Weekly Q&A Sessions for Trillium Providers 

• SPECIAL BULLETIN COVID-19 #63: NC Innovations and NC TBI Waivers Community-Based Services (HCBS) Flexibilities - Retainer Payments [medicaid.ncdhhs.gov] - April 24, 2020.
• SPECIAL BULLETIN COVID-19 #60: Fidelity Reviews Delayed for Current Individual Placement and Support (IPS) and Assertive Community Treatment (ACT) Teams [medicaid.ncdhhs.gov] - April 23, 2020
• SPECIAL BULLETIN COVID-19 #59: Telehealth Clinical Policy Modifications - Outpatient Behavioral Health Services [medicaid.ncdhhs.gov] - April 23, 2020
• SPECIAL BULLETIN COVID-19 #55: NC Medicaid Receives Approval for Expanded Flexibilities for Home and Community-Based Services [medicaid.ncdhhs.gov] - April 21, 2020
• SPECIAL BULLETIN COVID-19 #46: Behavioral Health Service Flexibilities [medicaid.ncdhhs.gov] - April 16, 2020
• SPECIAL BULLETIN COVID-19 #45: Increase in Therapeutic Leave Days for ICF/IDD Facilities Due to COVID-19 [medicaid.ncdhhs.gov] - April 15, 2020
• SPECIAL BULLETIN COVID-19 #35: Telehealth Clinical Policy Modifications - Enhanced Behavioral Services [medicaid.ncdhhs.gov] - April 7, 2020
• SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Definitions, Eligible Providers, Services and Codes [medicaid.ncdhhs.gov] - April 7, 2020
• SPECIAL BULLETIN COVID-19 #23: NC Innovations and NC TBI Waivers Community-Based Services (HCBS) Flexibilities for Waiver Beneficiaries Enrolled in 1915(c) HCBS Waivers [medicaid.ncdhhs.gov] - March 27, 2020

The Department of Health and Human Services and NC Medicaid are reaching out to beneficiaries to share the benefits of receiving care using telehealth services. For many people, telehealth is a new option and our Medicaid providers have shared that some patients are hesitant to use technology to "see" their doctor. With telehealth being an important way to receive services while avoiding the risk of exposure to COVID-19 by leaving the home, DHHS and NC Medicaid have developed a video and a flyer to help alleviate some of these concerns and encourage beneficiaries to talk with their doctors about using telehealth to get the care they need to stay healthy.

 

The three-minute video  (and optional one-minute version ) and  flyer are available on the Beneficiary COVID-19 Guidance and Resource webpage of the  NC Medicaid website. These resources explain the different types of services available through telehealth; how telehealth can help individuals stay healthy-especially during the COVID-19 public health emergency; technology available for telehealth; and how to ask a doctor about using telehealth in place of an office visit.

 

With over 1.2 million Medicaid beneficiaries throughout the state, telehealth is a significant tool to help reduce the spread of COVID-19. We appreciate your help in sharing these tools with your patients and colleagues who will benefit from this information.

NC Medicaid COVID-19 Bulletin Article Recap (#70-74)

The NC Division of Health Benefits (DHB) has recently published Medicaid Bulletin articles related to COVID-19. Below are exerts or summaries of some of the most recent articles and links for more details. All articles may be found on the DHB website.

 

SPECIAL BULLETIN COVID-19 #70: Addition of Mailing and Delivery Fees to Retail Pharmacy Claims

Effective April 27, 2020, prescriptions for NC Medicaid and NC Health Choice beneficiaries are eligible for the addition of a mailing or delivery fee via the guidelines.  Guidelines and more

 

SPECIAL BULLETIN COVID-19 #71: Extension of Temporary Suspension of Level I and Level II Assessments for New Nursing Home Admissions

Effective April 25, 2020, the temporary suspension of Level I and Level II PASRRs has been extended for new admissions. If the individual is expected to remain in the nursing facility for more than 30 days, a notice of the need for a PASRR review should be submitted through NCMUST.  Continue reading

 

SPECIAL BULLETIN COVID-19 #72: Additional Home Health Clinical Coverage Policy Provisions

In response to the recent CMS announcement, effective March 30, 2020, NC Medicaid is adjusting home health requirements currently in Home Health Clinical Coverage Policy No: 3A to align with this recent CMS regulatory change as well as other provisions related to Home Health in the CMS changes during the existence of the COVID-19 pandemic.  Change details

 

SPECIAL BULLETIN COVID-19 #73: Personal Care Services Telephonic Assessments Update

Effective May 1, 2020, Medicaid will resume use of the full assessment for all initial assessment requests, and effective May 1, 2020, Liberty Healthcare of North Carolina will resume completion of annual assessments.  Read more

 

SPECIAL BULLETIN COVID-19 #74: NC Medicaid Temporarily Increases Rates for Federally Qualified Health Centers and Rural Health Clinics

Requesting Personal Protective Equipment

NC DHHS and NC Department of Public Safety understand organizations across North Carolina are in need of PPE and state government is actively working to help get PPE to those who need it. They have put together a process for fulfillment of requests for PPE in an effort to make sure that those at highest [...]
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At President Trump's direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services today issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation's seniors and provide flexibility to the healthcare system as America reopens. 

T hese changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS's efforts to further expand beneficiaries' access to telehealth services.

May 04, 2020: 2:00 - 3:00 pm

May 15, 2020: 10:00 - 11:00 am

May 15, 2020: 2:00 - 3:00 pm

The following codes have been added to Medicaid contracts with an effective date of March 10, 2020, with no action required by providers. These codes are in addition to those that were included in Partners Provider Alert COVID 19 #21-Behavioral Health Service Flexibilities | Place of Service, dated April 24, 2020.    Read more.

Outpatient Opioid Treatment (OOT) Service Authorization Requests

For Medicaid Members:

Effective June 1, 2020, Outpatient Opioid Treatment (OOT) providers may begin submitting Service Authorization Requests (SARs) for Medicaid members with the following service code:

 

H0020 (U3) (OU) - Weekly Rate for Outpatient Opioid Treatment

H0020U3OU is an alternative payment method utilized for Medicaid OOT. The cost of dosing visits, medication, medication dispensing and counseling will be bundled under a weekly rate. Please submit a   Change Request Form to Credentialing and Enrollment if you are an Outpatient Opioid Treatment provider interested in adding this service to your contract.

 

The H0020 service code (no modifier) may be used for dually insured members with Medicare and Medicaid. Providers must submit claims to Medicare as primary payor before Medicaid.

 

OOT Retroactive SARs:

Partners Utilization Management will allow submission of OOT retroactive SARS for Medicaid members back to March 8, 2020.    Read more.

Partners to Host Service Informational Sessions for Members and Their Families

Do you work with members that are confused about service changes due to COVID-19? Partners is here to help. Members that receive services from Partners' providers as well as their family members are invited to an upcoming question and answer session:

 

Partners Member Information Session for Intellectual/Developmental Disabilities and Traumatic Brain Injury Service Changes

Tuesday, May 5, 2020 at 4 p.m.

 Click here to register for the May 5 webinar

 

Partners Member Information Session for Mental Health and Substance Use Service Changes

Thursday, May 7, 2020 at Noon

 Click here to register for the May 7 webinar

 

Members and their families are welcome to email any questions to memberquestions@partnersbhm.org or call 704-884-2666 for more information.

Personal Protective Equipment

During the COVID-19 pandemic, there has been a shortage of Personal Protective Equipment (PPE). NC DHHS and the NC Department of Public Safety are actively working to get PPE to organizations in need. To learn more about conservation measures of existing supplies or to request additional PPE, please visit  https://www.ncdhhs.gov/divisions/public-health/covid19/health-care-providers-hospitals-and-laboratories/requesting-ppe.

1. Supporting essential frontline workers: Activities addressing the social and behavioral health needs of healthcare and other frontline workers (e.g., administrative, food service, security, facilities maintenance, cleaning, and other services to hospital or non-hospital entities) as result of COVID-19
2. Supporting underserved populations: Services for rural and underserved populations that are disproportionately affected by COVID-19 (e.g., uninsured, communities of color, immigrant populations, etc.)

• Led by person(s) from underrepresented groups
• Experience difficulty accessing available federal and state resources
• Reflect an orientation toward post-COVID-19 recovery and renewal, beyond initial emergency needs
• Are currently embedded in rural services and networks, as applicable

A total of up to $1.5 million will be granted in the first round of awards. Grants will range from $25,000 to $150,000, with a total of 15-25 grants awarded in the first cycle.

Consider Employee Child Care Needs as Part of Return-to-Work Planning

As employers begin planning for a return to work, child care needs may impact workers' ability to resume normal schedules. As states extend school closure orders, the availability of child care and camps through the summer remains in doubt. Without reliable child care alternatives, many employees will struggle to find options that allow them to return to work.

Employers have a number of options for dealing with these situations. For employers with fewer than 500 employees, the Families First Coronavirus Response Act (FFCRA) may provide employees with job-protected paid leave for up to 12 weeks due to child care unavailability. Outside of these legal requirements, some employers may consider allowing employees to bring children to work or even establishing temporary child care services. These options raise obvious financial and liability concerns, including the potential for children in the workplace to interfere with COVID-19 exposure control efforts.

Other options include extending telework arrangements or providing paid or unpaid leaves of absence. Any such plans should be set forth in a written employer policy and should be consistently applied to employees in similar circumstances. In some situations, employers may decide that they cannot accommodate employees who are unable to return to work due to child care needs. In general, outside of FFCRA, employers are not legally required to accommodate such needs and could decide as a last resort to terminate employment.

Employers should monitor additional federal and state legislative developments that address employee child care needs.

EEOC Blesses Employer COVID-19 Testing

As employers begin formulating return-to-work plans, one step under consideration is workplace testing of employees for COVID-19. While such tests are not widely available yet, these plans have raised questions regarding their conformance with the Americans with Disabilities' Act's restrictions on medical examinations.

On April 23, the Equal Employment Opportunity Commission issued a technical assistance guidance stating that COVID-19 testing of employees meets the ADA's requirement that such examinations are job related and consistent with business necessity. In other words, employers can require such tests as a condition of employees entering the workplace.

In its guidance, the EEOC cautions employers on the potential unreliability of certain tests, recommending that companies rely on FDA guidance when selecting tests for use with employees. The agency again advised employers to treat the results of such testing as confidential employee medical records. The technical guidance does not address the use by employers of antibody tests. Although these tests are not widely available, their possible use has raised concerns over disparate treatment of employees who do not possess COVID-19 antibodies and, therefore, possible immunity from the disease. The EEOC will likely issue guidance on these questions in upcoming weeks.

U.S. Labor Department Issues New Guidance on Expanded Unemployment Benefits

On Monday, the U.S. Department of Labor issued additional guidance to state agencies regarding recently expanded unemployment benefits. The Q&A format followed a DOL webinar where many of the questions addressed were first raised. The guidance answers a number of questions involving benefit eligibility for people who do not traditionally receive benefits.

For example, workers who lost their jobs and decline employer return-to-work notices are no longer eligible for benefits, even if they express concerns over exposure to COVID-19 at work. Employees who leave work due to diagnosed coronavirus-related medical issues can collect benefits, even if those conditions would not otherwise qualify the employee for such payments.

The guidance addresses complicated questions involving gig workers and self-employed people, including where to file benefits when they live in one state but work in another. A different question tells states how to pay benefits to non-employees who cannot substantiate their prior earnings. The Q&A offers guidance for employers asked by employees about their potential eligibility for benefits in certain situations. The guidance can be found here.