Note: New Content Noted with Asterisks*** and Highlighted
Dear KHF Providers and Practice Administrators,
We have several updates to share regarding payor updates, programs and upcoming events. There is a lot of information, and we want to make sure we are keeping our membership informed. We recommend reading through this communication in its entirety and please reach out to us with any questions you may have!
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***CMS rule would extend Medicaid, Marketplace coverage to DACA recipients
The Centers for Medicare & Medicaid Services released a proposed rule on April 26, 2023 that would extend Medicaid and Children’s Health Insurance Program coverage to qualified individuals in the Deferred Action for Childhood Arrivals program in states that cover legally residing immigrant children and pregnant women.
To learn more and to submit a formal comment, click here.
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***Recommended CME for Kids Health First Providers
The DEA recently announced that physicians renewing their DEA license from late June onward will need to demonstrate that they have completed 8 hours of training in opioid prescribing and treatment of opioid use disorder.
This training is mandated by the MATE Act. Physicians who have previously completed similar training to meet Georgia’s licensing requirements can count those courses, but they typically were not enough to fulfill the 8-hour requirement.
KHF has identified a free, online, Pediatric-specific course that satisfies the DEA requirement. This course has been vetted by Dr. Lori Desouter, KHF’s Medical Director.
Please click here to learn more and register for the class.”
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***Replay: Virtual PA Meeting- Active Shooter Training
Thank you to all who participated in our recent virtual PA meeting! If you weren't able to attend or would like a recap of the topics discussed, please click the links below:
KHF Updates: https://vimeo.com/819629693/b7d7ab5e02?share=copy
Active Shooter Discussion with Zachary Williams:
Recording is available for replay on the KHF Intranet site.
- Go to the University tab, then webinars to access the video.
Included below are contact details for practices who want to reach out to Mr. Williams directly.
Zach Williams
Protective Security Advisor (PSA) – Region 4, Atlanta, Georgia
US Department of Homeland Security
Cybersecurity and Infrastructure Security Agency
Mobile: 202-941-1319 | Email: [email protected]
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***Georgia Medicaid Fair Highlights
The Georgia Medicaid Fair was held last week on April 20th. For anyone who was not able to attend the event or would like a recap, we have created a summary of the topics discussed during the event.
Topics Include:
- Updates on payee enhancement
- Notice regarding the end of continuous member enrollment
- New initiatives and programs
Click here to download the summary.
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***KHF Question of the Day
Survey Results: Triage Call and Panic Button
What is your practice doing in reference to triaging night calls?
2 of 23 respondents said they employed a night triage nurse.
21 of 23 respondents said they use a service to triage night calls.
We surveyed! You answered! Previous Surveys are below!
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***Reminder! Benchmarking Request - practice survey - due 4/28/23
We want to thank you for your cooperation and participation in our benchmarking program thus far. The information you provide helps us continue to analyze aggregate data at a network level and spot trends that are affecting our practices.
Here is a blank copy of the 2023 Practice Benchmarking Survey. All information will be based off of calendar year 2022 data. To assist you in completing the survey, here is a word document with detailed instructions to guide you through the Benchmarking worksheet. The attached Benchmarking worksheet consists of a total of 11 tabs, but remember, you only have to complete the cells that are highlighted in yellow! As with all of our Benchmarking requests, the provided information will remain strictly confidential.
The deadline for returning the surveys is April 28, 2023. Please return your completed survey to Elizabeth Hogan at [email protected]. The results will be returned via email on or before the May or June Practice Administrator meeting.
The Board of Managers and Kids Health First appreciates the time it takes from your busy schedules to participate in the Benchmarking initiative. In addition to the valuable data your practice gets from participating, the Board is offering a $50 Amazon gift card to practices that complete the practice survey on time.
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Update: From KHF on HIPAA Compliance Requirement for Telemedicine Vendors
Dear Colleagues,
An important announcement was distributed this week from the HHS Office of Civil Rights describing the end of enforcement discretion regarding HIPAA compliance in the use of telemedicine during the COVID-19 public health emergency. As the PHE ends on May 11, your ability to use non-compliant HIPAA platforms for telemedicine will expire as well, at 11:59 PM on that date.
This gives you a 90-day period during which to ensure all providers in your practice are using a HIPAA compliant platform for telemedicine.
Please see the information below which details this announcement:
HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health Emergency HIPAA Notifications of Enforcement Discretion
Melanie Fontes Rainer, OCR Director, stated that the “OCR is continuing to support the use of telehealth after the public health emergency by providing a transition period for health care providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA Rules.”
The OCR is allowing 90 days for covered health providers to “come into compliance with the HIPAA rules” in regard to the delivery of telemedicine to their patients/families.
This transition period will begin on May 12, 2023, and end at 11:59 PM on August 9, 2023.
The OCR will exercise discretion in enforcement of these rules and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules when delivery of care “occurs in connection with the good faith provision of telemedicine during the 90-calendar day transition period.”
To learn more, click here.
As a reminder, TCCN has an agreement with Anytime Pediatrics which is a full service HIPPA compliant telemedicine provider. If you have questions and want to learn more about this program, please contact Barbara Douglas at [email protected].
Lori Desoutter, MD
Medical Director
Kids Health First IPA
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Update: All Opioid Pain Medicines: Drug Safety Communication - FDA Updates Prescribing Information to Provide Additional Guidance for Safe Use
The FDA is requiring several updates to the prescribing information for both immediate-release (IR) and extended release/long acting (ER/LA) opioid pain medicines. This includes stating for all opioid pain that the risk of overdose increases as the dose increases.
Click Here For Details and Recommendations
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Changing the Way People Think and Talk about Vaccinations: A Shift Toward a New Narrative***
The American Academy of Pediatrics and the Frame Works Institute recently completed research* focused on how we as a society talk about vaccinations. Using evidence-based strategies, the results of the research included five recommendations on how you as providers, advocates and public health communities can reshape your communications to build better and more effective understanding of and support for vaccinations in children and adolescents.
To read the full report**, click here. This article also lists out the five recommendations and how you as a provider can adapt your communication around the benefits of vaccinations.
** Source: American Academy of Pediatrics
To listen to a webinar on the same subject, hosted by Mark Del Monte, CEO of the AAP, and Sandy Chung, M.D., F.A.A.P., President of the AAP, and Frame Works Institute, click here.
*This study was funded by the CDC and the AAP Friends of Children.
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IPA-GA Committee & Board Recruitment
To KHF Physicians:
If you are interested in being part of the Quality/Utilization Management Committee or the IPA-GA Liability Program Board of Directors and would like more information, click on the link to leave your name and contact information.
Quality/Utilization Management Committee:
- Reports to the Board of Managers, serves as Board’s steward for overall quality improvement of the network
- Goals are to maintain the highest possible standards of practice that will improve the health outcomes of its members, promote accessibility and cost-effective quality care
- Provides oversight of network standards, monitoring adherence to those standards, makes recommendations for improvement
- Leads development of clinical practice and referral guidelines and potential Maintenance of Certification (MOC) programs
- Meeting frequency: Quarterly, mainly virtual, in person if needed
IPA-Ga Liability Program Board of Directors:
- Practice must be a participating member
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Tasked with financial oversight of the program, oversight of program policies and procedures and managing any claims
- Meeting frequency: Quarterly, virtual, usually 30-60 minutes
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DEI-Focused Clinical Quality Forum Recording
This module was the official kick-off for our member-facing Diversity, Equity, and Inclusion strategy, and we hope that the education on equity, the compelling parent interviews touching on medical bias, and the deeper dive into the clinical impact of social determinants of health on asthma and other chronic diseases give some context for TCCN’s broadened focus on DEI in our quality program.
If you were not able to attend live, we highly encourage you to watch the recording and complete the attestation via this link or the QR code above to receive your TCCN participation credit. The recording is roughly 1 hour. If you attended live, there is no further action needed for your practice to receive credit. One least one provider from each practice must view this program or the upcoming Fall Clinical Quality Forum. In addition, each practice must view the short DEI educational video that was at the beginning of the module, so your participation for this program will fulfill two of your 2023 requirements.
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News from the AHA related to the PHE and Medicaid
On Friday, March 17th, 2023 the American Hospital Association posted the following news from the HHS and the Kaiser Family Foundation on emergency use authorization in light of the coming end of the PHE, and the recent survey on states approach to ending the continuous enrollment on March 31st and how it will impact Medicaid and CHIP recipients. Please see below for the information.
HHS: FDA COVID-19 emergency use authorizations remain in effect
Health and Human Services Secretary Xavier Becerra this week amended the February 2020 COVID-19 emergency use authorization declaration so that the Food and Drug Administration’s emergency use authorizations for COVID-19 diagnostics, personal protective equipment, other medical devices, and drug and biological products will remain in effect until there is no longer a “significant potential” for a COVID-19 public health emergency or the authorized devices or products have been approved. For more information, see the FDA’s EUA questions and answers.
Survey looks at state approaches to renewing Medicaid, CHIP enrollments
The latest annual survey of state Medicaid and Children’s Health Insurance Program directors by the Kaiser Family Foundation and Georgetown University Center for Children and Families looks at state approaches to renewing Medicaid and CHIP enrollments over the past year and once the COVID-19 public health emergency’s continuous enrollment requirement ends on March 31. According to the January survey, all states have encouraged enrollees to update their contact information; 43 states have continued to process ex parte renewals over the past year; 41 states are engaging managed care organizations to help with renewals; and 35 states are prioritizing renewals based on factors such as time since last renewal and potential ineligibility. More than two-thirds of states said they have extended or plan to extend postpartum coverage for a full 12-months post pregnancy.
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Social Media Posts for Medicaid and End of PHE
To help your patients and families better understand the end of Public Health Emergency and the unwinding of Medicaid, and what it may mean to them, please feel free to post these on your social media platforms.
For more information, visit
for additional Questions and Answers they may have, visit the Kids Health First communication resource page.
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Communication #1-Stay tuned for updates
The End of the Public Health Emergency (PHE) for COVID-19: What does that mean for me and my family?
On January 30, 2023, the White House announced its plans to end the coronavirus public health emergency (PHE) in May. The PHE is scheduled to end on May 11, which will result in changes that will affect the access and cost to vaccines, tests, and treatment for COVID-19. This will include changes to telehealth policies.
During the pandemic, many of you received COVID tests, vaccines and treatments free of charge. When the emergency period ends on May 11, changes will occur on the availability and cost of the above. The White House did not want to end the PHE quickly and has given both patients and providers several months’ notice to learn more about the upcoming changes.
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Update from KHF and AAP on COVID Vaccines
Dear Fellow KHF Pediatricians,
As you have all heard, the public health emergency will be coming to an end on May 11, 2023. What will this mean for all of us? Many of you may have questions regarding COVID vaccines, testing and treatment moving forward. The AAP is aware of these concerns and is working at state and national levels to support pediatricians in our efforts to protect and treat our patients as the PHE ends.
Kids Health First has been an excellent source of information during the pandemic and will continue to gather and disperse information to all of you so that your offices may plan for these upcoming changes which will affect all of us. Be assured that we are here to support you and will continue to send helpful information as it becomes available.
This letter from Dr. Sandy Chung is our most up to date summary.
Best Regards,
Lori Desoutter, MD
Medical Director, Kids Health First IPA
Melinda Willingham, MD
Board of Managers, Kids Health First IPA
American Academy of Pediatrics, Chair, Committee on Federal and Government Affairs
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Gerber Infant Formula Recall
According to the AAP, some Gerber infant formula has been recalled due to possible bacteria contaminant. To learn more, click here.
This article from the FDA, has updated the information and lists out the items which have been recalled, which I have also listed below. There is also a 1-800 number which parents can call for more information:
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The "AAP's Bold Stance on the Value of Pediatrics"
by Allie Squires, Editor of The Independent Pediatrician
In a landmark policy statement, the AAP is stating the reasons why and how payment reforms are necessary for the future of the healthcare system. Read more.
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TCCN is pleased to announce the signature of a contract with CareSource.
The comprehensive agreement includes base contract terms for delegated primary care members and a value-based program for all TCCN members. The agreement will have an effective date retroactive to January 1, 2023. More details will be forthcoming as we implement this new agreement.
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CMO State Request for Proposal (RFP) Update
As the State continues its CMO bidding process for contracts that are planned to start in 2024, you have likely noticed communications being sent to your practice by entities that are interested in entering our market with their CMO product. We are aware that the following entities may be reaching out to you:
- Aetna
- AmeriHealth Caritas
- Humana
- Molina
- UnitedHealthcare
TCCN is in discussions with several of these entities regarding potential contracting through TCCN should they be selected by the State. If your practice intends to contract with any of these entities through TCCN, you do not need to respond to these requests.
We reached out earlier this summer to request your delegation responses for the new entities. If you have not yet responded, or you are not sure, please reach out to Sahdeja Serieux. We need responses from all primary care practices, whether you participate with the CMOs or not.
We will provide additional updates as the State RFP process continues. Thank you!
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Anthem Contracting Update
TCCN has worked with Anthem since January 15, 2022 to resolve data issues following the contract implementation.
Anthem completed their audit of TCCN’s provider data and on March 2, 2023 initiated a claims sweep. The sweep will identify inappropriate denials and underpaid claims for dates of service 1/15/2022 to present.
The claims sweep could take up to 90 days to complete and practices may encounter recoupments as claims are reprocessed. This is especially the case for Anthem claims outside of BCBS of Georgia.
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Reimbursement policy update: Modifiers 25 and 57 - Professional
Effective March 1, 2023, the Modifiers 25 and 57: Evaluation and Management with Global Procedures reimbursement policy will be renamed Modifiers 25 and 57 - Professional.
Additionally, the Nonreimbursable section of the Modifiers 25 and 57 policy was updated to indicate that CPT® code 99211 is not eligible for reimbursement when billed with modifier 25. This update was previously communicated in the July 2022, edition of the Provider News article titled Reimbursement Policy update: Modifier Rules – Professional:
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Notification regarding reimbursement changes to COVID-19 laboratory services codes (MAC)
Beginning with dates of service on or after April 1, 2023, or the end of the public health emergency (PHE), whichever is later, reimbursement for COVID-19 laboratory service codes may be reduced for participating providers contracted with Anthem.
New COVID-19 laboratory service codes were implemented and reimbursed at rates to meet the needs of providers during the PHE. Reimbursement will now be revised to Anthem's standard reimbursement methodology for the following codes:
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CareSource Updates
CareSource 2023 Pharmacy Network Change
Summary Beginning on Jan. 1, 2023, the CareSource pharmacy network (managed by Express Scripts), will be changing. Kroger will no longer be participating in the network. Your members who currently fill prescriptions at Kroger will need to update their preferred pharmacy with your office. Additionally, you may receive a request to send new prescriptions to another participating pharmacy. If your member has active refills, their new pharmacy should be able to transfer the prescription from Kroger to the new pharmacy; however, you may receive requests for a new prescription to be forwarded during this time.
CareSource published new modifier policies effective January 1, 2023.
Please see the links below for specific details.
Modifier 25 New Policy
Modifier 59 New Policy
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United Healthcare
New ID cards coming for some commercial plan members
Effective 4/1/2023
Updates to Evaluation and Management Coding
Effective with date of service January 1, 2023, the Evaluation and Management reimbursement policy will be revised to align with the Evaluation and Management (E/M) CPT coding and guideline changes from the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS).
Reconsiderations, appeals and claims moving to digital submissions only
The effective dates for these incoming paper-to-digital transitions will be announced in Network News at least 90 days prior to the change.
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Georgia Medicaid
Lactation Consultants – Revised Policy effective 3/15/2023
Medicaid Member Redetermination
DCH has not contacted members in 2 years and will begin member redetermination outreach on February 1, 2023. They must initiate contact with all Medicaid members within 12 months and complete the redetermination within 14 months in accordance with CMS guidelines. Members will be contacted during their renewal month. For example, if a member had a historical renewal in April, they will not be contacted until April. If the member utilizes SNAP/TANF, DCH will align with those programs to only contact the member one time.
How can the provider community help?
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Please review https://staycovered.ga.gov/ for the latest PHE Unwinding information.
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Proactively encourage and remind Medicaid patients to update their personal information on the Gateway website: https://gateway.ga.gov/access/
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Share video, images, and the PHE toolkit that are found on https://staycovered.ga.gov/ with your patients.
Georgia Medicaid Provider Revalidation
Provider revalidation has also been voluntary due to the PHE. However, in 2023 the revalidation will become mandatory. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application.
For providers with multiple service locations, you will be required to Revalidate each additional service location.
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Kids Health First Who to Call List
Please contact our team with any needs you may have.
TCCN 2-Week Data Submission Requirement
The TCCN BOD requires all practices to submit claims data to the PHM Tool within 14 calendar days of the most recent encounter date.
2023 Pediatric Coding Update and Managing the Challenge of Surge
The Georgia AAP held a webinar on January 31st titled 2023 Coding Updates and how to meet the needs of your patients during a surge.
Here is the link to view the recording. Passcode: u*1Xuh11
2023 Pediatric Coding Update and Managing the Challenge of Surge Slide Deck
Nov. 17th Pediatric Coding Seminar Recording and Materials
2023 Pediatric Coding Seminar Recording
Slides: Color and Black & White
Free OSHA Training
Here is the link to the OSHA Webinar held on 9/15/22.
Here is the pdf of the deck.
Here is the end of course test.
If you attended the meeting live your certificate will be emailed to the email address you posted in the chat. If you were unable to attend live and you watch the video above and complete the test and would like your certificate of completion, please email Tandric Bowden at [email protected].
The Georgia Department of Public Health has published a letter to all providers regarding administration of the meningococcal conjugate vaccine (MenACWY).
KHF Q&A for Parents
Q&A Resources are posted on the KHF Intranet here.
Topics Include:
- Q & A for parents on the end of the Public Health Emergency and the unwinding of Medicaid.
- Q & A for parents about the COVID-19 Bivalent Vaccine Boosters from Pfizer BioNTech and Moderna for children 5 years of age and older.
- Q & A for parents on what to know about monkeypox from Kids Health First.
- Q & A for parents on Covid-19 Booster Vaccines for 5-11 years old.
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Q & A for parents on recall of Abbott formula and re-opening of plant.
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TCCN Roundup:
The TCCN Roundup is designed to be a twice weekly information hub for all things TCCN.
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Please to check out the latest issue.
- Please note that the link above only accounts for some TCCN updates. In order to view the full TCCN Newsletter with your contracted payor updates please check your TCCN inbox!
TCCN Quality Steps Newsletter
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