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Benchmarks' Friday Membership Webinar:
February 24, 2023
Last Meeting with Dave Richard
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Benchmarks' Friday Membership Webinar:
March 17, 2023
Jay Ludlam & Karen McLeod
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Benchmarks' Upcoming Events & Webinars
Next Week! Benchmarks' Face-to-Face Public/Private Behavioral Health Forum
Date: Friday, March 24, 2023
Time: 10:30 am thru 2:30 pm
Location: Royal Banquet & Conference Center, 3801 Hillsborough St., Raleigh, NC
(There is no virtual option for this meeting)
Register
New: Benchmarks' Child Welfare Webinar with Lisa Cauley & Team
Date: Thursday, April 13, 2023
Time: 8:00 am thru 9:00 am
Register
New: Benchmarks' Friday Membership Webinar with Jay Ludlam
Date: Friday, April 21, 2023
Time: 8:30 am thru 9:30 am
Register
Save the Date! Benchmarks --Destination 2023--
Date: October 11, 12, & 13
Location: Cherokee Convention Center, 123 Harrah's Service Dr, Cherokee, NC 28719
(More information will be shared SOON!)
Benchmarks' Collection of Past Updates
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NC Innovations Support Budget Advisory Group Introduction Meeting
Since 2016, each person receiving Innovations Waiver services, participates in a Supports Intensity Scale assessment, receives notice of their budget, and can use their budget to plan for services. NC Department of Health and Human Services (DHHS) wants to evaluate this model to decide whether any changes will be needed to better support people using services.
As part of this evaluation, NCDHHS wants to collaborate with people receiving services and other people involved in the Innovations Waiver. An advisory group is supporting the evaluation team to help to make the evaluation better. Our first meeting with the advisory group is scheduled for Tuesday March 21, 2023,11:00-12:00 p.m. This meeting is open to all community stakeholders.
Date/Time: Tuesday, March 21, 2023, 11:00-12:00 p.m.
Join Link: Click here to join
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Contract Award
The North Carolina Department of Health and Human Services has awarded a contract to Optum to implement a new Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution, scheduled to launch in 2024. Optum was selected after careful evaluation of the National Association of State Procurement Officials (NASPO) ValuePoint Contractors that responded to the state’s request for proposal.
The new PDM/CVO solution will coordinate enrollment, credentialing, and ongoing provider data maintenance as a multipayer system and applies to providers in all NCDHHS programs: Division of Health Benefits (NC Medicaid), Division of Mental Health (DMH), Division of Public Health (DPH) and Office of Rural Health (ORH). NCDHHS is committed to ensuring providers can continue to operate their business with minimal interruption during the transition to the new PDM/CVO.
As the PDM/CVO vendor, Optum will work closely with NCDHHS to ensure that the PDM/CVO solution will:
- Align North Carolina’s provider enrollment and credentialing standards with the National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) Standards and Conditions
- Improve multipayer services and the provider experience under a centralized credentialing process.
- Offers enhanced security protocols, an interactive enrollment process collecting data using common accreditation standards and allows delegation within the organization for multiple users to complete an application.
- Improves the provider notification process to streamline collaboration and effectively maintain provider data.
NCDHHS will support providers in the transition from the current enrollment process with education and outreach through webinars, stakeholder meetings, training workshops and communication bulletins, offering ongoing opportunities for providers to share feedback as the solution develops.
For additional information, please visit the NC Medicaid Provider Data Management / Credentialing Verification Organization webpage.
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NC Medicaid Managed Care Patient Risk List Companion Guide
NC Medicaid has released the NC Medicaid Managed Care Patient Risk List Companion Guide. This is intended for business and technical users responsible for the testing, setup and ongoing transmission of Patient Risk List data to be shared between prepaid health plans (PHPs), Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans and/or Prepaid Inpatient Health Plans and their contracted Advanced Medical Home (AMH) Tier 3s, AMH+s, Care Management Agencies (CMAs), Clinically Integrated Networks (CINs) or other data partners.
This companion guide is designed to create uniformity in the completion of the Patient Risk List across Medicaid Managed Care programs and health systems throughout NC Medicaid’s managed care system. NC Medicaid has also released updated Data Specifications Guidance documents for AMHs and Tailored Care Management (TCM) providers with the Patient Risk List Companion Guide integrated into each document.
Webinar Recording
NC Medicaid and NC Area Health Education Centers (AHEC) hosted a webinar on Dec. 12, 2022, providing an overview of the NC Medicaid Managed Care Patient Risk List Companion Guide.
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NC Managed Care Capitation Rates – Care Management Assumptions
The North Carolina Department of Health and Human Services is releasing updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Prepaid Health Plan (PHPs) Standard Plans. The PHP Standard Plan capitation rates developed by the Department reflect its belief that investment in robust community-based care management will drive improvements in care outcomes and achieve greater value from the State’s Medicaid dollar.
The new document provides assumptions for the Standard Plan managed care capitation rates for State Fiscal Year 2023 (July 1, 2022-June 30, 2023). Rate updates will be considered as part of capitation rate setting for future state fiscal years.
Under the Advanced Medical Home (AMH) Tier 3 program, Standard Plans must delegate certain care management functions and responsibilities to certified practices that meet the program’s requirements. By providing additional information on the assumptions the Department used to develop components of the care management component of capitation payments, PHPs and AMH Tier 3 practices will be better positioned to enter into care management contracts that enable all parties to meet the Department’s expectations in the execution of care management responsibilities and achievement of improved health outcomes.
Details on the current care management rate assumptions are available in Programmatic Guidance on Care Management Component of PHP Capitation Rates. Additional information is available on the NC Medicaid Advanced Medical Home webpage.
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Medical Care Advisory Committee Handouts
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Joint Communication Bulletins
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The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles:
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
SPECIAL BULLETIN COVID-19 #265 Available
The NC Division of Health Benefits (DHB) has recently published new a Medicaid Bulletin article pertaining to COVID-19:
SPECIAL BULLETIN COVID-19 #265: Ending Clinical Policy Flexibilities Associated with the Federal Public Health Emergency
NC Medicaid has evaluated data from the use of federal COVID-19 public health emergency flexibilities and stakeholder feedback on the State’s pandemic response. Based on this review, many of the policy flexibilities implemented during federal PHE have been or will be incorporated into permanent NC Medicaid Clinical Coverage Policy. These flexibilities have been shown to be beneficial for both providers and members, improving the access and/or quality of care provided to NC Medicaid beneficiaries. More information
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
NC Health Choice Integrating Into NC Medicaid
North Carolina Session Law 2022-74 directs the NC Department of Health and Human Services to combine the NC Health Choice Program with the NC Medicaid benefit plan. As of April 1, 2023, all NC Health Choice beneficiaries with active eligibility will be moved to Medicaid, providing them access to Medicaid services that are not currently covered under NC Health Choice. Additional benefits include enhanced behavioral health services, Early Periodic Screening, Diagnosis and Treatment (EPSDT) services, and non-emergency medical transportation (NEMT). Once children in NC Health Choice are enrolled in Medicaid, they will no longer be subject to cost sharing.
NCTracks System Error when Checking Health Plan Eligibility
Due to a system error, providers are receiving an error message and/or incorrect results when attempting to check health plan eligibility. NCTracks is researching this issue and working to resolve it as quickly as possible. Thank you for your continued patience.
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New Medicaid Waiver Rules Take Effect
After nine years and multiple delays, a new Medicaid rule establishing standards for what counts as home and community-based services for people with disabilities will take effect this week, but many states remain ill-prepared.
The deadline for states to come into compliance with the so-called “settings rule” is Friday.
The 2014 regulation from the Centers for Medicare & Medicaid Services requires that programs meet certain criteria in order to qualify as community based and be eligible for funding provided by Medicaid home and community-based services waivers
Read Here
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Upcoming Webinars & Events | |
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New: Tuesday, March 21, 2023
CMS & North Carolina Monthly Stakeholder Meeting
Time: 11:00 am thru 12:00 pm
Register
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New: Tuesday, March 21, 2023
Stakeholder Engagement Behavioral Health Clinical Coverage Policy Update-Clinically Managed Low-Intensity Residential Treatment (ASAM Level 3.1)
Time: 10:00 am thru 10:45 am
Join Here
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New: Tuesday, March 21, 2023
NC Innovations Support Budget Advisory Group Introduction Meeting
Time: 11:00 am thru 12:00 pm
Join Here
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Tuesday, March 21, 2023
State Opioid Response III Webinar (two sessions offered)
Time: 11:00 am thru 12:00 pm
Register
Time: 2:00 pm thru 3:00 pm
Register
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Next Week! Friday, March 24, 2023
Benchmarks' Public/Private Behavioral Health Forum (PPBH) Face-to-Face
Time: 10:30 am thru 2:30 pm
Location: The Royal Banquet & Conference Center, 3801 Hillsborough St., Raleigh, NC
Register
There is not a virtual option for this meeting. Registration is limited to the first 200 people.
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New: Wednesday, March 29, 2023
Transforming Care Through Data: Better Insights, Better Engagement, Better Health
Time: 2:00 pm thru 3:00 pm
Register
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New: Thursday, April 13, 2023
Benchmarks' Child Welfare Webinar with Lisa Cauley & Karen McLeod
Time: 8:00 am thru 9:00 am
Register
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New: Friday, April 21, 2023
Benchmarks' Friday Membership Webinar with Jay Ludlam & Karen McLeod
Time: 8:30 am thru 9:30 am
Register
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Tailored Care Management Educational Offerings
Ongoing Webinar Sessions and Trainings: Some are free, some require a fee, and some are for CMA organizations that have passed the desk review only.
NC AHEC has partnered with the NC Department of Health and Human Services and Division of Health Benefits to equip Tailored Care Management (TCM) candidates with the tools and knowledge to effectively provide care management services to North Carolina’s Tailored Plan beneficiaries through Continuing Professional Development (CPD) opportunities. Find a list of monthly offerings below and join us for one or for all!
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