Provider Bulletin #96

Partners’ September Provider Webinar

Partners will host its next quarterly Provider Webinar on Wednesday, September 11 from 1 p.m.-3 p.m.

Click here to register. To view past webinars, slide decks, and handouts, please visit https://providers.partnersbhm.org/provider-webinars-forums/. Please contact Beth Lackey at blackey@partnersbhm.org with any questions.

Use of Measurement Based Care Requirement to Continue in Partners Network—Effective Implementation November 1, 2019

As Partners prepares the Provider Network to be positioned to work within both a standard plan and tailored plan environment, it is critical that providers are using a measurement-based care tool and can demonstrate a data sample from the use of that tool.  While you as a provider may be in the process metric category, the use of the tool is key and the measurement conducted frequently, using the tool, is critical to move towards population health management.

As this is such a critical area in improving the quality of the care and improving the lives of the members served, it is Partners expectation that currently credentialed and contracted Network Providers identify and use a Measurement Based Care tool by November 1, 2019.

The following Measurement Based Care Tools are acceptable options for implementation:

Mood Disorders

Anxiety D/O

Psychotic Disorders

Substance Users

Developmental Screening
  • PHQ-9 Depression
  • GAD-7 Anxiety
  • Brief Psychiatric Rating Scale
  • CAGE-AID
  • ASQ
  • MDQ-Bipolar Depression
  • PCL-C: PTSD
  • Positive and Negative Syndrome Scale
  • AUDIT-C
  • SWYC
  • CIDI: Bipolar
  • SCARED
  • DAST
  • CHAT
  • EPDS: Postnatal depression
  • Mini Social Phobia: Social Phobia
  • CRAFFT
  • PEDS
  • BAM
  • Healthy Days
  • WHO 5
  • Other; however, this must be a validated tool.  Please identify.

If you are an Innovations or Intellectual/Developmental Disability Provider, the following tools are acceptable Measurement Based Care Tools for implementation:

Tool
A1C or blood pressure could be important treat to targets for MBC
Satisfaction with Life Scale
Council on Quality and Leadership (CQL) created a set of Personal Outcomes Measures (POMS) (myself, my world, my dreams)
Maryland Ask Me Survey
QOL-Q (Propriety so have to pay for it)
*Tool needs to be Likert-Type with quantifiable score, has option for proxy scoring in addition to self-report, be brief, and be measurement oriented – can repeat regularly and see change

This requirement has been added to the Annual Performance Reviews and will be assessed during your recredentialing cycle.  If you elect to not implement measurement based care tools, it may impact your status in the network and your contract with Partners Behavioral Health Management.

If you have questions, please contact your Provider Network Account Specialist.

National Accreditation Required for Level II through IV Children or Adolescent Group Homes

Since 2010, North Carolina Department of Health and Human Services (DHHS), through the State Plan under Title XIX of the Social Security Act, has required that all providers of Level II through IV Children or Adolescent Group Home services obtain national accreditation. Providers have one year from the date of Medicaid enrollment to obtain national accreditation. While enrollment could be as early as when a provider is approved by the State into NC TRACKS and the State Plan, or contracts with any LME/MCO, Partners considers the enrollment date the day the provider enters Partners’ network.

North Carolina General Statute § 122C-81(d) has established benchmarks and timelines to ensure that Level II through IV Children or Adolescent Group Home service providers will meet the one-year deadline for obtaining national accreditation. Failure to meet the benchmarks are grounds for discontinuing service delivery and termination of any service contracts. The requirement is to ensure that providers are demonstrating sufficient progress in achieving national accreditation following the date of enrollment in the Medicaid program. Those benchmarks are as follows:

  1. Three months – On-site accreditation review scheduled by accrediting agency as documented by a letter from the agency to the provider and completion of self-study and self-evaluation protocols distributed by the selected accrediting agency.
  2. Six months – On-site accreditation review scheduled by accrediting agency as documented by a letter from the agency to the provider.
  3. Nine months – Completion of on-site accreditation review, receipt of initial feedback from accrediting agency, plan to address any deficiencies identified developed.

If a provider’s Medicaid enrollment or service delivery contracts are terminated because of a failure to meet accreditation benchmarks or failure to continue to be nationally accredited, the provider will work with Partners to transition members served by the provider to other service providers in an orderly fashion within 60 days of notification of such failure.

A provider that has its Medicaid enrollment or service delivery contracts terminated because of failure to meet accreditation benchmarks or failure to continue to be nationally accredited may not reapply for enrollment in the Medicaid program or enter into any new service delivery contracts for at least one year following enrollment or contract termination.

If you have any questions, please contact your Provider Network Account Specialist.

New Rate for Comprehensive Trauma Informed Assessments (CTIA)

Provider agencies who have been participating in the CTIA learning collaborative hosted by the Center for Child and Family Health can now request to add the code 90791 TI to their contracts.  The rate for this code is $125 per hour for up to 5 hours.

The provider agencies participating in the CTIA learning collaborative are:

  • A Caring Alternative
  • Alexander Youth Network
  • Children’s Home of Cleveland County
  • Children’s Home Society
  • Children’s Hope Alliance
  • Support, Inc.

Please completed the Provider Change Form, located at https://providers.partnersbhm.org/provider-enrollment-credentialing/, to add this code. For reference purposes, please refer to the below Scope of Work.

Description of Services–Comprehensive Trauma Informed Assessments:

Treating children with complex trauma which has been identified by a third party (ex.  Department of Social Services, Juvenile Justice, Primary Care, school system) involves ongoing training and support of the existing workforce in terms of an enhanced, standardized trauma assessment.  Providers also receive extensive training and follow-up technical support to conduct the TICAs by a licensed clinician, and ongoing consultation training and support post Learning Collaborative by their clinical supervisor.

Trained and supervised clinicians provide a comprehensive trauma assessment that includes standardized tools such as the UCLA and use of SDQ and CBCL.  In addition to the standardized assessment tools, interviews are conducted with collaterals with the outcome of having an assessment that covers all domains.

Trained supervisors may train additional licensed clinicians to complete with Partners- approved curriculum and a supervisor sign off for a period of six months.

Required Elements of the Program/Service:

  • A review of records (including at minimum mental health, academic/educational, physical health records);
  • Evaluations to be completed within timeframes designed to meet the deadline requirements of court, placement and/or other external agents requiring such evaluations for the purpose of determining treatment/education/legal disposition of the adult/child/youth, written report due within 14 days of completion.

To include:

  • Current/Past History summary.
  • Assessment Participants and their relationship to the youth including face to face contact with the child/youth and caregivers and other collaterals.
  • Including Primary Care Physician whenever possible
  • Case Overview
  • Type of exposure to trauma/maltreatment, source of third party validation
  • Child and Family Support Systems
  • Safety (past and present)
  • Trauma Exposure and Secondary Adversities
  • Trauma Assessment Results
  • All Comprehensive Clinical Assessment elements as identified in CCP 8C and APSM.

Target Population and Eligibility Criteria:

  • Children and adolescents who have trauma, or suspected trauma who are not maintaining stability in outpatient therapy (rule out youth who have been assessed, provided therapy, and doing well without this specialized assessment)

-OR-

  • Youth for whom a Comprehensive Clinical Assessment (CCA) has not delivered treatment recommendations leading to successful treatment

-OR-

  • Youth with validated trauma histories identified by a third party (DSS, JJ, Primary Care, School System) who could be set on an effective treatment course which is “the right treatment at the right time” after receiving the Comprehensive Trauma Informed Clinical Assessment.

-OR-

  • Youth with documented concerns about the impact of trauma who have or are receiving multiple enhanced services, residential, or Psychiatric Residential Treatment Facility (PRTF) services.

Exclusionary Criteria:
Youth with no identified trauma history and youth currently receiving Trauma Informed services that are meeting their needs.

Required Outcomes:
Completed Assessment due within 14 days of completion.  Completed assessments are to be uploaded in AlphaMCS.

Collaboration:
Agencies selected for the Comprehensive Trauma Informed Assessment Learning Collaborative are eligible to provide this service.  All clinicians performing the assessment must be under the clinical supervision of a supervisor trained at the Learning Collaborative.

Utilization Management:
Prior authorization required

Finance:
CTIA’s can be billed for up to 5 hours at $125/hour. The code is 90791 TI

Changes to Outpatient Opioid Treatment (OOT) Benefit Limit for State-Funded and Medicaid

  • Service Codes:

    • H0020 (Per diem) – Opioid Treatment Servic
    • H0020U3BU (Weekly) – Opioid Treatment Services

Effective August 5, 2019, providers of Outpatient Opioid Treatment (OOT) may request up to 90 units for 90 days for initial H0020 authorizations and up to 13 units for 90 days for initial H0020U3BU authorizations. For concurrent Service Authorization Requests (SARs), providers of OOT may request up to 180 units for 180 days for concurrent H0020 authorizations and up to 26 units for 180 days of H0020U3BU authorizations. These changes are applicable for both State and Medicaid funded members. If you have any additional questions, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.

Reminder—Quality Improvement Projects Due August 30

It is a requirement of Partners that providers/contractors that deliver Medicaid and/or State Funded services conduct organizational Quality Improvement Projects (QIPs). Licensed Independent Practitioners are not required to submit QIPs at this time.

Here is what Providers need to know to submit their QIPs to Partners:

  1. Identify your organization’s contact person [preferably staff that is responsible for QI activity] and email their name, telephone number and email address to Tamikka Woods (Twoods@partnersbhm.org) (If your staff contact changes at any time, you will need to submit updates in the same manner.)
  2. The contact person in your organization will receive an email from Partners’ ShareFile system.
  3. Follow the instructions in the ShareFile email to create a password. Upload three Quality Improvement Projects by August 30, 2019 [No specific topics are required at this point].
  4. Every year by the last business day of August [ the next deadline will be August 31, 2020], until further notice, the expectation is for providers to submit three Quality Improvement Projects in this manner

If you have further questions regarding this requirement, please contact Tamikka Woods by calling 704-884-2568 or email twoods@partnersbhm.org.

Claims Information

Providers should send all inquiries to claimsdepartment@partnersbhm.org so 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 consumers/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.

Medicaid—July 2019:   Number of Days to Process and Pay All Claims
Received Date to Paid Date: 8.4
Top Five Medicaid Claim Denials—July 2019
Claim Denial Provider Recommended Action Steps
Service is not authorized Verify Service Authorization for the consumer. Contact Utilization Management.
Duplicate Claim The claim has previously been submitted and adjudicated. Do not refile.
Billing Taxonomy submitted is not associated with billing NPI Rebill claim with correct taxonomy/NPI information.
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.
Invalid DCN (Document Control Number) or Resubmission Reference Number Review the RA (Remittance Advice) with the original claim number and make sure it was entered correctly.
Referenced claim has already been resubmitted. Multiple resubmissions are not allowed. Duplicate claim. Do not refile claim.

Fair Housing Training

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.

In order to better advocate for our members, having a better understanding of these laws are helpful. Partners will be hosting a Fair Housing Training on Thursday, September 19, 2019 at Isothermal Community College in Spindale. There will be a morning session for service providers and an afternoon session for housing providers. Seating is limited and registration is required. To register, please contact Bre Griffin at bgriffin@partnersbhm.org or 704-884-2514.

Reminder—Mandatory Therapeutic Foster Care Services Meeting on

August 27, 2019

This meeting notice was first published in the July 23, 2019 Provider Alert

In an effort to continually improve the network and referral system of Therapeutic Foster Care services within our community, Partners is hosting a mandatory meeting that will be facilitated by Beth Lackey, Provider Network Director and Danny Nolen, CEO of Rapid Resource for Families. The following items will be presented/discussed

  • TFC Provider Expectations
  • TFC Database/Reporting Overview
  • Rutherford County Provider Transitions

This session will also provide TFC providers with an opportunity for additional training, specifically on how to achieve full participation status with the Rapid Resource for Families (RRFF) database. The purpose of the RRFF database is to improve referral responses and provide outcomes that will enhance the delivery of the therapeutic foster care services.

Date and Time: Tuesday, August 27, 2019, 3:00-4:30 p.m.
Location: Partners’ Hickory Office, Multipurpose Room (Basement), 1985 Tate Blvd. SE, Hickory, NC 28602
To register, click here.

Questions? Please contact Lisa Jordan by emailing ljordan@partnersbhm.org or call 828-323-8058.

Partners Training Academy

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

Provider Orientation

9:00 a.m. – 12:00 p.m., Gastonia:  September 5  or October 3 (click a date to register)

Description: Join Partners’ Provider Network, Claims, Access to Care, Utilization Management, Care Coordination, and Quality Management staff for an interactive provider orientation. These open-house style events will allow attendees time to work one-on-one with Partners’ staff to discuss any issues or unfamiliar topics. Participants are encouraged to bring their own laptops to access and review their specific workflow.

These sessions will reoccur monthly on the first Thursday of each month from May – October 2019 (excluding the month of July due to the Independence Day holiday).

These training sessions are open-house style with no formal presentation or start time. As a registered attendee, you are welcome to arrive and exit at your convenience, depending on the amount of time you feel is needed with our staff. The intended audience for these orientations is not limited to only providers who are new to Partners’ network, but it is advised that attendees already have access to AlphaMCS prior to attending a session.

LOCUS (CLASS FULL)

Friday, September 13, 2019, 9:00 a.m. – 12:00 p.m., Hickory

Description: Level of Care Utilization System for Psychiatric and Addiction Services – Service providers are required to use the Level of Care Utilization System for Psychiatric and Addiction Services, or LOCUS, a clinical tool to evaluate and determine the level of psychiatric or addiction services care needed for adults. This training is conducted by Partners’ Mental Health and Substance Use Utilization Management staff. This hands-on training includes the review of a case and the use of the LOCUS screening form to score the level of care needed.

Target Audience: Persons responsible for service authorization requests for mental health and substance use services.

Trainer: Partners BHM MH/SU Utilization Management Department

CALOCUS (CLASS FULL)

Friday, September 13, 2019, 1:00 p.m. – 4:00 p.m., Hickory

Description: Child and Adolescent Level of Care Utilization System for Psychiatric and Addiction Services – Service providers are required to use the Child and Adolescent Level of Care Utilization System for Psychiatric and Addiction Services, or CALOCUS, a clinical tool to evaluate and determine the level of psychiatric or addiction services care needed for individuals ages 6-18. This training is conducted by Partners’ Mental Health and Substance Use Utilization Management staff. This hands-on training includes the review of a case and the use of the CALOCUS screening form to score the level of care needed.

Target Audience: Persons responsible for service authorization requests for mental health and substance

Trainer: Partners BHM MH/SU Utilization Management Department

Human Trafficking and Internet Safety – A Common Intersection

Wednesday, September 18, 2019; 10 a.m.-12 p.m., Gastonia (Registration)

Description:  Human trafficking:  North Carolina has the eighth highest reported rate of human trafficking in the country. Learn how human trafficking can manifest in different ways, how to identify signs of labor and sex trafficking, and resources to help find support for trafficking victims.

Internet safety:  We live our lives connected to the internet, and while that can often be a benefit, it also carries major safety risks. Learn how to protect your personal and financial information online, manage your digital footprint, and navigate social media and other gaming and mobile apps.

Target Audience:  Providers, Members, and Community

NC Medicaid Managed Care

Providers are reminded to frequently visit https://medicaid.ncdhhs.gov/providers to learn about events and access tools, the Provider Playbook and more to help transition to managed care.

DHHS Webinar: Tailored Plan Transition – What These Changes Mean to Me or My Family?

The NC Department of Health and Human Services is committed to making the transition to Medicaid Managed Care as smooth as possible for members and families. Providers are asked to share the following information with members about an upcoming webinar that will provide up-to-date information about the design and implementation of Tailored Plans

The “Tailored Plan Transition – What These Changes Mean to Me or My Family” webinar will be held on Tuesday, August 20, 2019,  from 1:15 p.m.-2:15 p.m. To register, click here.

Attention Physicians, Providers and Community Agencies—Community Meeting Scheduled for August 26:
Senator Gladys Robinson and Senator Michael Garrett, partnering with the Department, will host a Community Meeting for physicians, providers and community agencies to provide an update on managed care, answer questions and obtain feedback. Representatives from the Medicaid Managed Care health plans and enrollment broker will be available.

Date and Time:  Monday, August 26, 2019
Location:  Guilford Technical Community College, Jamestown Campus
Hospitality Management Building, Koury Auditorium Room 125
601 East Main Street, Jamestown NC 27282
Event Details and Registration

Behavioral Health I/DD Tailored Plans – News about Eligibility and Enrollment Policy Updates (Aug. 2, 2019):
In response to stakeholder feedback, the Department has issued several updates to the March 2019 eligibility and enrollment policy guidance for Behavioral Health I/DD Tailored Plans. Updates include

  • Additional claims/ecounter data markers to determine eligiblity based on functional impairment for qualifying diagnoses of serious mental illness or serious emotional disturbance.
  • New forms for beneficiries assigned to Standard Plans to request to stay in NC Medicaid Direct (fee for service) and the LME-MCO.
  • Updated enrollment policy to transition Standard Plan enrollees who urgently need a service covered only by NC Medicaid Direct/LME-MCO. A new policy is added for urgent transfer requests.
  • Change reflecting substance abuse intensive outpatient program (SAIOP) and substance abuse comprehensive outpatient treatment program (SACOT) services will be covered only by Behavioral Health I/DD Tailored Plans, instead of both Standard Plans and Behavioral Health I/DD Tailored Plans.

The full text of the update, changes to Appendix B of the policy guidance, and the new provider and beneficiary attestation forms are available on the DHHS Medicaid Transformation Policy Papers web page. The forms also will be available on the Enrollment Broker website mid-August.

Alerts and LME/MCO Joint Communication Bulletins

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:

All LME-MCO Joint Communication Bulletins are located at http://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins.

Recent Joint Communication Bulletins:

Providers are encouraged to review the monthly Medicaid Bulletin. Bulletins are posted at https://medicaid.ncdhhs.gov/providers/medicaid-bulletins.

Training, Announcements and Reminders

Iredell Overdose Awareness Vigil:  Drug-Alcohol Coalition of Iredell will be hosting a candlelight vigil on Thursday, August 29, 2019 to honor individuals, families, and friends who have been affected by overdose or overdose death. Luminaries are available for purchase in honor or in memory of loved ones.

Please visit http://daciredell.org/event/international-overdose-awareness-day/ for more information.

MARS Open House:
Integrated Care of Greater Hickory will host an open house on Thursday, August 29 from 2:00 – 3:30 pm at ICGH’s location at 1228 North Flint St, Lincolnton, NC. Come learn more about Medication Assisted Recovery Services (MARS), which includes medication, counseling and peer support services for adults ages 18 and older who have an opioid use disorder and live in Lincoln and Gaston counties.  Services are funded through a SAMHSA grant awarded to Partners. To learn more about the MARS grant, please visit https://www.partnersbhm.org/mars/.

Benchmarks Public/Private Behavioral Health Forum:
Benchmarks will host its Public/Private Behavioral Health Forum on Friday, August 30, 2019  from 10:30 a.m.-2:30 p.m. at the Royal Banquet and Conference Cetner, 3801 Hillsborough St., Raleigh, NC. To register, visit https://www.eventbrite.com/e/publicprivate-behavioral-health-forum-tickets-66333957653.

Benchmarks’ Partnering for Excellence Conference:
Benchmarks’ Partnering for Excellence (PFE) 4th Annual Conference, “Envisioning Resilient Communities” will be held  Wednesday, September 11 and Thursday, September 12, 2019 at the Hawthorne Inn & Conference Center, 420 High Street, Winston Salem, NC.

Benchmarks’ Partnering for Excellence is a leader in system integration and this conference brings together leaders from various systems all across the state. Not only will private providers be in attendance, so will Departments of Social Services, various LME/MCOs, experts with lived experience, and other child and family-serving systems.

The Benchmarks’ Partnering for Excellence conference attracts some of the largest, most influential and progressive child-welfare, mental health, intellectual/developmental disability, and substance use organizations, thought leaders, and executives in North Carolina. This is a unique opportunity to engage with an extensive network of our service provider leadership and executive teams.

This event provides the opportunity to forge new partnerships that maximize the collective impact of our community, share best practices with like-minded and experienced colleagues, and learn from the best and brightest minds in the sector, under one roof!  Learn more about the conference here.

Julian F. Keith Alcohol and Drug Abuse Treatment Center:
The NC Department of Health and Human Services invites you to celebrate the Julian F. Keith Alcohol and Drug Abuse Treatment Center’s 50th Anniversary on September 21, 2019  from 10 a.m.-2 p.m. The event will be held at the center at 201 Tabernacle Road, Black Mountain, NC 28711. To learn more, contact Kelli Angel at 828-257-6362.

2019 NAMI North Carolina Statewide Conference:
The 2019 NAMI North Carolina Annual Conference will be held on October 11, 2019 at the McKimmon Center in Raleigh, North Carolina. At this year’s Conference, we will explore the theme of “Amplifying Voices: Advocacy, Recovery, Transformation.” We are looking to provide experiences for attendees to come to a deeper understanding of how we can all amplifying our voices to improve the lives of those affected by mental illness.  In addition to various speakers and breakouts sessions, NAMI NC is pleased to welcome various artists to showcase their talents and demonstrate how art can play a role in mental health at this year’s conference.

Registration for the conference includes lunch, parking, and access to all workshops and exhibits. Members will be invited to attend the annual meeting in the afternoon. CEU’s will also be available. To learn more or to register, please visit https://naminc.org/nami-north-carolina-events/8584-2/.