Benchmarks' Friday Membership Update and Recording
Benchmarks' Friday Membership Webinar 5-29-2020
Benchmarks' Friday Membership Webinar 
May 29, 2020


NC Cases:  25,639
NC Cases Hospitalized:  708
NC Deaths:  866
 
Increase in COVID-19 Cases and Hospitalizations
With North Carolina in its first week of Phase Two and the state's coronavirus update showed troubling numbers on Thursday.
The number of deaths attributed to COVID-19 increased by 33 to 827 and hospitalizations established a new single-day high of 708.
The state has reported 83 deaths since Sunday. Reported hospitalizations have jumped 20.6% from 587 to 708 over that same time.

The average number of positive cases tested rose to 8% this week as well.
 
Access To COVID-19 Testing
Many providers with residential facilities have been struggling to identify companies that will come out to the facility to test clients for COVID-19 when needed. There have also been challenges in finding companies to test staff as well. Many agencies found that when they did identify a company to do the testing, the cost was too high and many weren't willing to bill Medicaid or Medicare for the agency.
 
We reached out to DHHS to see if they had lists of companies that would come on site AND would be willing to bill Medicaid directly. They provided us a list of companies that are providing the tests -to see them click here. Of the companies on the list, DHHS confirmed that LabCorp, Mako, and Quest are billing Medicaid for the tests. There may be other companies on the list that are billing Medicaid, but those are the only ones that DHHS had confirmed as billing Medicaid. Mako will also do testing of uninsured patients and will bill HRSA (Health Resources Services Administration) on behalf of the uninsured patient.  
 
For agencies that need staff tested (with and without insurance), they recommend reaching out to your local FQHC (Federally Qualified Health Center). Some of them have the capacity to bring teams out to the facility to do testing, but all can provide testing at their center. FQHCs can bill Medicaid and private insurance. They can also provide testing to your staff without insurance as they have funding to be reimbursed for those tests. To find a an FQHC near you go to their locator website here  .
 
Faces of the Frontline
Thank you to all our member agencies that supported our social media blast, tied to our full page ad in the News and Observer, that recognized and thanked the frontline child welfare and MH/DD/SA workers as well as DHHS and the NC GA for their support during COVID-19. Please keep the media blasts coming and don't forget to hashtag your social media posts with:

#FacesoftheFrontlines
#NCHeroes
#CareforNC
#TogetherOnTheFrontLine  
 
 
I/DD Group Homes
There is growing confusion over family visitation, work allowance, home visits, etc. in response to the COVID-19 restrictions aimed at reducing outbreaks in group homes. While DHHS has released guidance on eliminating all outside visitors and other significant restrictions, calls they have hosted for families have provided other guidance such as allowing visits outside the home, allowing residents to return to work and yet not allow family members in their home. All of these types of mixed messaging has created a tremendous amount of confusion for both providers and families.
 
DHHS has a workgroup putting together new guidance for providers as restrictions are loosening. The guidance should be out by next week and we hear that much of the decision-making will be left up to the provider based on the clientele and type of facility. While flexibility in these types of settings can be a good thing, it also means increased liability for providers for the decisions they make. We are hoping for guidance that will offer a balance. DHHS welcomes any and all suggestions so please send any recommendations you have to   lmartin@benchmarksnc.org so that we can submit them to DHHS for consideration.
 
Child Welfare Update
The number of children coming into care has dropped over the last two months because the places that most frequently report abuse and neglect, schools and daycare centers, have been closed. Currently there are 11,639 children were in foster care statewide as of March 31. It is expected that there will be a surge of abuse and neglect reports in the fall when schools open and as daycare centers resume providing services.
 
Legislation was passed May 5th to allow background checks of foster families using name-based rather than fingerprint checks, however, NC DSS still has not provided guidance on how to move forward. According to NC DSS, the process has been stalled by concerns raised by the FBI to the NC SBI that the legislation does not include all the language necessary to override the fingerprint checks. NC DSS is still attempting to find a work-around to the problem.
 
Once Phase One began, many of the county DSS agencies began pressing for family, site and home visits and this has only been accelerated under Phase Two. Benchmarks has pressed hard on NC DSS to provide guidance and protocol to the counties on ways to safely and thoughtfully move toward resuming some of these face-to-face visits. NC DSS, the Division of Public Health (DPH) and 5 county DSS Directors came together to work on some draft protocol for the counties. That protocol is expected out next week. 

It will be stressing to the counties that all visits should be determined on a case-by-case basis based on safety. They provide protocol on the visits. They recommend that now, and in the future, if you have concerns about the safety of a visit that is being requested and the county DSS agency continues to insist moving forward, that you refuse and request they take it to the Director level or contact Linda Waite to address the issue.
 
We have given them feedback that under no circumstances should any visit take place without all parties wearing masks and heath checks being conducted. We have also advised them against allowing any day or multiday home visits taking place for children in residential Children's Homes due to the transmission risk being too great for the agency staff and clients.
 
Second Request of Appendix K Approved
The second request under Appendix K was approved on Wednesday, May 27th. The Division of Health and Human Services will be sending out a bulletin next week with information about the approval. To see what all was included under the second request of Appendix K see below.
 
Innovations:
TBI:
 
Unemployment Rate
North Carolina's unemployment rate nearly tripled from 4.3% in March to 12.2% in April, a stark reflection of the COVID-19 pandemic's impact on the state's economy. By comparison, the state unemployment rate reached a 33-year peak of 10.9% in 2010 as the state and national economies began their slow recoveries from the Great Recession.
 
Economists forecast that as many as 2.5 million North Carolinians may be at high- or moderate-risk for a layoff or reductions in wages, tips and work hours, or for furloughs. The private sector experienced a 14.3% decline from March to April, representing a loss of 545,700 jobs, while the government sector had a 3.5% decline representing 26,000 jobs. As expected, the state's leisure and hospitality sector took the brunt of the job losses and furloughs with a 48.8% decline in its workforce, down 249,800 to 262,300
 
Revenue Forecast
Top state government fiscal researchers predicted Friday that North Carolina will collect $4 billion less in revenues over a two-year period than previously due to COVID-19. The General Assembly's Fiscal Research Division and the executive branch Office of State Budget and Management jointly estimated that state collections for the current fiscal year will fall $1.6 billion short of a pre-pandemic forecast. And for the 2020-21 fiscal year, the group predicted that revenue will fall short of the previous forecast by nearly $2.6 billion.
 
The group did note that because the current pandemic is unprecedented, their forecast reflects more uncertainty than normal. They also noted that delays in state tax deadlines for individuals and businesses also clouded the picture.
 
Legislative Session Update
Appropriations committees in the House and Senate are working on budget bills, but this will not be a normal budget bill process. Both chambers are creating spending bills for individual programs. This is how they plan to address all the 2020-2021 fiscal year's most pressing funding needs.
 
Asked if avoiding a single omnibus budget bill is a strategy to avoid a veto from Gov. Roy Cooper, Brown said "pretty much." The House appears to be taking a similar approach, with a committee agenda featuring separate spending bills for law enforcement communications upgrades and funding for housing funds. A blank budget bill on the agenda titled "omnibus" will become an area-specific bill, according to budget writer Rep. Jason Saine, R-Lincoln. Brown said many funding requests won't make the cut this year. "We're having to say no to a lot of people," he said.
 
Some of these appropriation "omnibus" bills are placeholders without funding as they wait for guidance from the federal government as to whether they can use the CARES Act funding for budget holes and have a clear picture of just how significant the deficit will be.
 
The legislature is also dealing with an additional unexpected budget loss due to a $467 million hole in Medicaid rebase due to increased physical health COVID-19 costs.
 
Bill Highlights
Below are some bill highlights but to see all the bills that Benchmarks is tracking:
H 728 Increase Innovation Waiver Slots
Would create up to an additional 500 waiver slots. Not likely to move forward in the current budget environment.
 
H 1187 - Raise the Age Funding
Provides about $10.5 million for Raise the Age. Very likely to move forward if at all fiscally possible in this current environment.
 
H 1196 - Funds/COVID-19 Test & PPE For Congregate Living
Allocates $12 million in non-recurring money for testing and PPE supplies. The sponsors are Democrats so not sure the likelihood of this being included as a budget item, although Republican House and Senate members have acknowledged the need to fund more of this.
 
H 1214 - Dept of HHS Svcs Revisions
This is a DHHS bill that addresses a number technical, conforming and other changes they want, not all COVID-19 related.
  • Eliminates the rule-making process to implement a co-payment schedule for MH/DD/SA services.
  • Changes to expand First Exams for Involuntary Commitment
  • DHHS authority to adjust single stream funding allocations for LME/MCOs
  • LME/MCO utilization of standardized out-of-network agreements for MH/DD and for youth in foster care or independent foster care adolescent.
 
S 708/H1048 CPS Intake Screening/PED Recommendations
This bill came from a Program Evaluation Division of the NCGA. It makes recommendations to improve the consistency of county abuse and neglect screen-in/ screen-out reports.
  • Doesn't allow more stringent screen in process than state policy
  • Requires state to set up a consultation call center for counties to contact if unsure about a correct screening decision, assessment track or response time frame of a specific case.
  • Requires DHHS to periodically assess county DSS workers and supervisors' comprehension and correct implementation of State policy. Assess their training needs for screening and respond to meet those needs.
  • Requires DHHS to revise the structured intake form.
  • Requires DHHS to implement statistically valid program monitory for county intake screening procedures, as well as establish measurable performance benchmarks for all counties.
S 476 - School Based Mental Health
Danielle Battaglia, THE INSIDER, 5/28/20
Sen. Don Davis told senators Wednesday afternoon that suicide is the 11th ranked cause of death in North Carolina. His statement came minutes before a bill passed the Senate that aims to help high school and middle school students struggling with mental health. The bill is now awaiting approval by Gov. Roy Cooper.
 
Sen. Deanna Ballard, R-Watauga, introduced the conference report in the Senate Education Committee meeting Wednesday morning and then to the Senate during the afternoon session. "This is a bill that directs the State Board of Education to adopt a school-based mental health policy..." Ballard said. She added that various stakeholders including Davis, D-Pitt, and Sen. Joyce Krawiec, R-Forsyth, were involved. The required mental health policies will include training for school staff on mental health issues, including how to identify suicide risk among students. Other provisions in previous versions of the bill, which addressed teaching assessments and teen dating violence, were dropped from the final conference report that passed the House and Senate on Wednesday.
 
The education committee's concern about the bill was whether funding for the initiative would fall on the individual school boards. They were assured that there was already funding available as well as partnership agencies willing to step up and help.
 
"This bill is indeed designed to help provide a life jacket to reach out to these kids," Davis said, adding that it was years in the making and would go a long way to help other people. Davis said students today are dealing with things the senators never had dealt with. "To get a child to the point in their life that they're in a dark place that they feel hopeless and the only thing they feel that they have left that they can do is to take their own lives in their hand," Davis said. "I must believe that is a place we don't want to see our kids."
Upcoming Events
Monday:  June 1, 2020 
Statewide Developmental Disabilities Council Launches Virtual Road Tour to "Meet" Communities

Times:  
  • 12:30 pm to 2:00 pm 
  • 6:30 pm to 8:00 pm 
New:  Monday:  June 1, 2020 
Joint DMHDDSAS and DHB (NC Medicaid) COVID-19 Update Call  For BH/IDD Consumers, Family Members and Community 

Time:   2:00 pm 

Join Meeting:  
PLEASE NOTE NEW NUMBER
Toll-Free:
888-557-8511
 
Access Code:
1410463
Tuesday, June 2, 2020
Weekly Q&A Sessions

Time:  10:00 am to 11:00  


Submit Questions in Advance  (due the Friday before the meeting)
New:  Thursday, June 4, 2020
Benchmarks' Child Welfare Member Webinar

Time:  8:00 am to 9:00 am 

Monday:  June 15, 2020 
Connecting Expertise to Communities to Support Comprehensive Care for People with I/DD: Building on North Carolina's Assets 

Time:  11:00 am to 12:00 pm

Monday:  July 20, 2020 
PCIT Information Calls

Time:  10:00 am
 
Meeting number: 730 385 489
You can also dial 173.243.2.68 and enter your meeting number. Or, join by phone: 1-650-479-3207 Access code: 730 385 489 
Thursday:  July 23, 2020 
PCIT Information Calls

Time:  10:00 am
 
Meeting number: 730 385 489
You can also dial 173.243.2.68 and enter your meeting number. Or, join by phone: 1-650-479-3207 Access code: 730 385 489 
Updates and Announcements
Raleigh, N.C.
May 27, 2020

The North Carolina Department of Health and Human Services is using radio and video messages to reach historically marginalized populations to share important messages about reducing risks for COVID-19. The messages are part of the Department's focus during the COVID-19 response to address the underlying causes of long-standing health disparities impacting communities of color across North Carolina.

NCDHHS is partnering with key influencers who represent the communities hardest hit by COVID-19 to deliver messages about precautions, testing and contact tracing that resonate with historically marginalized populations. The Department has been working with Radio One, whose market includes urban areas and communities of color, to air a series of preventive messages from prominent leaders, including former Congresswoman Eva Clayton, faith leader Reverend Prince R. Rivers [youtube.com] and physician Dr. Roxie Wells.  

African Americans and LatinX/Hispanic communities make up a disproportionate number of North Carolina's COVID-19 laboratory confirmed cases and deaths. African Americans make up an estimated 22 percent of North Carolina's population and 31 percent (as of May 26, 2020) of laboratory confirmed COVID-19 cases and 35 percent of deaths. LatinX/Hispanic populations make 9.6 percent of North Carolina's population and 35 percent of confirmed COVID-19 cases. Disparities in health occur when the impact of a health risk is impacting a larger percentage of the population than the population's representation within the general population. 

"These disparate outcomes need to be called out - and addressed. In addition to the actions we are taking to reverse these trends, we need to be sure that our communities of color are getting the information they need to protect themselves and their loved ones. I am so appreciative to partner with these prominent and trusted leaders," says Dr. Michelle Laws, Assistant Director for the Division of Mental Health, Developmental Disabilities and Substance Abuse Services and co-lead of the NCDHHS COVID-19 response team focused on historically marginalized populations.

In addition to the radio ads, NCDHHS is releasing video messages. The videos cover a range of topics, including mental health self-care to promote resiliency, coping strategies for historically marginalized populations and guidance on the 3 Ws: wear a face covering, wait six feet from others and wash hands often to protect yourself and others from COVID-19. People are encouraged to share the messages widely using social media and share with members of their family and communities.

Videos feature Dr. Viviana Martinez-Bianchi, MD, FAAFP, Associate Professor and Family Medicine Residency Program Director for the Duke Department of Family Medicine and Community Health and member of the NCDHHS COVID-19 Response Historically Marginalized Populations workgroup (in English [youtube.com] and Spanish [youtube.com]); North Carolina Poet Laureate Jaki Shelton Green [youtube.com]; and psychiatrist   Dr. Jacquetta Foushee [youtube.com].

For more NCDHHS videos related to COVID-19, visit the Department's YouTube channel [youtube.com], and go to covid19.ncdhhs.gov [covid19.ncdhhs.gov] and nc.gov/covid19 for the most up-to-date information on the COVID-19 response in North Carolina. 

Pharmacy Criteria Updates for Systemic Immunomodulators
 
Effective June 28, 2020, the prior approval (PA) criteria and/or forms for Topical Systemic Immunomodulators will be updated. 
 
At the request of NC Medicaid, these changes will be implemented via system updates in the secure portal, as well as in existing paper drug forms and criteria on the public portal. Please see the summary of changes in the lists below.
 
Criteria Updates:
  • Stelara Infusion
  • Skyrizi
  • Stelara
  • Otezla
  • Taltz
  Pharmacy PA criteria can be found here .
 
Form Updates:
  • Ankylosing Spondylitis
  • Oral Ulcers Associated with Behcet's Disease
  • Non-Radiographic Axial Spondyloarthritis 
  • Plaque Psoriasis (Adult)
  • Psoriatic Arthritis
  • Systemic Onset Juvenile Idiopathic Arthritis
  • Ulcerative Colitis
  • Plaque Psoriasis
  Pharmacy PA request forms can be found here.
 
Updates to Beneficiary Notices of Adverse Determination for Prior Approvals
 
The format and content of Notices of Adverse Benefit Determinations for Prior Approvals (PAs) is changing. On June 28, 2020, updates will be made to the NCTracks system to implement new, State-designed Notices of Adverse Benefit Determination. The updated format will now provide decision information for each service requested. Previously, only a single decision statement was communicated for all services in a PA request. 
 
The new detailed service information includes the following items:
  • Listing of each service requested, approved and denied;
  • All requested Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes on the PA request;
  • Listing of each service voided or approved at a reduced amount than what was originally requested;
  • Specific reason for each service not approved and the supporting State policy information for the decision; 
  • For re-authorization requests, the previously approved service(s) information;
  • For recipients under the age of 21, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) criteria rationale for each service not approved as requested.
 
Notices of Adverse Benefit Determination (denial, reduction or modified approvals) will be sent to both the requesting provider and the recipient via USPS. The provider notice is sent via regular mail and the recipient notice is sent via certified mail.

Provider Participation Requested

NC Pediatric Society's Fostering Health project seeks to make measurable improvements in health outcomes for children in DSS custody throughout North Carolina. The project s guided by AAP's Standards of Care and the work of the statewide multidisciplinary team.  In addition to the Statewide Advisory Team, the group is guided by several subcommittees including the Private Agency Workgroup. 

The goal is to get input from those on the front lines of private agency work for youth in DSS custody (both congregate care and foster homes) to help improve the health and well-being aspects of youth in custody. 

The group works through barriers and challenges as well as discussing successes and ideas. We are currently seeking additional private providers to join us, especially smaller providers are those who are on the eastern or western side of the state. For more information, reach out to Christy Street, the project's Program Director ( Christy@ncpeds.org ). 

CDC COVID-19 Guidance for Family Members and Caregivers
The Centers for Disease Control (CDC) has released COVID-19 guidance, with a primary focus on family members and caregivers who support people with disabilities.

e-News for Small Business, Issue 2020-9

Inside This Issue
The Families First Coronavirus Response Act provides tax credits to reimburse employers for the costs of providing paid sick leave and paid family and medical leave to employees unable to work because of the coronavirus (COVID-19). These credits are refundable. That means if the amount of the credit exceeds the amount of tax owed, the remainder is refunded to the business or organization.
For more information, see the complete IRS FAQs regarding the new credits.

Taxpayers within the small business community are reminded that the IRS regularly posts new and updated answers to the most frequently asked questions about   Economic Impact Payments and the   Get My Payment tool . Those who wish to know the status of their Economic Impact Payment are reminded to check Get My Payment regularly.

The IRS has announced several online tools are available to help taxpayers get the tax information they need as the IRS has limited operations due to the coronavirus. The tools on IRS.gov are easy-to-use and available 24 hours a day:
Free File products
  • Convenient payment options
  • Tax account information online
  • Economic Income Payments Information
  • Scam alerts
Treasury and the IRS have issued guidance on how the reduction of the personal exemption deduction to zero under the Tax Cuts and Jobs Act (TCJA) of 2017 applies to certain rules relating to the Premium Tax Credit. These proposed regulations affect those who claim the credit.
LME/MCO Updates
Includes New Updates From This Week Only

 
Update: Provider Financial Stabilization Program for Child MH/SUD Residential and PRTF Services
Due to the COVID outbreak, Alliance Health is committed to providing financial support for our Medicaid funded Child Residential Services.  The rates are specifically to support direct care staff and families, increased expenses to meet children's' education and nutrition needs during extended school closure and COVID related supplies. Each level of service  has a Scope of Work to clarify those expectations.

Alliance is extending the date of the rate enhancement thru June 30, 2020 for the Child MH/SUD Residential and PRTF services. The table below outlines the rate increase per level of care along with the associated procedure codes. 


Background
Benchmarks is administering a mental health block grant, sponsored by the NC Division of Mental Health, Developmental Disabilities, and Substance Use Services, to pilot changes in processes that allow for children in foster care to receive trauma screening as part of a standardized process of evaluation. This two-year process will allow for multiple DSS agencies to receive training in the National Childhood Traumatic Stress Network's Trauma Training Toolkit for Child Welfare Professional curriculum. Mental health and DSS providers who are selected to provide services will receive an enhanced rate through the LME/MCO. 

Benchmarks will provide clinical coaching as well as implementation and data support for this project. All efforts will be made to work toward processes that will ensure sustainability of the changes and processes made during the duration of the project.   Read more here.

Provider Alert

June Provider Information Sessions
Partners is continuing to host Provider Information Sessions that are focused on provider input and brainstorming. To register for a session, click on the date and time listed below. You may submit your questions to questions@partnersbhm.org in advance; we also recommend that you review the FAQs from past information sessions.
 
Information Sessions will be held:
Important Information about Appendix K
The Centers for Medicare & Medicaid Services (CMS) has approved North Carolina's request to amend the NC Innovations waiver with the Emergency Preparedness and Response Appendix K in order to respond to the COVID-19 pandemic. The amendment that the state has requested in this Appendix K is additive to the Appendix K approved April 6, 2020, is effective from April 30, 2020 through March 12, 2021
.
 

Claims Processing Information
 
Beginning July 1, 2020, the authorization edit will be enabled.
 
What this means for providers and claims processing:
  • Any claims submitted after June 30, 2020 will deny if there is no authorization and an authorization is required for the procedure code.
  • Claims dated March 19, 2020-June 30, 2020 will be manually processed if the claims deny for no authorization only.
  • We encourage providers to submit claims as soon as possible to prevent claims from going through the manual process. This will ensure provider claim reimbursement in a timelier manner.
Taxonomy Code 193200000X: Taxonomy Code 193200000X should not be submitted on claims as the rendering taxonomy code. All claims submitted with this taxonomy code as the rendering code will be reverted.

June Quarterly Provider Webinar
The next Quarterly Provider Webinar will be held June 10, 2020 beginning at 1 p.m.  Click here to register. To view past webinars, please check out our  Provider Webinar Archive.

Urgent Notifications
Reopening Requirements for Day Treatment and Psychosocial Rehabilitation Providers
Documents from Webinar Today:
My Learning Campus Launch
On schedule for June 1
Trillium Health Resources is pleased to announce the new Provider.MyLearningCampus.org site will launch on Monday, June 1. On that day we will send an email with instructions to log in once the site is accessible. Please note that email will only be sent to those names/emails associated with accounts in the previous Provider Learning Portal.
 
If needed, you can reference previous communications about this launch from   Urgent Notification (May 15) and   Network Communication Bulletin #82(May 1).

EXTENSION OF TARGETED RATE ENHANCEMENT FOR RESIDENTIAL PROVIDERS
To help network providers retain residential staff and support increased operational costs due to the COVID-19 pandemic, Vaya Health increased rates by 10% for eligible Medicaid residential services effective March 10, 2020. The rate increase is applied to each facility's standard rate. Vaya has extended this rate increase through June 30, 2020. We will re-evaluate the rate each month until the COVID-19 State of Emergency is lifted. 


LAST CALL: APRIL COVID-19 HARDSHIP PAYMENT REQUEST DEADLINE
COVID-19 Provider Hardship Form submissions for April payments are due this Sunday, May 31, 2020. Starting Monday, June 1, Vaya will begin accepting hardship requests for May dates of service from providers that meet established criteria and are exhibiting a financial hardship as evidenced by their April billed claims.