Attention NC Innovations Providers: Clarifying Transition from In-Home Skill Building, In-Home Intensive Services and Personal Care Services over to Community Living and Supports
Community Living and Supports is a new NC Innovations service that combines In-Home Skill Building (IHSB), In-Home Intensive Service (IHIS), and Personal Care Service (PCS).
NC Innovations Providers cannot seek new authorizations for In-Home Skill Building, In-Home Intensive Service, or Personal Care Service as of November 1, 2016.
In summary, the individual and/or family options are as follows:
- Continue with current services (IHSB, IHIS, PCS) through the end of the existing authorization
- Fully transition to Community Living and Supports, prior to the existing authorization ending
- Request a Service change within an existing authorization without fully converting over to Community Living and Supports.
- Innovations Member X is currently receiving 10 hours a week of IHSB and 20 hours a week of PCS authorized through May 2017.
- Innovations Member X requests a revision to get two additional hours of PCS-type support each week.
- A request can be submitted for 22 hours per week Community Living and Supports and the 10 hours per week of IHSB can continue through end of current authorization period. The member may also choose to convert IHSB to Community Living and Supports at the time of revision, but it is not required.
Should you have further questions regarding this clarification, please feel free to contact Doug Gallion at firstname.lastname@example.org.
Attention ACTT Providers: Clarification regarding ACTT Encounter Data Submissions
Partners is required, by Joint Communication Bulletin J204, to comply with ensuring we are capturing the encounter data for Assertive Community Treatment Team (ACTT) services. On October 7, we issued a Provider Alert regarding ACTT Encounter Submissions. This alert provides more detail regarding how to submit these encounters.
Partners allows the provider to bill one unit per week up to four per month, with the understanding that the provider is meeting the requirements in Clinical Coverage Policy (CCP) 8A-1 related to intensity of services. CCP 8A-1 states that a provider must have a minimum average of 1.5 contacts per week for at least 60 minutes per week. In addition, CCP 8A-1 states four of those contacts, per month, should be face to face with the consumer. It is expected that additional face-to-face and phone contacts are made with consumers, their natural supports, and other providers on their behalf.
Effective for dates of services November 1, 2016 forward, Partners is requiring provider to submit their encounter claims. So, for clients receiving ACTT Services, providers would be required to bill the following for both State Funded and Medicaid Funded ACTT consumers:
- For the four face-to-face contacts in the month, providers should submit a Service Authorization Request (SAR) requesting four units per month, or 24 units for six months under code H0040, up to four per month.
- You will bill the same code, H0040 (these are the ones you receive the payment for)
- No authorization will be required for the additional contacts, however, for every client encounter (past the authorized four face to face contacts), you would submit a claim with the code H0040 EN. No authorization is required for this code. This will allow all client interactions, as required in the clinical coverage policy, to be captured. (These entries will not pay a claim.)
Partners will ensure that these codes and modifiers are in the contract.
If you have questions, please contact your Account Specialist.
Attention Providers delivering Residential Treatment Services: Residential Treatment Services Level III Meeting
There will be a meeting with Residential Treatment Services Level III Network Providers on Monday, December 19, 2016 from 11 a.m.-1 p.m. This meeting will be held at Partners’ Hickory Office in the Multipurpose Room, at 1985 Tate Blvd SE, Hickory, NC 28602.
The purpose of this meeting is to:
- present recommendations from Partners’ Special Review Unit;
- discuss future directions for Evidence Based Practices; and
- NC TOPPS data submission.
Partners strongly encourages each provider to bring up to three participants to the meeting, such as your CEO/Executive Director, Clinical Director and Quality Assurance or Quality Improvement Director.
Registration for this meeting is required by December 11, 2016. To register, click here, or visit the Calendar on the Provider Knowledge Base at http://providers.partnersbhm.org/. Lunch will be provided, so please note any dietary restrictions when registering.
Please contact Vanessa Anderson at 828-323-8062 or email@example.com if you have questions about this meeting.