Better With Time: Managed Medicaid Update With your Hosts: Hugh - - PowerPoint PPT Presentation

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Better With Time: Managed Medicaid Update With your Hosts: Hugh - - PowerPoint PPT Presentation

Jun 29, 2023 388 likes •667 views

NC Department of Health and Human Services Better With Time: Managed Medicaid Update With your Hosts: Hugh Tilson and Shannon Dowler And Special PHP CMO Guests: Michelle Bucknor RCC (Relay Conference Captioning) William Lawrence

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 1

NC Department of Health and Human Services

Better With Time: Managed Medicaid Update

With your Hosts: Hugh Tilson and Shannon Dowler

And Special PHP CMO Guests: Michelle Bucknor William Lawrence Genie Komives George Cheely Michael Ogden

RCC (Relay Conference Captioning) Participants can access real-time captioning for this webinar here:

https://www.captionedtext.com /client/event.aspx?EventID=460 1554&CustomerID=324

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 2

Video Settings

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 3

How We Will Spend Our Time Together

1. Introduction to the Series 2. Better With Time: Transformation 3. Get to Know Your CMOs 4. What to do NOW for LATER 5. Medicaid Hot Topics 6. Open Questions and Answers with PHP & Medicaid CMOs

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 4

“To

  • improve the

he he health of h of Nor

  • rth

h Carol

  • linians t

thr hrou

  • ugh a

h an n inn nnovative, w whol hole-person

  • n

centered, a and nd w well-coord

  • rdinated

sy syst stem of

  • f care t

tha hat addresse ses s both h the he medical a and nd non non- medical d dri rivers of

  • f he

health. h.”

North Carolina’s Vision for Medicaid Transformation

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 5

5

Moving to Managed Care

  • 1.6 - 1.8 million Med

edicaid benef neficiaries wi will enr enroll in n Sta tand ndard Pl Plans.

  • Benef

Beneficiaries wi will be e able e to

  • choos

hoose e from

  • m 5 Prep

Prepaid Hea ealth Pl Plans (PHPs) − Ameri eriHealth Ca Cari ritas, Hea ealth thy Bl Blue, e, Uni nited ed Hea ealthCare re, WellCa Care, e, Car arol

  • lina

a Compl plete He Heal alth (Reg egion

  • ns 3,

, 4, , 5)

  • All hea

health plans ns, all reg region

  • ns wi

will go

  • live

e on

  • n Ju

July 1, 2021.

  • Som
  • me

e benef eneficiaries wi will sta stay in n fee ee-for-service e bec ecause se it t provi vides es ser services tha that t mee eet t sp spec ecific need needs, or

  • r the

they ha have limited ed benef

  • enefits. Thi

his wi will be e called ed NC C Med edic icaid Direc rect. t.

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 6

NC Medicaid Managed Care Regions

6

LINCOLN

REGION 1 REGION 2 REGION 4 REGION 3 REGION 5 REGION 6

CHEROKEE CLAY GRAHAM SWAIN MACON JACKSON TRANSYLVANIA HAYWOOD HENDERSON BUNCOMBE POLK RUTHERFORD MCDOWELL BURKE AVERY YANCEY MADISON CLEVELAND GASTON CATAWBA CALDWELL ALEXANDER IREDELL ROWAN CABARRUS STANLY UNION ANSON MECKLENBURG MONTGOMERY RICHMOND MOORE LEE HARNETT SAMPSON BLADEN PENDER BRUNSWICK COLUMBUS ROBESON SCOTLAND HOKE CUMBERLAND WATAUGA ASHE WILKES YADKIN SURRY STOKES ROCKINGHAM GUILFORD RANDOLPH DAVIDSON DAVIE FORSYTH ALLEGHANY CASWELL PERSON GRANVILLE VANCE WARREN FRANKLIN NASH WILSON JOHNSTON WAKE DURHAM ORANGE ALAMANCE CHATHAM HALIFAX EDGECOMBE GREENE WAYNE DUPLIN ONSLOW CARTERET HYDE DARE WASHINGTON BEAUFORT PAMLICO CRAVEN JONES LENOIR PITT MARTIN BERTIE HERTFORD NORTHAMPTON TYRRELL GATES

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 7

7

Challenges

  • CO

COVID ID-19 19 − Uncertainty inty about provid ider’ r’s prioritiz itizing ing contracting ting − Compl plexi xity in pr project ct pl plan anning – rapi apid d evolvi ving co condi dition

  • ns
  • Other

ther Pr Prog

  • gra

ram Cha Changes − Tai ailored d Plan an Request est for Appl pplicat cation

  • n (RFA) an

and d ope perat ation

  • nal

transition in preparation for July 2022 2022 launch − DHHS is s wor

  • rki

king wi with th the the Ea East ster ern Ba Band nd of

  • f Che

Cherokee ee Ind Indians to

  • develop

elop a PC PCCM “Tri ribal Opti tion”

  • n” to
  • go
  • live

e in n Reg egion

  • n 1
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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 8

DRAFT

Medicaid Transformation Timeline

Begin State-wide Open Enrollment

3/15/21 OPEN ENROLLMENT 5/15/21

AUTO ENROLLMENT TRIBAL OPTION & MANAGED CARE LAUNCH

7/1/21

Conclude State-wide Open Enrollment

5/14/21

BEGIN OPEN ENROLLMENT END OF CHOICE PERIOD

9/29/21

The fun starts way before March!

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 9

9

Restarting Managed Care Implementation – Highlight of Activities

  • Update a

all s stakehol

  • lder materials, websites, smart phone apps and technical systems across

multiple platforms (Enrollment Broker, health plans, NCTracks)

  • Formulate capitation
  • n r

rates s beginning in November ’20 and submit to CMS for approval

  • Re-review and resu

submit t to

  • CMS f

for

  • r approval several health plans’ contractual policies and

procedures deliverables (annual compliance plans, call scripts, member marketing, value added service materials, and clinical coverage policies)

  • Update the Consolidated P

Provider Directory (NC DHHS, Enrollment Broker, health plans)

  • Test Prima

mary Care P Provider A Aut uto A Assi sign gnment

  • Comp

mplete k key test sting activities s to finalize data, analytics, reporting functionality including Transition of Care (NC FAST, Enrollment Broker, NCTracks, health plans, LME-MCOs, UM Vendors & CCNC) and Data Warehouse

  • Re-validate Enrol
  • llment B

Broker r readiness ss including call center staff and scripting once rehired

  • Re-evaluate internal Divisi

sion

  • n o
  • f Health B

Benefit s staff r readiness ss

  • For netw

twork a k adeq equacy – monitor progress of provider c contracting g (health plans and providers)

  • Moving forward with managed care related procurements including Member Ombudsman,

EQRO, Health Opportunities Pilots

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 10

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Medicaid Transformation Provider Outreach and Education Timeline

DRAFT

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 11

  • October:

r: La Launch A h AMH MH T Technical Advisory G Group

  • up

an and D d Data ata S Sub-Com

  • mmi

mittee; A AMH MH Mod Modifications re released

  • No

Novem embe ber: Laun unch A AHEC EC A AMH MH T Tier 3 r 3 C Coaching ng Progr

  • gram
  • June

une 2 2021: AM AMHs Hs r rece eceiv ive f fir irst data: ata: histori

  • rical

claims s inf nformation a and nd b bene neficiary f files on s on assi ssigned p patients

  • July 2

2021: AMH T Tier 3s l s laun unch

11

Advanced Medical Home MCL Timeline

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Get to Know Your CMO’s

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 13

Three Things To Do NOW To Be Ready LATER

13

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 14

SOURCE:

  • 1. Update the Provider Directory
  • A new, redesigned, Provider Directory will be available January 1

1, 2021.

  • In advance, you s

shoul

  • uld r

review NCTracks with attention to the following sections:

− Basic Information − Health Benefit Plan Selection (i.e. Medicaid and NC Health Choice) − Addresses and the associated Taxonomy Classification − Accreditation − Hours of Operation − Services (i.e. Accepting New Patients, Siblings, and Physically Handicapped indicator, Languages Supported, Ages Served) − Affiliation Provider Information

  • Confirm that individual providers are correctly affiliated to organizations billing on their behalf and to each

appropriate location within that organization.

  • When a beneficiary searches for an individual doctor at a specific organization’s location, the affiliated

information from NCTracks is used in the search. Therefore, all individual providers should check their affiliations not only to the group NPI, but also to the specific location(s) where services are rendered.

  • Bot
  • th Individual and Orga

ganization

  • n records s

s shoul

  • uld b

be reviewed.

  • The NCTracks Manage Change Request (MCR) process is used to view and update record

information:

− NCTracks User Guide & Fact Sheets webpage or call the CSRA Call Center at 800-688-6696.

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 15

  • 2. FINALIZE YOUR CONTRACTS

Don’t Delay!

− Amendments may occur; if so, you will have the

  • pportunity to review any changes.

− Once you are contracted, there is a process that follows before your information is populated to DHB and to the provider directory. − Getting it right NOW will minimize disruption to your patients and practice later.

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 16

  • 3. Ready,

Set, AMH!

  • Don’t put off making

changes to perform as an AMH Tier 3 practice!

  • Look for updates coming

soon to the AMH program that provides a “glidepath” for Tier 3 practices.

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 17

Medicaid Hot Topics

17

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 18

  • NC Me

Medicaid i is s adding t thi his s CPT cod

  • de to
  • NCTrac

acks ks for m

  • r medically ne

necess ssary labor

  • ratory t

test sting effective S

  • Sept. 1, 2
  • 2020. Mor

More i inf nformation is s included i in n SPECIA CIAL B BULLETIN CO IN COVID VID-19 # #132: La Labor

  • rator
  • ry C

Cod

  • des

s for

  • r Cor
  • rona
  • navirus (C

s (COVID-19) Testing ng

18

Medicaid Coverage of Antigen Testing

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 19

  • Physicians/APPs may be reimbursed for a telemedicine

visit conducted with a simultaneous home visit made by an appropriately-trained delegated staff person.

  • Special Bulletin #78 (Hybrid Telemedicine with Supporting Home Visit)
  • Special Bulletin #49 (Interim Perinatal Care Guidance)(specific to perinatal providers)

Hybrid Telemedicine w/Supporting Home Visit

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 20

  • Interprofessional consultation between a

consultative physician and a treating/requesting physician or other qualified health care professional may occur via telemedicine.

− Primary Care to Specialty − APP to Supervising Physician − Specialty to Specialty

  • Special Bulletin # 34 (Telehealth-Definitions, Eligible Providers,

Service and Codes) (all Medicaid providers)

Interprofessional Consultation

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 21

  • Communication between a physician/APP and a

patient through secure EHR portal.

  • Special Bulletin # 34 (Telehealth-Definitions, Eligible Providers,

Service and Codes) (all Medicaid providers)

  • https://medicaid.ncdhhs.gov/blog/2020/04/07/special-bulletin-covid-

19-34-telehealth-clinical-policy-modifications-%E2%80%93- definitions

Portal Communication

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 22

DRAFT

  • De

Dependent on F

  • n Federa

ral P Pub ublic H Health E h Emergency

  • Ope

Open C n Com

  • mment o

t on 1-H: H: http ttps:/ s://medicai caid.ncd .ncdhhs.g hs.gov/mee eeti ting ngs-and and- noti tice ces/ s/prop

  • posed

sed-medicaid-and and-nc-heal alth th-choice ce-po policies

  • Rate E

Extensi nsion

  • ns

s to

  • 10/31/20 (at a m

at a mini nimum)

Pandemic Clinical Policy

Waiver Document​ Expiration​ Implementation Requirement​ (e.g., State may vs. State must implement)​ Authority to End Early​ (e.g., State may end early vs. must remain through end of Waiver period)​ 1115 Waiver​ Expires at end of PHE + 60 days (evaluation due 1 year after end of demonstration completion)​ State may implement granted flexibilities​ State may end early​ 1135 Waiver​ Expires at end of PHE​ State may implement granted flexibilities​ State may end early​ Medicaid Disaster SPAs​ Expires at end of PHE​ State must implement granted flexibilities​ State may end early​ CHIP Disaster SPA​ Expires at end of PHE or state-declared emergency​ State must implement granted flexibilities​ State may end early​ CMS Blanket Waivers​ Expires at the end of the PHE​ State must implement granted flexibilities for Medicare*​ Flexibilities remain through PHE**​ Concurrence Letter​ Expires at the end of the PHE​ State may implement granted flexibilities​ State may end early​ Appendix Ks​ Expires on March 12, 2021 State must implement granted flexibilities​ State may end early​

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 23

DRAFT

  • https:/

://me /medic icaid aid.n .ncd cdhhs.gov/blog/2020/ 2020/09/ 09/29 29 /upda pdated-breast st-and nd-ce cervica ical-can cance cer-co contr trol- pro rogram-criteri ria

Breast Cancer and Cervical Cancer Prevention

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 24

Equity Lens in Clinical Policy

Where and when does Medicaid policy and/or process inadvertently contribute to health inequities?

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 25

25

Payments for COVID-19 Related Services for Uninsured North Carolina Residents

Many North Carolina residents have lost their health insurance due to the COVID-19 pandemic and still require healthcare Program Overview

North Carolina developed a program to support uninsured North Carolina residents get access to healthcare for COVID-19 related needs The program is aimed to quickly distribute reimbursement funds to primary care providers (PCP) who are providing COVID-19 related services to uninsured North Carolina residents The program provides $150 for each eligible claim to PCPs while the fund lasts or until 12/30/2020, whichever comes first Provides COVID-19 related services (e.g. follow-up appointments) Confirms resident has no health care coverage (e.g. Medicaid, Medicare, or other health insurance) and completes the attestation form in NCTracks Files reimbursement claim through NCTracks portal

Provider Process Key Information

Receives $150 payment/encounter not per service Portal will go live in late October on NCTracks Providers should hold claims from 9/1/2020, and submit when portal is live in October

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 26

*NCIOM has convened an COVID-19 Vaccine Planning with key stakeholders and partners to enhance development of COVID vaccine

plans, refine prioritization of critical populations, expand reach of activities, communication, and implementation

  • Determine organizational structure and partner involvement*
  • Identify gaps in preparedness
  • Review requirements and assess capacity of Immunization

Information System or other reporting system

  • Identify critical populations
  • Plan for early COVID-19 vaccine administration
  • Plan for expansion of COVID-19 vaccination provider
  • utreach and enrollment
  • Propose COVID-19 vaccine allocations
  • Develop communications plan

Key Planning Activities

In anticipation of vaccine doses becoming available, perhaps as early as November, North Carolina must submit COVID-19 Vaccination Plan by October 16th and then implement the plan

COVID-19 Vaccination Plan

  • Four current US-funded Phase 3 trials (Pfizer, Moderna, AstraZeneca,

Johnson & Johnson)

  • Different scenario planning depending on which vaccine(s) are approved,

when, for what populations, and how much supply

  • Prioritization will be important in beginning when limited supply of vaccine

– health care workers at high risk of exposure, staff at Long Term care, staff at congregate living, critical infrastructure workers, people at high risk

  • f complications in priority groups
  • Expect relatively high vaccine hesitancy, linch pin of communication is

trust

  • Providers will need to enroll as a COVID-19 vaccinating provider.

Details coming!!!!

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NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202 27

BURNING QUESTIONS?