May 19th, 2023


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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!


Important Updates

HHS Fact Sheet: Telehealth Flexibilities and Resources and the COVID-19 Public Health Emergency



As the Department of Health and Human Services (HHS or the Department) continues the process of transitioning away from the policies enabled by the COVID-19 emergency declarations, the Department would like to provide clarity regarding the future of federal flexibilities related to telehealth and tele prescribing to ensure that patients may continue to access and receive the care that they need.


The HHS released a fact sheet outlining key details of what will change and what will stay the same for patients and providers when the COVID-19 public health emergency ends.


Click here to learn more.

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

End of Public Health Emergency (PHE) Resources



TCCN Seizure Action Plan Video and Resources


TCCN member group, Children’s Neurology, has been awarded a 1998 Society grant for a quality improvement project aimed to reduce emergency department visits and hospitalizations for patients with breakthrough seizures. 

 

Why? 


Epilepsy is the most common neurologic condition. Compared to other pediatric hospitals, Children’s Healthcare of Atlanta was seeing more patients in the Emergency Department with breakthrough seizures.

 

What are they trying to accomplish? 


Decrease ED visits and hospitalizations for breakthrough seizures, identify barriers to successful self-management, and cultivate a culture of support and empowerment for patients, families, and members of their care team. By decreasing ED visits and hospitalizations for breakthrough seizures, this project aims to decrease unnecessary utilization and improve the quality of life for epilepsy patients and families.

 

What changes can they make that will result in improvement? 


Grant interventions are designed to facilitate consistent patient and family education across the care continuum and to empower patients and families to improve epilepsy self-management. Interventions include identification of high risk patients to receive targeted outreach and prioritization of follow up needs, implementation of programs to provide enhanced epilepsy education, and collaboration with TCCN to facilitate consistent messaging for patients and families across the care continuum.

 

TCCN has developed the following video in support of this grant. The video provides an overview of the self-management education and resources provided to patients and families as well as coordination of care documents for providers and how to locate them in accessCHOA. Teaching sheets utilized by the neurology team are also included.


Click Here to View the Seizure Action Plan Video


Resources: 


AAP Online Course Opportunity: Managing Acute and Chronic Pain and Substance Use Disorders in Pediatrics


This course will meet the new government-mandated requirement for all DEA-registered practitioners to complete eight hours of training on the treatment and management of patients with opioid or other substance use disorders prior to applying for or renewing their license.

 

Pain in pediatric patients is common, under-recognized, and undertreated. Unrelieved acute, chronic, and needle pain in childhood directly results in poorer clinical outcomes, including increased morbidity, degree of anxiety, needle-phobia, health care avoidance, and chronic pain, which may contribute to substance use disorders.

 

Please click here to learn more.

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.”

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​
  • 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


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.

Reminders

WHO Director-General concurs with advice regarding the ongoing COVID-19 pandemic



Dr. Rochelle Walensky announced departure from CDC


FDA Simplifies Recommendations for Bi-valent mRNA COVID-19 Vaccines



CMS rule would extend Medicaid, Marketplace coverage to DACA recipients



Changing the Way People Think and Talk about Vaccinations: A Shift Toward a New Narrative


To read the full report, click here.


To listen to a webinar click here.



All Opioid Pain Medicines: FDA Updates Prescribing Information to Provide Additional Guidance for Safe Use


Georgia Medicaid Fair Highlights


Gerber Infant Formula Recall

The "AAP's Bold Stance on the Value of Pediatrics" 

From Chip Hart: 2023 Telemedicine Requirement Grid


Developed by Jan Blanchard.  Click on the link to download the pdf.

TCCN Payor Updates

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!

Reminders:


Anthem Reimbursement policy update: Modifiers 25 and 57 - Professional


Anthem Notification regarding reimbursement changes to COVID-19 laboratory services codes (MAC)


Additional Anthem Resources:

Click to review Claims Resolution instructions, alerts, and updates

Click Here to Subscribe to Anthem's Provider News


To find the latest Provider News, visit the Anthem Provider News home page.



KHF Payor Updates

Humana


Updated Provider Manual effective March 1, 2023


Introducing an online community resource directory


https://humana.findhelp.com/


Addressing health-related social needs can be important to your patient’s health. That’s why Humana Community Navigator, powered by findhelp, offers an online directory of community resources with more than 500,000 social service programs across the United States.

CareSource Updates


CareSource 2023 Pharmacy Network Change


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

United Healthcare


Get ready to submit electronically in 2023

Reconsiderations, appeals and claims moving to digital submissions only

Cigna Updates


Q1 2023 News Publication



Additional Virtual Care Services Now Permanently Reimbursable


Georgia Medicaid


Medicaid Unwinding Toolkit Resources


Beginning April 1, 2023, all Georgia Medicaid and PeachCare for Kids® members will undergo an eligibility review. This process will take approximately 14 months. A member’s date for redetermination may be anytime between April 2023 and March 2024. Notices will be sent to all members, so please ensure your contact information is up to date. If the state finds that a member is still eligible for Medicaid, coverage will be renewed. If a member is no longer eligible, he/she will be connected with alternative healthcare options. For more information, please visit https://staycovered.ga.gov or https://dhs.georgia.gov/medicaid-unwinding


Additional Resources


AAP unwinding two pager_3.15.23.pdf


Practice_Template_Letter_Unwinding_Medicaid.docx (live.com)


Practice Template Letter Unwinding Medicaid Spanish Copy.docx (live.com)


Microsoft Word - AAP_Georgia.docx


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?


  1. Please review https://staycovered.ga.gov/ for the latest PHE Unwinding information.
  2. Proactively encourage and remind Medicaid patients to update their personal information on the Gateway website: https://gateway.ga.gov/access/
  3. 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. 


In Case You Missed It

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.



Replay: Virtual PA Meeting- Active Shooter Training


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.


2023 Pediatric Coding Update and Managing the Challenge of 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]



Georgia DPH: Meningococcal Conjugate Vaccine Requirement



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.
  • Q & A for parents on recall of Abbott formula and re-opening of plant. 

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!


Communications


TCCN Roundup:


The TCCN Roundup is designed to be a twice weekly information hub for all things TCCN. 

  • 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

 

Resources