July 2021 Newsletter

Managed Care Minute

July 2021 Volume 26

Did You Know?

naviHealth

This applies to all states

naviHealth (nH) has now served 8,500,000 members, managed 181,000 annual episodes, works directly with 875 hospitals and currently facilitating 16,000 PAC providers. naviHealth now serves Humana and United Healthcare (UHC) in authorization efforts for parts of the MCCFL portfolio Texas, Florida, Georgia, Indiana Mississippi and South Carolina. (Speak to your Liaison for specifics for your market.). This power house is now taking over contracting efforts as well - in some markets. We can say with no reservations, they have our attention!

naviHealth came onto to the scene in 2012 to transform post-acute care needs. They decided in 2013 to enter Bundle Payment Programs known as BPCI’s with the Medicare Advantage plans. In 2014 nH partnered with several Blue Cross Blue Shield organizations. In 2015 nH partnered with Accountable Care organization. Curaspan joined naviHealth in 2016 to heighten their company’s ability to manage the transition of post-acute care. Between 2017 and 2018 nH expanded into 13 states of post-acute services and started the upward movement of BPCI Advanced. As of 2020, naviHealth's coverage has increased into 37 states. naviHealth has utilized technology to expand their capabilities to reduce readmissions and care gaps. In 2021, naviHealth has added Optum/United Healthcare to their list of partnerships.

This company is dominating health plans, hospital systems, physicians’ groups, accountable care organizations but more importantly for us post-acute providers! naviHealth operates in all six states MCCFL currently works in as well.

What this means for you:

Quick access to your facility case managers
nH portal training
Direct contractor contacts (Quarterly & Annually requesting new contracts and rates) - only Texas at this time
Provide forms needed for authorization, updates, diagnosis changes and discharges.

These are just a few things we offer. Each Liaison has a relationship with one or more naviHealth representatives. Please don’t hesitate to reach out to us if there is ever a question or concern. We have seen the growth of naviHealth and the importance of staying connected. We have that connection for you!

Discharge Planning

This applies to all states

When planning for a Medicare or Medicare Advantage patient to discharge to home, it is important to consider what services the patient does and does not need. Sending a one size fits all order to your home health partners is not doing them any favors. When determining the patient’s needs, establish if they meet the basic Medicare criteria for home health: Beneficiary is ‘Homebound’ and ‘Beneficiary has a ‘Skilled Need’. Homebound does not mean bedbound but rather leaving their home would require considerable and taxing effort. If they are able to drive or go to the store as a daily activity, for example, they may not qualify as homebound.

Ordering a ‘laundry list’ of services such as Medical Social Worker, RN nursing, PT, OT and home health aide requires the agency to evaluate for the services to remain compliant with the orders or seek to do a change order. Be specific about the services needed; if it is determined that additional services are needed, the Home Health Agency can make the request to the physician following the patient in the home setting.

For Medicare Advantage plans, the process for engaging home health can vary. Ask the plan’s concurrent review nurse for direction or reach out to your MCCFL Liaison for assistance.

VA Community Care Network

This applies to all except Texas

The VA Community Care Network (CCN) is the VA’s link with your community providers to ensure Veterans receive the highest quality care. CCN is comprised of six regional networks covering all of the United States and territories. Optum, part of the United Health Group, has partnered with the Department of Veteran Affairs through the VA’s new Community Care Network. Optum has been named as the TPA for the CCN network as of December 2018 for Regions 1,2 and 3. CCN is rolling their programs out through each of these regions. While facilities may hold the CCN contract, their particular county may not have the CCN in place. Working with your areas VA Case Manager and your MCCFL Liaison will be the fastest and easiest way to expedite current information and potential admissions. Once the VA Community Care Network is fully implemented, it will be the preferred national network the VA uses to assist Veterans with their continual needs in their community.

Do you read our newsletter?

What is the month and the year Optum was named as the TPA for the CCN network? email The first 5 responders can pick a gift card to Amazon or Target.

Small print: if you have already won you can not win again.

Webinars hosted by MCCFL

July

Woundtech: Learn how to lower costs and improve transition of care for your Managed Care residents; hosted by Woundtech.
Direct Admissions: Hint and Tips on how to handle Manage Care admissions from another setting than the hospital hosted by Regina Wild.

AUGUST

NOMNC's and Appeals: Come learn about NOMNC's and QIO appeals hosted by Nanette Johnson Smith.

Reach out to your Managed Care Liaison to get links to join webinars!

Florida Medicaid Waivers Coming to an End...

Florida Medicaid COVID-19 Flexibilities Ending on July 1, 2021 Notice
Reinstatement of Interfacility Transfer Prior Authorization Requirements Effective July 1, 2021 Notice
Reinstatement of PASRR and Bed Hold Requirements Effective July 1,2021 Notice
Providers Must Bill Dual Eligible Special Needs Plans (D-SNP) for All Services effective July 1, 2021 Notice

Paying Attention To The Details!

Housekeeping items...

As best practice we suggest reverification of all Medicare benefits on ALL skilled members on the 1st and 15th of the month to catch potential payer changes.
When reviewing fax authorizations, ensure to verification of dates of service are correct and authorization is for your provider's name.
When employees are no longer employed by a facility, please remember to remove their access to insurance portals. This practice will assist in keeping the facility HIPAA compliant.
Do you need access to our client portal? Reach out to your liaison for direction.

KnowBe4

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