Partners 2020 Needs Assessment and Gaps Analysis Survey

Every year, Partners conducts a Needs Assessment and Services Gaps Analysis to understand the behavioral health needs of the citizens in the regions we serve. Partners will use a number of tools–focus groups, consultation with community and provider stakeholders, extensive data analytics, and web-enabled surveys–to develop an effective plan for a more targeted deployment of precious healthcare resources.

This year, a Community Needs Assessment survey will be delivered from March 1, 2020 through March 31, 2020. To assist with this process, we want input from every person and from every perspective touched in some way by mental illness, substance use disorders, or intellectual and developmental disabilities.

We sincerely appreciate your help in this process, and we look forward to hearing from you!

February Provider Council Meeting

Partners’ Provider Council will host its next meeting on Friday, February 28, 2020, from 9:30 a.m.-noon in the Multipurpose Room at Partners’ Hickory location, 1985 Tate Blvd. SE, Hickory, NC 28602. Providers will meet from 9:30 a.m.-10:30 a.m. Partners’ employees will join the meeting at 10:30 a.m.

If you have questions or would like to learn more about the Provider Council, visit https://providers.partnersbhm.org/provider-council/.

Quarterly Provider Webinar—March 11, 2020

Partners will host its Quarterly Provider Webinar on Wednesday, March 11, 2020, at 1 p.m. Click here to register for the webinar. Learn more and view information from past Provider Webinars at https://providers.partnersbhm.org/provider-webinars-forums/.

Social Determinants of Health

We have all heard that 90% of health care spending in the United States is spent on medical care. While access to high-quality medical services is crucial to health, research shows that up to 80% of a person’s overall health is driven by other social and environmental factors and the behavior influenced by social determinants of health (SDOH).

In order to ensure long-term risks are identified, Partners has expanded the SDOH tool developed by the NC Department of Health and Human Services (NC DHHS), enhancing the overall analysis. Partners has collected in excess of 2,000 assessments thus far, with 1,183 of the assessments from adults with Medicaid and serious mental illness. One of Partners’ 2020 strategic goals is to ensure that “80% of the Adult Medicaid Serious Mental Illness (SMI) members will have an SDOH evaluation; and if three or more SDOH needs are identified, the member will have a documented plan.” Partners is well on our way to meeting the goal for the number of administered assessments. We continue to provide technical assistance to providers who do not have documentation that the deficits are being addressed in a plan. The primary focus of the assessments is to assist members with current needs.

All providers are encouraged to participate in this important effort. Partners has two options to submit data: electronically or using a template. Partners will work with providers and offers technical assistance as needed. For those who participate in our SDOH initiative, the data from your agency will be analyzed, compiled and included in a comprehensive SDOH report.

A quick overview of the SDOH initiative is included in our SDOH Guide.

If you have questions or would like to request a site visit to get started, please contact Danielle Sigmon, Population Health Specialist at 980-289-2551 or email dsigmon@partnersbhm.org.

Claims Information

Providers are reminded to use the email claimsdepartment@partnersbhm.org for all email inquiries so that they are handled in the most efficient manner. Please do not send email directly to individual employees. 

AlphaMCS Portal University is an available resource and guide for navigating AlphaMCS. If you need additional claims training, email rcolvard@partnersbhm.org to schedule a time for training.

Explanation of Benefits Requests for Coordination of Benefits Claims: As a reminder, Partners does request copies of the Explanation of Benefits for members/claims submitted indicating Coordination of Benefits. The request will originate via email from Partners Claims staff. Once requested, please submit the information, via secured email, prior to the date indicated in the emailed request. If a response is not received, the original claim payment will be recouped.

Steps to be taken for Retro-Medicaid members that have previously received State Procedure Code H0038TY beginning with dates of service November 1, 2019:

  • State Benefit Procedure Code H0038TY claims will be reverted
  • Providers will need to request a new authorization for Medicaid procedure code H0038HK
  • Providers will need to submit a new claim with Medicaid procedure code H0038HK

January 2020: Medicaid—Number of Days to Process and Pay All Claims

Received Date to Paid Date: 9.0

Top Five Medicaid Claim Denials for January 2020

Claim Denial

Provider Recommended Action Steps

Service is not authorized Verify Service Authorization for the member. Contact Utilization Management.
Duplicate Claim The claim has previously been submitted and adjudicated. Do not refile.
No coverage available for Patient/Service/Provider combo

 

Go to Patient -> Patient Search and search for the patient in question. Check the insurance to ensure the patient has effective insurance covering to date of service submitted on the claim. If this appears to be correct, contact the MCO for further assistance.
Claim received after billing period. Write off charges as non-billable. Do not rebill.
Client has other covered insurance. Ensure primary insurance for the member has been billed and is indicated in the claim submitted to the MCO.

State News

Medicaid Managed Care: Providers are reminded to visit https://medicaid.ncdhhs.gov/ for the most up-to-date information about NC DHHS’ plans regarding Medicaid Managed Care. At this time, beneficiaries will continue to get physical and behavioral health services as they do now. They do not need to choose a health plan.

DHHS continues to work to launch the Behavioral Health and Intellectual/Developmental Disability Tailored Plan in 2021. This plan is designed for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DD). The Behavioral Health I/DD Tailored Plan also will also serve other special populations, including Innovations and Traumatic Brain Injury (TBI) waiver enrollees and waitlist members. Providers are reminded to visit https://medicaid.ncdhhs.gov/providers/programs-and-services/behavioral-health-idd-tailored-plan for the most up-to-date information regarding Tailored Plan transition.

Comprehensive Independent Assessment Entity Award Announcement:  On January 31,2020, the North Carolina Department of Health and Human Services announced that Keystone Peer Review Organization, Inc. (KEPRO), received the contract as the Comprehensive Independent Assessment Entity (CIAE). KEPRO was selected based on a thorough and fair evaluation of responses submitted to the Request for Proposal released by the Department in March 2019.

The CIAE will streamline access to Medicaid Long-Term Services and Supports (LTSS), providing beneficiaries a much-needed single point of entry for accessing Medicaid LTSS services and streamlining the process between initial contact and service enrollment. The CIAE will conduct assessments and screenings to determine eligibility for the following LTSS programs:

  • State Plan Personal Care Services (PCS)
  • Community Alternatives Program for Children (CAP/C)
  • Community Alternatives Program for Disabled Adults (CAP/DA)

In addition, the CIAE will also provide management and oversight for the Pre-Admission Screening and Resident/Review process (PASRR) Level II and serve as North Carolina’s local contact agency (LCA) for nursing home residents who have requested information about options for less restrictive care settings.

The Department will provide additional information in the coming weeks regarding the onboarding of the new CIAE, the transition of services from the current vendor and phased initiation of services by KEPRO. Until that time, PCS providers should continue to submit PCS requests to Liberty. Medicaid will host webinars in the next two weeks to provide the details of the transition plan for each of the affected program groups. Our process will ensure that Medicaid LTSS continue without disruption to our providers and beneficiaries.

Comment Period Extended – Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper: The Department has extended the public comment period for the Behavioral Health I/DD Tailored Plan Request for Applications (RFA) Pre-Release Policy Paper published on January 30, 2020. The Department welcomes feedback on the paper at Medicaid.Transformation@dhhs.nc.gov by February 21, 2020.

Provider Application Process for Tailored Care Management – extended deadlines: The Department received many thoughtful comments on the Draft Provider Manual released December 11, 2019. To ensure that the Department gives providers enough time to prepare their applications after the release of the finalized manual, the Department has decided to further extend the initial application deadline for providers from February. 21, 2020, to June 2020 (date TBD). The finalized manual and application form will be forthcoming.

Joint Communication Bulletins, which are issued by the NC Department of Health and Human Services, can be found at https://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins.

News from Program Integrity

U.S. Department Of Health And Human Services Office Of Inspector General (HHS-OIG) Recommends $14.9 Million Repayment to New Jersey for Claims Associated with its ACT Program: HHS-OIG has audited New Jersey’s Programs of Assertive Community Treatment (PACT)[1], which service is essentially the same as North Carolina’s Assertive Community Treatment (ACT).[2] It sampled 100 PACT services claims and found that only half complied with federal and state requirements. Of the non-compliant claims, 21 contained more than one deficiency. HHS-OIG found that New Jersey’s PACT program services:

  • were not adequately supported or documented (36 claims),
  • plan of care requirements was not met (17 claims),
  • PACT teams did not include staff from required clinical disciplines (eight claims),
  • providers did not obtain prior authorization for beneficiaries (five claims), and
  • there was no nursing assessment (one claim).

It further identified potential quality-of-care issues, namely PACT team psychiatrists associated with 33 sample claims did not provide the minimum amount of face-to-face psychiatric time required for their caseload. Also, despite defining the PACT program as rehabilitative, New Jersey did not require periodic reauthorizations or reevaluations of beneficiaries’ program eligibility.

Compliance with the rules, regulations, and clinical policies is not just a bureaucratic paperwork exercise, non-compliance can have implications for the quality of care our members receive. Johns Hopkins found that receiving care from a provider that had engaged in fraud and financial abuse could be dangerous to your longevity. It conducted a three-year study suggesting that receiving medical care from a provider who has engaged in fraud, waste, and abuse may be associated with significantly higher rates of mortality and emergency hospitalizations.[3]

HHS-OIG made four recommendations, including that New Jersey refund $14.9 million. How are 50 claims worth $14.9 million? Those 50 claims were valued at $36,024, but HHS-OIG used a sampling methodology that let it extrapolate its findings across all the claims for the service audited. Extrapolation is commonly used in Federal and Medicaid Recovery Audit Contractor audits.

By ensuring you stay current on the requirements around delivery and documentation of the services you provide our members, you help to ensure they receive the quality of care they are entitled to and reduce the risk of an overpayment. Partners’ Provider Knowledge Base (https://providers.partnersbhm.org/) is a great resource specifically for providers to educate themselves on the requirements that surround the service(s) provided to our members. Additional compliance resources can be found in this Provider Bulletin: https://providers.partnersbhm.org/provider-bulletin-91/#Toolbox.

[1] https://oig.hhs.gov/oas/reports/region2/21701020.asp
[2] https://www.ncdhhs.gov/divisions/mhddsas/servicedefinitions
[3] Association Between Treatment by Fraud and Abuse Perpetrators and Health Outcomes Among Medicare Beneficiaries, by Johns Hopkins Bloomberg School of Public Health, JAMA Internal Med, Published October 28, 2019. Doi:10.1001/jamainternmed.2019.4771.

National Quality Partners™ Leadership Consortium Announces 2020 Participation 

The NQF National Quality Partners (NQP™) Leadership Consortium has announced its 2020 roster, welcoming leading healthcare experts from 33 diverse member organizations, including Selenna Moss, MHA, BS-HIM, CHC, CHP, RHIT, Partners Behavioral Health Management. To view the complete roster of the NQP™ Leadership Consortium, click here.

The NQP Leadership Consortium is a prestigious, active forum of annually selected NQF members committed to influencing meaningful and lasting change on the nation’s highest priority healthcare issues. Members of the NQP Leadership Consortium convene to discuss and prioritize some of the nation’s most complex, emerging healthcare issues from across the continuum of care.

This year, the group welcomes returning NQP Leadership Consortium member and 2020 Chair, Robert Dean, who leads the Vizient Transformation of Clinical Practice Initiative team and the Vizient Practice Transformation Network. In his role at Vizient, he is responsible for providing medical leadership and expertise across a range of clinical, advisory and nursing projects as well as development of interprofessional practice resources.

Amy Nguyen Howell joins Dr. Dean as the 2020 NQP Leadership Consortium Vice Chair. Dr. Nguyen currently oversees all clinical education programs at America’s Physician Groups and supports advocacy work in Sacramento and Washington, DC. She has a long history of NQF involvement and actively serves on numerous committees, including the Measures Application Partnership (MAP) Clinician Workgroup and Prevention and Population Health Standing Committee, providing input on matters related to the selection and endorsement of measures for clinicians.

NQP™ Leadership Consortium’s collective expertise set in motion actionable recommendations and strategies to drive change for individuals and their families across the nation. Learn more about the NQP Leadership Consortium and the 2020 Priorities for Action identified by the 2019 body.

The National Quality Forum (NQF) works with members of the healthcare community to drive measurable health improvements together. NQF is a not-for-profit, membership-based organization that gives all healthcare stakeholders a voice in advancing quality measures and improvement strategies that lead to better outcomes and greater value. Learn more at www.qualityforum.org.

Partners Training Academy

All Partners Training Academy sessions are free to registered attendees. Register in advance at PartnersTraining.org. If you have any questions about Partners Training Academy events, please email Training@PartnersBHM.org.

Cultural Competency: CLAS Standards (Register)

Date, Time, Location: February 25, 2020, 1-3 p.m., Hickory Multipurpose Room

Description: The Office of Minority Health has established Culturally and Linguistically Appropriate Services (CLAS) standards to address health equity and improve outcomes. This training will not only review the standards themselves but review the wealth of tools and training materials available free of charge to providers.

Trainer: Partners Provider Network Trainers

Measurement Based Care: Tools and Strategies (Register)

Date, Time, Location:  March 4, 2020, 9-11 a.m., Hickory Multipurpose Room

Description: If you are new to Measurement Based Care (MBC) and want to learn best practices and strategies for data collection, establishing registries and learning efficient/effective use of data, then this training is for you. Take some of the guesswork out of getting started with hands on practice in a classroom setting.

Target Audience:  All network providers

Trainers: Partners Provider Network

Provider Open House (Register)

Date, Time, Location: March 5, 2020, 9 a.m.-11 a.m., Gastonia-New Hope Auditorium

Description: Join Partners’ Provider Network, Claims, Access to Care, Utilization Management, Care Management and Quality Management staff for an interactive information session. This open-house style event will allow each attendee to work one-on-one with Partners’ staff to discuss any issues, questions, or unfamiliar topics.

Target Audience: New and Existing In-Network Providers

Enhancing Skills to Succeed with Independent Living (Register)

Date, Time, Location:  Friday, March 6, 2020, noon-3 p.m., Webinar

Description: This webinar training meets the Community Support Team (CST) service definition requirement for the Basics of Psychiatric Rehabilitation and Functional Assessments. The webinar will cover:

  • Housing First model
  • Community living and participation skills – Taking Inventory!
  • Assessment – gathering the right level of data to inform services and supports
    • Person-centered planning – what matters most, and how to help them get there by building on strengths, and overcoming barriers
  • Enhancing community living and participation skills by delivering planned interventions

Presenter: Dr. Lorna L. Moser with the UNC Institute for Best Practices

Cost:  $30

Person Centered Thinking (PCT) (Register)

Date, Time, Location:  March 9-10, 2020, 9 a.m.-5 p.m. (one hour lunch on your own), Hickory Multipurpose Room (basement level)

Description: Person Centered Thinking (PCT) is a foundation and philosophical framework for those involved in supporting people with disabilities. This activity-filled, two-day training consists of applied stories, guided exercises, group work and discussion. This approved National Learning Community Curriculum meets the 12-hour requirement of NC service definitions.

Target Audience: Providers

Trainer: Mary Beth Clemmons, Mentor Trainer, The Learning Community

Incident Response Improvement System (IRIS) (Register)

Date, Time, Location: March 17, 2020 10:30 a.m. – noon webinar

Description: This webinar training will help attendees with understanding best practices related to reporting incidents in the IRIS system. The training will address common questions/concerns about completing, leveling and/or submitting Level 1,2, or 3 incident reports. Please have each individual participant register separately for the training.

Trainer:  Partners Quality Management

Community Support Team – Permanent Supportive Housing (PSH) (Register)

Date, Time, Location:  April 6 -7, 2020, 8 a.m.- 5 p.m. (one-hour lunch on your own), Hickory Multipurpose Room

Description: In preparation for the implementation of the new Community Support Team (CST) policy, we have scheduled a series of two-day trainings on the evidence-based model for Permanent Supportive Housing (PSH). With the policy change, CST providers are to provide ongoing, tenancy support services. This training will support CST providers by improving their understanding and practice of the PSH model. Experienced and certified PSH trainers from the Technical Assistance Collaborative (TAC) created the training content.

Target Audience: Providers working with members with housing needs.

Trainer: Michelle Stroebel, MA, NCC, LPCA and Carolyn Shoaf, LRT

Fair Housing Training (Register)

Description:  In order to better advocate for our members, it’s helpful to have a good understanding of Fair Housing laws. Partners will be hosting free Fair Housing Trainings this spring for housing providers and service providers. Fair Housing Laws have helped millions of people since its inception to provide equal access to housing and prevent housing discrimination. This act provides for reasonable accommodations and reasonable modifications, which are a valuable resource to our members.

  • Reasonable Accommodations are requests to make changes to any rule, policy, or practice to afford a person with a disability the equal opportunity to use and enjoy their home.
  • Reasonable Modifications are physical alterations to a dwelling to allow a person with a disability greater accessibility.

Courses: A basic course will be offered on May 6, 2020, at Gaston College-Lincoln Campus with morning and afternoon sessions. An advanced course will be offered on April 9, 2020, at Partners Hickory Office, with the completion of a basic course as a prerequisite. Seating is limited and registration is required.

For more information or registration assistance, contact Bre Griffin at bgriffin@partnersbhm.org or 704-884-2514.

Target Audience: Housing Providers and Service Providers

Re-envisioning Care for People with Involved Disabilities (Register)

Date, Time, Location: Ongoing Online Training

Description: The Center for Consumer Engagement in Health Innovation has launched a new video series to help clinicians and health system leaders understand and adopt principles of person-centered care. The videos examine how the values of the independent living model can help to create a system of care that lowers barriers to care and honors the lived experience of people with disabilities; changes organizational culture to reflect a holistic, person-centered system of care; and highlights how home-based primary care can improve the support of people with complex health and social needs.

Supervising NC Certified Peer Support Specialists (Register)

Date, Time, Location: Ongoing Online Training

Description: This course is designed to introduce participants to the identified supervisory competencies and to enhance their understanding of the central principles of Peer Support. Participants are asked to evaluate their own systems of service and to apply course concepts to the implementation of Peer Support Services within their organizations. This course has been approved for three hours of General Skills Building credit from the North Carolina Substance Abuse Professional Practice Board.  Approval #16-228-H-S Contact Hours: 3.00
Continuing Education: NCCPSS and NCSAPPB.

Target Audience: Providers working with members with housing needs.

Trainer: Online through Behavioral Health Spring Board

Additional Training Resources:

Provider Training Survey 2020:

Please take a moment to share your training needs using this brief survey.  Feel free to distribute the survey link throughout your agency. We welcome your feedback. Deadline for submission is Friday, March 6, 2020.  https://www.surveymonkey.com/r/CWNC5XH

Community Training

Risk & Resiliency: Buffering Toxic Stress Training (Register) Register by February 28, 2020

Date, Time, Location:  March 3, 2020, 1-4 p.m. Elkin

Description: Participants learn how early childhood stress and trauma affect learning, behavior, and health throughout the lifespan. A core component of this training is learning the importance of promoting healthy social-emotional development from birth throughout early childhood.

Target Audience: Community

Trainer: Kim Rhoads, Partners

 

Community Resilience Model (CRM) Training (Register)

Date, Time, Location:  March 17, 2020, 1-4 p.m., Elkin

Description: The Community Resiliency Model® teaches participants about the impact of trauma and chronic stress on the nervous system, behavior, and long-term health. Participants learn how to reset the nervous system with easy to learn, concrete, coping skills. One of the goals of CRM® is to create trauma-informed and resilient communities.

Target Audience: Community

Trainer: Kim Rhoads, Partners

Provider Alerts

Provider Alerts are sent to all providers who subscribed to receive Partners’ Provider Communications. Published alerts are available on the Provider Knowledge Base at https://providers.partnersbhm.org/provider-alert-archive/. To subscribe to Partners’ various communications, please visit https://www.partnersbhm.org/subscribe/.

Alerts issued since the last Provider Bulletin:

January 31, 2020 – Community Support Team Service Authorization Requests

February 4, 2020 – AlphaMCS Build | ACTT SAR Changes | NC Medicaid Update

February 7, 2020 – Partners Requests Member Safety Checks

February 11, 2020 – Pyx Health | BH I/DD Tailored Plan News

February 19,2020 – Peer Support Clarification

Please note that this alert has been updated to include “Credential of Ordering Practitioner” as an additional required element of a Service Order.

Training, Announcements and Reminders

NEW! Brain Injury Association of North Carolina 2020 Family ConferenceThe Brain Injury Association of North Carolina will host its 2020 Family Conference “Life After Brain Injury—Journey Toward Wellness” on April 26-27, 2020 at Great Wolf Lodge Conference Center in Concord, NC. Visit www.biancfamilycon2020.com for registration and more information. Exhibitor opportunities are also available.

NEW! Women’s Recovery ConferenceMountain AHEC is hosting a Women’s Recovery Conference “Raising Resilience through Authenticity” May 6-8, 2020 at Mountain AHEC, Asheville NC. Visit https://mahec.net/event/61047 to learn more and to register.

Person-Centered Thinking: Benchmarks NC will host Person-Centered Thinking training February 26 and 27, 2020, at The Arc of North Carolina, 353 East Six Forks Rd., Suite 300, Raleigh, NC. The cost for Benchmarks members is $108; cost for non-members is $120. To learn more or register, click here.

Eleventh Annual NC “One Community in Recovery’ Conference: The NC ‘One Community in Recovery’ Conference is an inspiring and informative event, designed to foster the continuing growth of the North Carolina Recovery Movement, to teach participants how to get recovery programming up and running in their own communities, to showcase some of the most progressive recovery practices and to bring the community of providers and individuals in recovery together as students and partners. This conference is also designed to educate and motivate participants to apply principles of recovery in their personal and professional lives.

The conference will be held March 11-13, 2020, at the Wyndham Garden Greensboro, 415 S. Swing Rd., Greensboro, NC 27409. For more details, to download the event brochure, or to register, please click here.

The Arc of North Carolina’s Rooted in Advocacy Conference will take place on March 13, 2020, at the Benton Convention Center in Winston-Salem, NC. To learn more about this event or to register, please visit https://www.rootedinadvocacy.org/.

NC Tide Spring Conference: Registration is now open for NC TIDE’s Spring conference, being held April 19-22, 2020 at the Hotel Ballast, Wilmington, NC. To learn more, visit http://nctide.org/. Early bird rate ends April 1, 2020.

NC TIDE Seeks Nominees for the Empowering Hope Award: NC TIDE is encouraging behavioral health organizations to nominate one of their members for its Empowering Hope award. If you feel you have a member who would qualify and would like to be recognized, please complete the application and submit to the contact person noted on the application by March 1, 2020. The member identified as the 2020 recipient will be recognized at the NC TIDE 2020 Conference in Wilmington, NC (April 19-22, 2020) at the Hotel Ballast. To learn more about the NC TIDE 2020 Conference, visit nctide.org.

Motivational Interviewing (MI):  The UNC Institute for Best Practices has developed a two-day Motivational Interviewing training for community support team (CST) service providers.  It is not required that CST providers receive MI from the UNC Institute of Best Practices, however they must receive the full two-day MI training as part of the requirement.  This two-day workshop on motivational interviewing (MI) will focus on orienting CST staff to the philosophy and practice of MI with attention toward supporting people in community inclusion. Workshop participants will practice core MI skills and learn more about the key role ambivalence plays in the change process. Helping people come up with their own arguments for change will be a major focus as we explore housing, employment, substance use, and psychiatric rehabilitation challenges for those we serve.

This 13-hour, two-day (plus one hour on-line) training fulfills the MI training requirement for CST providers and is provided by Stacy L. Smith, LCMHC, Member of MINT from the UNC Institute for Best Practices. Training begins at 9 a.m. each day and ends at 4:30 p.m. Participants earn 12 NBCC CEU’s.

Questions can be directed to stacy_smith@med.unc.edu