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Dear Benchmarks' Members,
We have a few updates that have come in from DHHS and LME/MCOs and wanted to be sure to share with you!
Take care of each other and stay safe and healthy!
The Benchmarks' Team
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See below for an email we received from Deputy Secretary Kody Kinsley re: Approval of Pandemic EBT Program
Good morning State and Local CFAC members, Brain Injury Advisory Council Members, DMHDDSAS Commission Members, Provider Partners, and LME/MCO CEOs,
We are excited to share that North Carolina just received approval for the Pandemic Electronic Benefits Transfer (P-EBT) program to help more families purchase food during the COVID-19 pandemic. The P-EBT program provides a benefit on an EBT card to North Carolina families whose children have access to free and reduced lunch at school.
The North Carolina Department of Health and Human Services (NCDHHS) is working to operationalize the program and P-EBT recipients will receive this benefit in coming weeks. More than 800,000 children are expected to receive help buying food through the P-EBT program.
Families will not need to apply for the P-EBT program. P-EBT eligible families already receiving Food and Nutrition Services (FNS) benefits will receive an additional benefit on their existing EBT card. P-EBT eligible families not already enrolled in FNS will be mailed a new EBT card in the next few weeks. Families who receive a new EBT card will receive a letter from DHHS in the mail explaining how to activate and use their card.
NCDHHS, working in collaboration with the North Carolina Department of Public Instruction, requested activation of the P-EBT program for North Carolina families to use during school closures. This request was approved earlier today by the U.S. Department of Agriculture (USDA).
This new P-EBT program is in addition to other services families may be participating in currently. We encourage families to continue utilizing local school and community meal sites for free, nutritious meals for children. Families can text FOODNC to 877-877 to find local meal sites. The service is also available in Spanish by texting COMIDA to 877-877.
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Latest Medicaid Bulletins
(We are up to 54)
Note: Additional Family Planning guidance may be released in the future, which would replace this bulletin.
SPECIAL BULLETIN COVID-19 #53:
Coronavirus Code Added as Billable Diagnosis and Annual Office Visit Limit Exemption
Effective April 1, 2020, in response to the anticipated spread of coronavirus (COVID-19) in North Carolina, NC Medicaid is adding "U07.1 - 2019-nCoV Acute Respiratory Disease" as a billable diagnosis. Additionally, diagnosis code U07.1 is being added to the list of diagnoses exempt from the annual visit limit also effective April 1.
SPECIAL BULLETIN-19 #52:
Coverage for Weight Scales and Portable Pulse Oximeters - Temporary Flexibilities
Effective retroactive to March 10, 2020, Medicaid and NC Health Choice plans are temporarily covering weight scales and adding a purchase option for portable pulse oximeters.
SPECIAL BULLETIN COVID-19 #51:
NCDHHS COVID-19 Guidance for NC Clinicians and Laboratories
An update to
COVID-19 guidance for North Carolina clinicians and laboratories includes updated laboratory testing guidance; updated criteria for submission of specimens to the North Carolina State Laboratory of Public Health (NCSLPH); and replacement of information that is not North Carolina-specific with links to relevant CDC guidance.
SPECIAL BULLETIN COVID-19 #50:
Provider Webinar Added for COVID-19 Appendix K Flexibilities for the NC Innovations and TBI Waivers
NC Medicaid has implemented flexibilities on how Medicaid providers deliver and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver.
SPECIAL BULLETIN COVID-19 #49:
Telehealth Clinical Policy Modifications - Interim Perinatal Care Guidance
This SPECIAL BULLETIN COVID-19 #49 replaces SPECIAL BULLETIN #42: Telehealth Clinical Policy Modificatoons - Postpartum Care. Please note billing guidance change to postpartum care visits, which can be billed separately OR as part of a pregnancy package code.
SPECIAL BULLETIN COVID-19 #48:
Telehealth Clinical Policy Modifications - Remote Physiologic Monitoring Services
NC Medicaid has added coverage for providers to help their patients engage in Remote Physiologic Monitoring (RPM), providing the opportunity to improve management of diseases and engage patients in their own care.
SPECIAL BULLETIN COVID-19 #47:
Updates for PACE Organizations
PACE organizations should continue to follow the guidance of the local, state and federal officials regarding COVID-19 and thoroughly document reasoning for making decisions which may fall outside of the PACE program model. This guidance supplements the Special Bulletin COVID-19 #27 released on March 30, 2020. The temporary flexibilities noted in Special Bulletin COVID-19 #27 and this Special Bulletin will end the earlier of the cancellation of the North Carolina state of emergency declaration or December 31, 2020.
SPECIAL BULLETIN COVID-19 #46:
Behavioral Health Service Flexibilities
Effective April 16, 2020, NC Medicaid, in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services, is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.
SPECIAL BULLETIN COVID-19 #45:
Increase in Therapeutic Leave Days for ICF/IDD Facilities Due to COVID-19
WEDNESDAY, APRIL 15, 2020
Effective March 10, 2020, through the conclusion of the North Carolina declared state of emergency related to the COVID-19 crisis, NC Medicaid is temporarily increasing the number of therapeutic leave days for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) from 60 days to 90 days and waiving the requirement of approval needed more than 15 consecutive days per Clinical Coverage Policy 8E.
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Providers with Single Case Agreements (SCA)
Trillium is working with the North Carolina Department of Health and Human Services (NC DHHS) on service specific guidance in response to the COVID-19 pandemic. The North Carolina Division of Health Benefits (DHB) coordinated with the Center for Medicare and Medicaid Services (CMS) and requested waivers that support flexibility in service delivery that both protects the public and ensures our most vulnerable citizens are able to continue receive support for their Behavioral I/DD needs.
This guidance is not retroactive; it goes in to effect April 20, 2020 until June 30, 2020 and may be extended if necessary. This guidance applies to providers with Single Case Agreements with Trillium. Trillium may require at some future point replacement claims to add modifiers to service codes used for billing during this event; however, until that time providers should bill the existing codes until addendums are complete for the new rates.
Trillium is providing a 10-30% rate enhancement on services that may require providers to pay overtime for staff when other staff cannot work due to COVID-19, OR due to paying direct care staff a higher rate for hazard pay during this event. Specific services and funding sources impacted include:
Single Case Agreement for State funds for:
* Group Living
* Facility Based Crisis
* Supervised Living
Single Case Agreements for Medicaid Funds for:
* CLFS (all levels)
* Facility Based Crisis
* IAFT
* ICF
* Residential Level III/IV
* Residential Treatment Level II Single Family
* PRTF
Single Case Agreement for Medicaid Innovations Wavier:
* Residential Supports
* Supported Living
* Community Living and Supports
B3 Medicaid Services:
* B3 Innovations Waiver Residential Services
* B3 Community Living and Supports
Trillium is currently in the process of updating rates and codes in Single case agreements for the above services, along with an amendment. The rates may be used between the time periods of April 20, 2020 to June 30, 2020 and may be extended or lifted early by Trillium if necessary. Codes for the above services will be added to contracts with a CR modifier. Trillium may audit records for providers that bill these codes to assure compliance with the billing and to ensure these enhanced rates go to direct care staff. If the rates and contract amendments are not received by your agency in time to impact cash flow, you may consider billing the regular service and then replacing the claim once the code/rate are updated in your contract. Please note that it may take up to three weeks to load all applicable contracts.
We are continuing to work internally to address any concerns related to service delivery for our members, so please be patient as we work to address all populations.
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