Issued:  March 26, 2020

Provider Council Meeting Tomorrow, March 27, 9:30 a.m. 

Partners’ Provider Council will meet via teleconference tomorrow, March 27, 2020at 9:30 a.m. to answer questions you may have related to COVID-19.  

Partners to Host Focus Groups Tomorrow, March 27 

Partners will host a number of focused discussions with various provider service delivery groupsThe intent of these discussionis for providers to share ways that Partners can support you during the COVID-19 pandemic. We want to hear your input and determine how we can continue to support you in the work you are doing. Please see times and registration information below: 

SAIOP/SACOT/Partial Hospitalization Focus Group 

Date and Time: Fri, Mar 27, 2020 1:00 PM – 2:00 PM EDT

To register, visit https://attendee.gotowebinar.com/register/8069582323886296333. After registering, you will receive a confirmation email containing information about joining the webinar.

Psychosocial Rehabilitation Providers (PSR) Focus Group 

Date and Time: Fri, Mar 27, 2020 2:00 PM – 2:30 PM EDT

To register, visit https://attendee.gotowebinar.com/register/365302149036807437. After registering, you will receive a confirmation email containing information about joining the webinar. 

COVID-19 Children’s Residential Providers Level 2-4 Group and Family Provider Focus Group 

Date and Time: Fri, Mar 27, 2020 2:30 PM – 3:00 PM EDT

To register, visit https://register.gotowebinar.com/register/8398037233429684748. After registering, you will receive a confirmation email containing information about joining the webinar. 

Partners’ Information Sessions 

Partners is hosting a series of information sessions focused on provider input and brainstorming. Partners wants to ensure that we are allowing opportunities for the provider network to vocalize concerns, present ideas and problem-solve together. Please register for each event individually. We have scheduled these two times per week for the next few weeks. Thanks in advance for your ideas and for the opportunity to interact and stay connected. 

Please register for the events here: https://attendee.gotowebinar.com/rt/8012464893823427595. 

We ask that you register for each date that you can attend. We are setting aside the following dates and times for the next few weeks. 

Information Sessions will be held: 

  • March 31, 2020, 11 a.m.-12 p.m. 
  • April 2, 2020, 3 p.m.-4 p.m. 
  • April 7, 2020, 1 p.m.-2 p.m. 
  • April 9, 2020, 3 p.m.-4 p.m. 

Service Changes Due to COVID-19 

Partners is working with our fellow LME/MCOs and the North Carolina Department of Health and Human Services (NC DHHS) to develop and implement In Lieu of Service Definitions to address barriers to traditional treatment provisions during the COVID-19 pandemic. NC DHHS is fast-tracking its review of In Lieu of Service Definitions. The submission process is moving quickly, and we are collaborating with our peer LME/MCOs to streamline these definitions across LME/MCO’s. 

Until we have approved In Lieu of Service Definitions in place for the services outlined in this bulletin, Partners is implementing the following changes. All service notes during this time must include the following statement: This service was delivered during the COVID-19 State of Emergency requiring social distancing. Services can start IMMEDIATELY using the telehealth approaches included below for all members participating in these services: 

The following codes are being loaded into contracts for 15 min increments and can be provided according to the telehealth guidelines below. Staff can bill these codes for the duration of the service provided. All team members of team-based services can bill these codes.  

Service 

Code 

Unit 

Rate 

Documentation Expectations 

Provider Expectations  

SAIOP  H0015 CV  15 min  $10.96  This service was delivered telephonically/through video conferencing during the COVID-19 State of Emergency requiring social distancing  Provider may bill up to the daily limits in the service definition and can deliver through audio connectivity OR through visual connectivity.  It is important for the provider to document appropriate oversight clinically for members and staff 
SACOT  H2035 CV  15 min  $11.34  This service was delivered telephonically/through video conferencing during the COVID-19 State of Emergency requiring social distancing  Provider may bill up to the daily limits in the service definition and can deliver through audio connectivity OR through visual connectivity.  It is important for the provider to document appropriate oversight clinically for members and staff 
PH  H0035 CV  15 min  $12.00  This service was delivered telephonically/through video conferencing during the COVID-19 State of Emergency requiring social distancing  Provider may bill up to the daily limits in the service definition and can deliver through audio connectivity OR through visual connectivity.  It is important for the provider to document appropriate oversight clinically for members and staff 
ACTT  H0040 CV  15 min  $29.06  This service was delivered telephonically/through video conferencing during the COVID-19 State of Emergency requiring social distancing  Provider may bill up to the daily limits in the service definition and can deliver through audio connectivity OR through visual connectivity.  It is important for the provider to document appropriate oversight clinically for members and staff 

Additionally, the following services that are already billed as a 15-minute unit can be provided according to the telehealth guidelines below: 

  • Community Support Team (CST)  
  • Peer Support  
  • Mobile Crisis Management 
  • Psychosocial Rehabilitation (PSR) 

DEFINITIONS:  

Tele-Behavioral Health subset of Telemedicine – The term describes the delivery of on-going care through the use of two-way real time-interactive audio and video (webcam) communication between a member, located at a distant site, and a licensed clinician, located at an alternative provider site. It is intended to overcome geographical barriers, connecting users who are not in the same physical location. For the purposes of this policy, this is also inclusive of telephonic visits for enhanced service delivery during a State of Emergency related to natural disaster or pandemic.  

During the COVID-19 State of Emergency timeframe, neither the originating site nor the distant site is required to be credentialed and enrolled.   

Responsibility and Requirements of Staff Involved with Tele-Behavioral Health Encounter  

  1. The clinician will minimize distractions during the telephonic/teleconferencing encounters to facilitate trust and rapport with the member.  
  2. The clinician will speak the language of the member whenever possible. When not possible, an interpreter will be utilized in the same manner as those used in face-to-face treatment.  
  3. The clinician will participate in treatment planning and consultation regarding members with members of the treatment team to the same extent as the other clinician and service providers.  

Regarding CV Modifiers: Partners will add these codes into your contracts in AlphaMCS but will not be updating the paper contract in an effort to reduce administrative burden.   

Important Claims Processing Questions:  

  • Providers who already have GT codes in their contract can submit codes that include the GT modifier if the code is appropriate for the service provided. Place of Service 02 would be considered a valid place of service for most of these codes. We can check any code you are unsure of. Also, check your contract to be sure the codes are listed.  
  • Providers who do NOT have GT codes in their contract should use the regular codes for the service they are providing via telehealth. Providers should document the telehealth activity in the service note but billing should be submitted with no changes and will be paid at the same rate. 

Note:  Place of Service (POS 02) “Telehealth (POS 02) requires the use of audio and visual equipment; telephonic only service codes do not meet this definition.” 

  • Codes 99441CR, 99442CR, 99443CR, 98966CR, 98967CR, 989687CR – Place of Service 02 (telehealth) is an invalid place of service for the new codes listed below. The CR modifier identifies the claim as catastrophe or disaster related. Office is considered a valid place of service. 
  • If you are submitting the same codes you submitted prior to the coronavirus, you will need to submit the claims as you always have.  

It is Partners’ expectation that all services are provided within the confines of the Service Definition except for what has been outlined in Partners and NC DHHS communications. Our goal is to partner (pun-intended) with our provider network to ensure services are provided to our members with as few barriers as permissible. Together we can make a difference! 

Clozapine REMS During COVID-19; FDA Issues Statement on REMS During COVID-19 

Partners wishes to share the following information with you regarding patients who are receiving clozapine treatment, which entails following an FDA mandated REMS due to risk of neutropenia. The FDA has released a statement for providers to consider during this time. 

Question: During an emergency (such as COVID-19 pandemic, natural disaster, or other disruption of community services), can patients get clozapine prescriptions filled if they have not had the required blood draw as required by REMS? 

Explanation: The first step is to consider what types of flexible communication and care can be available between clinicians and patients, such as phone or telehealth visits. Required CBC/ANC lab draws can now be completed in some locations using point-of-care testing. This enables patients to have only a finger stick completed for blood collection, similar to how people with diabetes test their blood sugar levels. This testing can be completed by a clinic nurse or other trained staff quickly without patients needing to go to a laboratory. In addition, there is a small window of flexibility for the CBC/ANC testing dates in relation to the processing of clozapine prescriptions. The current table from REMS includes a row entitled, “last ANC value on file is acceptable.” This regulation allows the pharmacist to determine somewhat flexible dates of the patient’s most recent CBC/ANC that will satisfy the requirement of REMS.   

Providers and pharmacies should communicate regarding how to best manage clozapine therapy during this time and ideally continue therapy is at all possible. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_PDA_Fact_Sheet.pdf . Pharmacies sometimes will dispense in an emergency situation, understanding that blood testing needs to be done as soon as possible, and that REMS will become concerned. The FDA notice is posted at https://www.fda.gov/media/136317/download. 

Lastly, an article from the Australian & New Zealand Journal of Psychiatry reviews two meta-analyses that support the emerging idea that for clozapine the risk of neutropenia is not significantly greater than that of other atypical antipsychotic agents, and that risk of relapse is much greater (without medication) than the risk of neutropenia. The entire FDA statement is also posted on the NC Board of Pharmacy webpage http://www.ncbop.org/PDF/REMS_guidance_COVID19FDA032320.pdf 

COVID-19 Information for SAMHSA Discretionary Grant Recipients 

SAMHSA has issued information for discretionary grant recipients affected by the loss of operational capacity and increased costs due to the COVID-19 crisis. Please visit https://www.samhsa.gov/coronavirus/discretionary-grant-recipients to learn about these flexibilities as well as frequently asked questions.