC)
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2021 Appropriations Act created a State Opioid Abatement Reserve + DHHS Opioid Abatement Fund
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NCGA Updates •
Joint Legislative Committee on Access to Health Care and Medicaid Expansion • •
Appointed members charged with making legislative recommendations for 2022 session Topics discussed across 5 meetings with both NC and national presenters: • • • •
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Medicaid Expansion [two meetings] Surprise Medical Billing Scope of Practice Certificate of Need law
Most recent April 11 meeting topics: CON law and the role of family physicians in the health care workforce, and the NCIOM Healthy North Carolina 20230 Initiative
Joint Legislative Oversight Committee on Health and Human Services • • •
Most recent meeting April 12 Presenters included Susan Osborne, NC DSS and Dave Richard, Deputy Secretary, NC Medicaid Topics included Foster Care System and the CFSP; Congregate Care; the Opioid Settlement; and Pre-K funding.
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NEW PHE SUNSET DATE! 7/16/2022 WAIVERS & POLICY FLEXIBILITIES
Federal PHE Extension At State level, the ongoing “State of Emergency”: •
Allows health care licensure and regulation flexibility • •
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Appendix K waiver continues 1135 waiver continues
Allows the State Health Director to issue standing orders for testing and treatment Allows continuation of Medicaid eligibility maintenance of effort Allows continuation of the federal 6.2% enhanced FMAP to NC
Read the official federal declaration to extend the PHE here.
NOTE: The federal government has committed to a 60-day notice before end dating the PHE.
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Preparing for PHE Waivers to Sunset
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Medicaid Updates WAIVERS, PROGRAMS, AND POLICIES
Medicaid Updates - Waivers TBI Waiver Renewal approved by CMS •
Expansion of the Waiver into the two additional counties that are transitioning into the Alliance catchment area (Mecklenburg and Orange);
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Increase federal poverty level eligibility threshold to 300%;
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Lower age of date of Traumatic Brain Injury down from 22 to 18;
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Add supported living as a service;
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Other changes as identified in the renewal application.
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Medicaid Updates - Waivers 1915(i) Waiver – not yet approved by CMS • • •
Currently with the EBCI for Tribal Consultation that began in early March. DHB will soon post the Waiver for public notice and commend. DHB creating a services crosswalk to facilitate proactive ISP planning and any changes needed before the 1915(i) waiver goes live. The (b)(3) services will end before the (i) waiver goes live; there won’t be overlap. o Services going away with the transition: Intensive Recovery Support (b)(3) Deinstitutionalization Services (b)(3) Community Navigator / Community Guide
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Most current DHB policy paper with a preliminary crosswalk between (b)(3) and (i) services: download (ncdhhs.gov) o 1915(i) services will be covered by Tailored Plans, the Tribal Option, and in Medicaid Direct – not in Standard Plans. o 1915(i) services will have to comply with conflict-free care management regulations just like Tailored Care Management services. o DHB will submit a State Plan Amendment [for the 1115 Demonstration Waiver] for CMS approval. o DHB will develop new clinical coverage policies for the 1915(i) services.
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Medicaid Updates - Policy Tailored Care Management Tailored Care Management Updated Guidance (April 21, 2022) | NC Medicaid (ncdhhs.gov) • • • •
Capacity Building Funding FAQs Extender Training Requirements and Eligibility & Billing Clarifications Tailored Care Management standardized contract terms and conditions for AMH+ and CMA contracts Updated Tailored Care Management Provider Manual
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Medicaid Updates - Policy Clinical Coverage Policy 8A (Enhanced Mental Health and Substance Abuse Services) – eff. 4/1/2022 as amended 1. Authorizes and clarifies telehealth coverage and billing 2. Identifies additional qualified providers to comply with Session Laws 3. Authorizes take-home doses 4. Removes service definitions that are covered under other free-standing BH policies Clinical Coverage Policy 8P (Innovations Waiver) – eff. 5/1/2022 as amended forthcoming
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Medicaid Updates - Programs HCBS Final Rule Transition Plan Updates
All HCBS Provider Self-Assessments affected by county transitions were transferred successfully to their respective LME/MCOs.
DHHS continually updating database functionality to support the LME/MCO and CAPDA reviewing entities.
North Carolina is currently 80.6% validated statewide.
Due to delays caused by the COVID-19 pandemic, DHHS amended the Statewide Transition Plan to include a virtual telehealth monitoring option to support North Carolina reaching 100% validation by March 17, 2023 [Desktop and on site also apply].
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Medicaid Updates - Programs HCBS Final Rule Transition Plan Resources: •
Please see this DHHS Web page for all HCBS Final Rule resources. It includes a provider self-assessment “tool” and related requirements.
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This NC DHHS dedicated Web page includes an HCBS Transition Plan FAQs document.
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ON YOUR RADAR
Current Network Needs • • • • • • • • •
Emergency Respite (child and adolescent) Therapeutic Foster Care Licensed Child AFL Homes Child and Adolescent Day Treatment Adolescent Substance Use Services Partial Hospitalization Psychosocial Rehabilitation (PSR) Research Based Behavioral Health Treatment (RBBHT) Financial Support Agency
All counties All counties All counties School system based All counties Rural counties Rural counties Rural counties All counties
For more information, please contact your Provider Network Manager, or provider.info@vayahealth.com Vaya Health | Q&A Webinar for Vaya Health Network Providers
Rate Schedule • Recap of Recent Changes o Integrated Rates Schedule – January 1, 2022 o EVV Rates – February 1, 2022 o ICF-IID Rates – February 1, 2022 o DCW Rates – March 1, 2022 o COVID-19/PHE Supplements which ended March 31, 2022 are now continued to June 30, 2022 • Your Source for Rate Schedules: https://providers.vayahealth.com/learning-lab/forms/ Vaya Health | Q&A Webinar for Vaya Health Network Providers
Rate Schedule • BIG NEWS!!! • COVID-19 / PHE Rate Supplements are being extended! • Retro to Date of Service April 1, 2022 • Through Date of Service June 30, 2022
• Rate Schedules being updated today: https://providers.vayahealth.com/learning-lab/forms/ Vaya Health | Q&A Webinar for Vaya Health Network Providers
Rate Schedule • Tell Me More!
• All previous COVID-19/PHE Rate Increase %'s will carry forward.
• But Keep It Simple!
• COVID-19/ PHE Rate Increases will be on top of any other eligible Rate Supplements, including DCW, DCW-ICF, and EVV. • Standard Rates will be increased • Any provider-specific or member-specific rates that fall below will be replaced by the new Standard rate.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
Rate Schedule • Can You Keep It Simple?!?
Why, yes, we can!
• COVID-19/ PHE Rate Increases will be on top of any other eligible Rate Supplements, including DCW, DCW-ICF, and EVV. • Standard Provider and EOR Rates (via Acumen) will be increased • Provider Specific Rates for ICF-IID, BH Long-Term Residential will be increased (PRTF were already extended) to June 30, 2022. • Any provider-specific or member-specific service rates that fall below the revised Standard rate will be replaced by the Standard rate. 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 June 30, 2022 (date of service). • CR and GTCR modifiers will also end-date June 30, 2022 in the Claims system.
• 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. • Standard Rates Schedules include standard codes, all rates changes Year to Date, and the newly revised PHE rates. Updated on April 22, 2022.
Vaya Health | Q&A Webinar for Vaya Health Network Providers
Rate Schedule Tips • Use the Provider Central Resources • Monitor Vaya Communications for Emerging Rate Changes • Adjust your Billing Systems to Charge the Contract Rate or Higher, including the HHA Exchange for services requiring Electronic Visit Verification (EVV) • Review your Remittance Advice's (RA's) • Have Questions or Concerns on Rates or Claims? o PNO Contract Specialist or provider.info@vayahealth.com o Claims Specialist or claims@vayahealth.com Vaya Health | Q&A Webinar for Vaya Health Network Providers
Tailored Plan Contracts • Physical Health Tailored Plan DocuSign contracts started going out on April 14, 2022. • Behavioral Health Tailored Plan DocuSign contracts will start going out the week of April 25th, 2022. • Vaya is currently in negotiations with several Clinically Integrated Networks (CINs). If you are participating with a CIN that Vaya contracts with you will be added through that contract. • Tailored Plan DocuSign Hospital contracts will start going out in May. Vaya Health | Q&A Webinar for Vaya Health Network Providers
LEARNING AND PARTICIPATION OPPORTUNITIES
SAPTBG Women’s Set Aside training Substance Abuse Prevention and Treatment Block Grant (SAPTBG) Women’s Set Aside Training Wednesday, April, 27, 2022, 10 a.m. – 12 p.m. This training will provide essential information for providers utilizing federal SAMHSA Substance Abuse Prevention and Treatment Block Grant (SAPTBG) funds with a focus on the Women’s Set Aside. It will include the following: • • • • • •
Purpose of the funds Funding requirements Restrictions in how the funds are used Specialized populations that must be prioritized “Set Asides” and special categorical requirements Maintenance of effort requirements
Register here: https://forms.office.com/r/9FH0hnghuu Vaya Health | Q&A Webinar for Vaya Health Network Providers
Freedom House Needs Assessment Survey For providers, members and families in Person, Caswell and Alamance counties • Freedom House is conducting a survey to better understand the needs of the consumers and communities we serve. The survey is designed for members and families, as well as community stakeholders to respond. • The survey takes less than 5 minutes and will close on April 28, 2022. • Results will help Freedom House develop services in line with consumer and community needs. • Complete the survey here: https://www.surveymonkey.com/r/C3XNRMB Vaya Health | Q&A Webinar for Vaya Health Network Providers
Q&A SESSION
Questions? Thoughts? Ideas?
OUR NEXT Q&A WEBINAR Friday, May 6, 2022 11 a.m. – 12 p.m.