Benchmarks' Wednesday Collection-December 22, 2021

DHHS' COVID-19 Website

Benchmarks' Upcoming Webinars

Benchmarks' Membership Webinar:

DHSR Licensure Discussion

Date: Thursday, January 6, 2022

Time: 9:00 am thru 10:30 am

Benchmarks' Child Welfare Webinar

Lisa Cauley Joins Karen McLeod

Date: Thursday, January 13, 2022

Time: 8:00 am thru 9:00 am

*Corrected Registration Link!*

(Huge Thanks to Leslie K):

Benchmarks' Member Webinar with Alliance LME/MCO

Friday, January 14, 2022

Alliance Health will present on the status of the Mecklenburg and Orange County realignments and the impact to providers. Updates will include information regarding provider contracting and claims submissions. There will also be time for questions and answers.

Time: 8:30 am thru 9:30 am

Benchmarks' Friday Webinar

Dave Richard Joins Karen McLeod

Date: Friday, January 21, 2021 thru December 16, 2022

Time: 8:30 am thru 9:30 am

(This registration is for a recurring meeting)

Benchmarks' Collection of Past Updates

NC DSS: Foster Care-Cost Model Rates Letter Rate Revised

NC DSS has notified the counties of the rate increases for foster care through the following announcements:

NC DSS: Expiring-Waivers of Administrative Rules for Licensing

Please see the following DCDL_ CWS_ 46_ Expiring of Waivers of Administrative Rules for Licensing and the following attachments sent on behalf of Lisa Cauley.

NCDHHS Publishes Summary Network Adequacy Results for Standard Plans

The North Carolina Department of Health and Human Services today published summary network adequacy results for Standard Prepaid Health Plans (Standard Plans) which were in effect for the July 1, 2021 “go-live." Network adequacy measures the ability of each NC Medicaid Managed Care health plan to deliver covered benefits by providing adequate access for members to all covered health care services through a network of contracted health care providers. Network adequacy and accessibility standards help verify that members have access to providers and offer an important tool for NC Medicaid to monitor and measure that access.

In NC Medicaid, network adequacy standards are either a maximum travel time or distance from a member’s residence to one or more providers of a certain type OR a minimum number of providers of a certain type within a geographic boundary (county or region). In advance of managed care launch, NC Medicaid focused on five priority-service groups and summarized network adequacy analysis results on a regional and county-by-county basis for those five categories of services – Primary Care, Hospitals, Pharmacy, OB/GYN, and Outpatient Behavioral Health for evaluation of the Standard Plans.

For more information, please see NCDHHS Publishes Summary Network Adequacy Results for Standard Plans.

Advanced Medical Home Provider Manual 2.2 Update

NC Medicaid is releasing the Advanced Medical Home (AMH) Provider Manual 2.2, which reflects program modifications and changes that impact Advanced Medical Home (AMH) Tier 3 contracts with Standard Plans. Only select AMH Tier 3s are impacted by this change. Those AMH Tier 3s and their Clinically Integrated Networks (CINs) will have already received targeted outreach on the program from Medicaid and the InCK program team. This manual supersedes the previous April 23, 2021 version (AMH Provider Manual 2.1).

Additional guidance and program information is available on the Advanced Medical Home webpage. Thank you for your help in supporting NC Medicaid beneficiaries and providers.

Electronic Visit Verification (EVV) Survey

Attention All Providers planning to use or currently using Electronic Visit Verification (EVV). NC Medicaid is conducting a short survey to help us better understand what EVV systems are already being used in North Carolina and to get information on how the use of EVV has been working for providers so far. Please take a moment to complete our brief survey to provide the state with insight on the EVV Program. The survey will be open through Jan. 15, 2022.

Click on the survey link and you will be redirected to the NC Medicaid EVV webpage where you can complete the survey. This webpage also contains in-depth educational resources for review at your convenience.

Staffing Announcements at DMHDDSUS

From Kody Kinsley: I am very pleased to announce Deepa Avula has been selected as the permanent Director of the Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS). As you know, Deepa has been serving in this role in an Interim capacity since her predecessor, Victor Armstrong, became NCDHHS’ first Chief Health Equity Officer. I am thrilled that she has agreed to continue her leadership of the Division and it’s important work during this pivotal time.

Deepa joined us in May as Interim Deputy Director and COO of DMHDDSUS. During her time with us she has not only shaped policy direction but has also helped optimize funding opportunities for our most vulnerable individuals, including those with IDD. Prior to joining the Department, Deepa served for several years as a member of the Senior Executive Service (SES) in the federal government, the highest level of career civil servants and elite cadre of executives. Before joining the Department, she was CFO and Chief of Staff at the Substance Abuse and Mental Health Services Administration (SAMHSA) in Washington, DC. She is a rare executive that has deep experience in grants and financial oversight, budget implementation, strategic planning, communication and stakeholder engagement, and management.

Director Avula’s thought leadership, along with the amazing work of the DMHDDSUS team, has already lent itself to numerous initiatives that have expanded the reach and service. Two recent ones I wanted to highlight:

Funding opportunity for SUD Services for individuals with IDD – leaning harder into our whole person health efforts, wrapping services around those with IDD.
Mobile units to support those with Substance Use Disorders. – which helps to address equity and rural access issues for historically marginalized populations.

Efforts like this, where we can use dollars to wrap services around folks that have a myriad of needs, is the creative thinking we need. We have to treat and serve individuals as whole people. We must continue to push breaking out of our silos and start wrapping services and systems around people, instead of vice versa.

Please join me in welcoming Deepa!

Meanwhile, we are continuing to recruit for another key leadership position at DMHDDSUS that is currently open, Deputy Director and COO. This key role will truly help us maximize the reach of the Division’s critical efforts. We had several strong candidates in the last application cycle, as we did for the Director role. After deciding that Ms. Avula was the strongest person for the role and this moment, we thought the most transparent thing to do was to re-open the Deputy role to give everyone a chance to consider applying. Please help us and continue to identify and refer candidates.

In addition to this ongoing search, we will soon be recruiting for a new Assistant Director for Consumer Support Services and Community Stakeholder Engagement. Dr. Michelle Laws, who has been an invaluable leader for the Division and our consumers will be taking a new role outside of state government in the new year. She has not only led initiatives to meaningfully engage with stakeholders, but has been a focal point for the behavioral health and IDD community statewide for many years. Her efforts during the COVID-19 pandemic have also earned her well-deserved praise and recognition throughout the Department. As saddened as I am by her departure from DMHDDSUS, I am comforted that in her new position she will continue work with community stakeholders with a focus on improving health outcomes among historically marginalized populations especially those in rural communities. In addition to thanking Dr. Laws for her contributions and service, please help me by sharing the job description once the position is posted.

Please join me in thanking Michelle for her heart filled leadership. As I have told her – she may be going to another position, but she is still on the team!

While this is a period of transition for the Department and the Division in many ways, I appreciate you for your tremendous and steadfast work to meet a growing need for services and supports for North Carolinians with behavioral needs, intellectual and developmental disabilities, traumatic brain injuries, and substance use disorder. I’m grateful for Deepa’s continued leadership as Director and commitment to driving whole-person health through engaging with external partners and stakeholders, providing services, and innovating policies and programs.

As I have mentioned before, this is an incredibly pivotal moment in North Carolina -- the lasting impacts of the pandemic, the coming launch of tailored plans, the pressure on our crisis system, an incredibly overstretched direct-care and healthcare workforce, a legacy of inequity in care and access, the need for diversion from our justice-system, homelessness, the impact on others and our families of intergenerational trauma, and underscoring it all, the insufficient insurance coverage for too many in our state – all call us to action. The work and needs are vast. I am incredibly humbled and honored to work alongside all of you to help meet these challenges.

SPECIAL BULLETIN COVID-19 #206: Coverage for COVID-19 Treatment for NC Medicaid Optional Eligibility Group

For eligible MAFDN Family Planning Medicaid beneficiaries, COVID-19 treatment services are covered effective March 11, 2021, when diagnosis code U07.1 (2019-nCoV Acute Respiratory Disease) is submitted as the primary/principal diagnosis code on the claim. Details

SPECIAL BULLETIN COVID-19 #205: Change in Age for Pfizer-BioNTech COVID-19 Booster Vaccine

Beginning Dec. 9, 2021, Medicaid and NC Health Choice will cover the Pfizer-BioNTech COVID-19 vaccine booster dose for administration to individuals age 16 and older. More information

SPECIAL BULLETIN COVID-19 #204: Monoclonal Antibodies Age Update for Code Q0245

COVID-19 vaccination has been approved for all pediatric patients who meet specific criteria regarding COVID-19. Read more

SPECIAL BULLETIN COVID-19 #203: NC Medicaid Revising and/or End-Dating All Temporary COVID-19 Rate Increases

Effective Dec. 31, 2021, NC Medicaid will end several of the temporary COVID-19 rate increases. Some of the rate increases in effect in December 2021 will be extended – at either current or revised levels - through Jan. 31, 2022. More details

SPECIAL BULLETIN COVID-19 #202: Extension of Hospital at Home Program

This Bulletin is an update to SPECIAL BULLETIN COVID-19 #182: Temporary Availability of the Hospital at Home Program. NC Medicaid is extending the Hospital at Home program through March 31, 2022. Details

Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.

NCTracks Call Center Closed for Christmas and New Year's Holidays, No Checkwrite on Dec. 28

As a reminder, NCTracks will follow the State schedule in observing the Christmas holiday. The NCTracks Call Center will be closed on Friday, Dec. 24 and Monday, Dec. 27. The NCTracks Call Center will also be closed on Friday, Dec. 31 for the New Year's holiday. (The Pharmacy Prior Approval Unit will be open holiday hours from 7:00 a.m. to 6:00 p.m. on Dec. 24, 27 and 31.)

Also, in keeping with the published NCTracks checkwrite schedule, there will be no checkwrite on Dec. 28, 2021. The last checkwrite of the year is on Dec. 21, 2021 and the first checkwrite of 2022 will be on Jan. 4, 2022.

The 2021 and 2022 checkwrite schedules can be found under Quick Links on the NCTracks Providers page.

New Medicaid Bulletins Available as of Dec. 20, 2021

The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles:

· NCDHHS Publishes Summary of Initial Network Adequacy Results for Standard Plans

· Advanced Medical Home Provider Manual 2.2 Released

· Provider Survey for Electronic Visit Verification

Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.

Dec. Pharmacy Newsletter Available

The latest Medicaid Pharmacy Newsletter, dated Dec. 2021, is now available on the N.C. Medicaid website. In addition to the Jan. 2022 checkwrite schedule, this edition of the newsletter includes the articles:

· Booster Dose of Moderna and Pfizer COVID -19 Vaccine for all Adults

· (including information about Janssen)

· Change in Age for Pfizer-BioNTech COVID-19 Booster Vaccine

· Clozapine Continuity of Care

· COVID-19 MONOCLONAL ANTIBODIES – An Update to Minimum Age for HCPCS Code Q0245 - Bamlanivimab and Etesevimab, for Intravenous Infusion

Providers are encouraged to review this important information. The 2021 Medicaid Pharmacy Newsletters can be viewed here.

**Benchmarks' will host Alliance LME/MCO for a conversation about the Mecklenburg and Orange county transition on January 14, 2022 from 8:30 am to 9:30 am. Register here.

New: Provider Updates Regarding the Transition of Mecklenburg and Orange Counties from Cardinal

Alliance has identified several issues related to the upload of authorization and provider files received from Cardinal that are currently impacting claims payment. We are working to resolve issues as they have been identified and believe we will have most corrected in the coming days.

Alliance will re-adjudicate all claims denials resulting from errors related to the transition from Cardinal to Alliance. Alliance will provide additional check writes in addition to the one scheduled for December 21, 2021, if this is determined to be needed. If Alliance is unable to resolve all issues related to the authorization transfer from Cardinal, we will begin outreaching to impacted providers.

If you have concerns around authorizations and payment, please contact your provider Network Development Specialist or our Provider Helpdesk before stopping or reducing care provided to our members. Please also remember that to activate your eligibility in our billing and authorization system that you will need to have an executed contract and a completed enrollment packet. Thank you for your ongoing commitment to serving our members.

Garner psychiatric facility to close after negative reports

A psychiatric hospital and treatment facility in Garner for children and seniors is closing after the state found serious care issues and ordered it to no longer admit patients.

Under an agreement signed Friday with the state Department of Health and Human Services, the center will discharge its patients by the end of the month or “as soon as is clinically appropriate for each patient or client.” It has paid $175,000 in administrative penalties, will terminate its participation in Medicare and Medicaid by Feb. 1 and must find a new operator for the center to be in place by June, DHHS spokeswoman Catie Armstrong said.

Strategic can’t be connected to the new operator, which would need to obtain a state license to run the facility, Armstrong said.

Strategic Behavioral Health has been operating the facility since 2012. It includes a 60-bed residential treatment facility for children, and a psychiatric hospital for 32 children and 24 seniors.

Last month, DHHS said it was revoking the facility’s license to operate the residential facility, and suspending admissions to the hospital. This came after inspections found violations ranging from a 16-year-old girl being handcuffed and drugged without proper authorization to a 60-year-old man who had escaped the hospital.

State regulators found widespread staffing shortages and poorly trained staff.

“Patient’s are not getting any treatment, only tele-psych and no therapy,” the site’s former chief medical officer told state regulators on Oct. 11, according to a written report by the regulators. “It’s a hotel. It’s not a hospital.”

One of the state’s findings said Evelyn Alsup, the CEO in charge of the facility, lacked the competence to run it.

Strategic had indicated it planned to fight the state’s actions in state administrative court, according to filings with that office. But those hearings were weeks away, and the state’s actions meant the facility would be largely without patients for much of that time.

Strategic had filed a plan of correction with the state that didn’t dispute its findings, but did in an appeal to the administrative court.

WHAT HAPPENS TO PATIENTS?

A letter Strategic’s president, Blair Stam, sent to employees, which is dated Friday, Dec. 17, said that “due to unforeseen business circumstances” the Garner center was closing at the end of the month. It referred to an agreement with the state on that day “requiring the immediate closing of the facility.”

The letter referred to the state’s refusal on Dec. 3 to lift its ban on admissions, and said the state had found an additional violation. The letter cited the federal plant-closing law — also known as the Worker Adjustment Retraining Notification Act or WARN Act — in notifying employees of the closure.

Staff at the Garner facility transferred a News & Observer reporter’s call to the company’s headquarters in Memphis, Tennessee. The person who answered provided no information. When the Garner facility opened in the Greenfield Business Park at 3200 Waterfield Dr. officials said 250 people would be employed there.

Strategic is a for-profit company owned by Dobbs Management Service, with psychiatric facilities in several states. Strategic also operates the Carolina Dunes psychiatric center in Brunswick County; it closed another center in Charlotte three years ago after the state found serious care issues there.

The state had previously threatened to pull Medicaid and Medicare funding from the Garner facility in 2014, but relented after the facility had made corrections.

State health officials say Strategic has to make “appropriate and safe discharges” for any remaining patients, which includes working with families, guardians, social services agencies and other providers to find proper placements and community services.

NC SPENDING ON TREATMENT

The state spends roughly $100 million a year on psychiatric facilities for children. Critics say the facilities do more harm than good by isolating children for long periods of time with little therapeutic treatment. In some cases, children are abused by staff or other patients.

Disability Rights North Carolina, a nonprofit advocate for people with mental and physical disabilities, has been investigating issues at Strategic for several years. Officials there say the state needs to shift its resources toward more community-based services such as intensive in-home therapy.

“North Carolina needs to invest the money it was pouring into Strategic into robust community-based services,” said Corye Dunn, Disability Rights’ public policy director. “That’s the only way we’re going to help kids and families be strong and healthy.”

A recent series in Gannett’s North Carolina newspapers — “Locked Away” — reported serious problems with psychiatric residential care facilities for children in the state.

Armstrong, the DHHS spokeswoman, said the department is working toward the goal of more community-based treatment, and has formed a new Child and Family Well-Being division “to ensure a long-term focus on these issues.”

“Matching treatment with need and focusing on the ultimate benefits to the consumer of the service is key in NC’s approach to mental healthcare,” she said in an email message earlier this month.

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STATEMENT FROM THE US DEPARTMENT OF LABOR ON THE 6TH CIRCUIT COURT OF APPEALS DISSOLVING THE STAY OF OSHA EMERGENCY TEMPORARY STANDARD ON VACCINATION AND TESTING

“OSHA is gratified the U.S. Court of Appeals for the Sixth Circuit dissolved the Fifth Circuit’s stay of the Vaccination and Testing Emergency Temporary Standard. OSHA can now once again implement this vital workplace health standard, which will protect the health of workers by mitigating the spread of the unprecedented virus in the workplace.

To account for any uncertainty created by the stay, OSHA is exercising enforcement discretion with respect to the compliance dates of the ETS. To provide employers with sufficient time to come into compliance, OSHA will not issue citations for noncompliance with any requirements of the ETS before January 10 and will not issue citations for noncompliance with the standard’s testing requirements before February 9, so long as an employer is exercising reasonable, good faith efforts to come into compliance with the standard. OSHA will work closely with the regulated community to provide compliance assistance.”

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