Provider Bulletin #80

• Rutherford County Announces Intent to Align with Partners
• Partners Organizational Changes
• Partners June Provider Webinar
• 2018 Perception of Care Survey
• Claims Information
• Over 400 Learn New Ways to Treat the Opioid Crisis
• April is Fair Housing Month

• Fraud vs Abuse—Can You Tell the Difference?
• Partners Training Academy Opportunities
• Partners Selected for and Participates in National Quality Efforts
• Partners Becomes First i2i Champion Supporter
• Alerts and LME/MCO Joint Communication Bulletins
• Announcements and Reminders

Rutherford County Announces Intent to Align with Partners

On Monday, April 9, 2018, the Rutherford County Board of Commissioners passed a resolution to disengage from Vaya Health and align with Partners Behavioral Health Management. View the resolution.

Counties that want to realign with a different LME/MCO must first obtain the approval of the Secretary of the Department of Health and Human Services. To learn more about the County Disengagement Rules, please visit https://www.ncdhhs.gov/divisions/mhddsas/lme-mcos.

Information regarding this topic will be shared at https://www.rutherfordcountync.gov/ and www.partnersbhm.org. If you are a provider and have questions, please direct them to questions@partnersbhm.org.

Partners Organizational Changes

Effective May 1, 2018, there will be a few changes to the reporting structure and names of some departments at Partners Behavioral Health Management. The intent of these changes is to provide an opportunity to refine processes, align subject matter experts, and realize efficiencies in operations.

The changes are as follows:

• The Access to Care Department will be known as Member Services and will consist of:
  • all current Access to Care employees.
  • Consumer Relations/Housing
• Two monitoring functions will be moving to Quality Management Department:
  • the current Provider Network Monitoring Unit
  • Consumer Rights Officers focused on Incident Reporting.
• A Training and Development Department is being created that will encompass Partners’ employee training and the Partners Training Academy.
• The Chief Community Operations Officer position is being reclassified as the Senior Director of Operations and will supervise System of Care, Provider Network, and Member Services.  This position will be posted in the near future.
• The Chief Public Relations Officer position has been reclassed as the Senior Director of Marketing and Communications.

These changes should not affect our partnership with our provider network, however, we wanted you to be aware you will see evidence of the changes on the Provider Knowledge Base, in provider communications, and in the phone tree available by calling 1-877-864-1454.

Partners June Provider Webinar

Make sure to mark your calendar for the next Provider Webinar, to be held Wednesday, June 13, 2018 at 1 p.m. Registration will open in May.  If you have questions about the Provider Forum or future Provider Webinars, please contact Roanna Newton at 828-323-8054 or email rnewton@partnersbhm.org.

2018 Perception of Care Survey

Each year, the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) oversees the administration of the annual Consumer Perception of Care (PoC) Survey to individuals participating in treatment for substance use and/or mental health disorders. The survey complies with requirements from the Federal Community Mental Health Services Block Grant and the Substance Abuse Prevention and Treatment Block Grant. This survey assesses the consumer’s perceptions of the quality of care and services they have received in the past year. Survey results are reported to the Substance Abuse and Mental Health Services Administration (SAMHSA) by NC DMH/DD/SAS and published by LME-MCOs in an annual report. If you are interested in the feedback received from previous Perception of Care Surveys, please visit https://www.ncdhhs.gov/divisions/mhddsas/reports/consumer-perceptions-care.

Selected mental health and substance use providers will be contacted by their Provider Network Account Specialists with information for administering this year’s Perception of Care Survey. View Survey Administration Guidelines.

The survey period begins May 7, 2018 and will end June 5, 2018. All surveys need to be returned to Partners by June 8, 2018.

Providers can return the surveys to Partners by:

• sending/delivering to your provider specialist; or
• sending/delivering to April Corder at the Gastonia office, 901 S. New Hope Road, Gastonia, NC  28054.

Please direct requests for additional surveys, surveys in Spanish, or any other questions regarding this year’s survey implementation to April Corder at 704-884-2591, acorder@partnersbhm.org or to Bill Rankin at 704-884-2688, brankin@partnersbhm.org.

Partners expresses its gratitude for your assistance in administering the 2018 Perception of Care survey.

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.

Timely Filing Override Requests:  Please make sure claims are being submitted according to the timely filing guidelines. If claims deny for any of the reasons below, make sure you submit timely filing override requests within the time frames below.

Timely filing override requests should only be submitted for the following reasons. The requests are reviewed for consideration.

• Retroactive Medicaid: Claims based on retroactive Medicaid eligibility must have authorization requested within 30 days and submit claims within 90 days of the date modified in NCTracks for eligibility date range. Claims department should be contacted prior to submitting claims.
• Retroactive Medicare/TPL: If claims are recouped due retroactive Medicare/TPL, the claim can be resubmitted once the claim has been resubmitted to other insurance. The only exception is claims that are not within the Fiscal Year for State benefit. Please resubmit within 90 days of the recoupment.
• NC Tracks License update/addition: Request must be submitted within 30 days of date modified in NCTracks.
• NC Tracks NPI/Taxonomy update/addition: Request must be submitted within 30 days of date modified in NCTracks.
• Site update: Request must be submitted within 30 days of update.
• AlphaMCS system issues identified by Partners
• Eligibility issue with NC Fast/NC Tracks: Request must be submitted within 30 days of date modified in NCTracks.

Timely Filing Requests should be sent directly to claimsdepartment@partnersbhm.org prior to submitting the claims.

Over 400 Learn New Ways to Treat the Opioid Crisis

Last Friday, April 6, 2018, Partners hosted Partners Health Summit: Treating the Opioid Crisis, our third summit focusing on opioid use and addiction. Nearly 430 behavioral health and social services professionals, expert presenters, and community leaders discussed how to fight the epidemic through prevention, education, and treatment and recovery.  For materials from this summit and previous summits, and for regular updates concerning our next summit, please visit https://www.partnerstraining.comorg/partners-health-summits/.

April is Fair Housing Month

Fifty years ago, the Fair Housing Act was enacted as part of the Civil Rights Act of 1968. 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 consumers.

• 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 consumers, having a better understanding of these laws are helpful. Partners will be hosting a Fair Housing Training on May 17^th at the Cleveland County Chamber of Commerce. There will be a morning session for service providers and an afternoon session for housing providers. Seating is limited and registration is required. Please contact Bre Griffin for registration information at bgriffin@partnersbhm.org or 704-884-2514.

Fraud vs Abuse—Can You Tell the Difference?

All of us – providers, LME-MCO employees, consumers, and citizens — are responsible for identifying and reporting health care fraud and abuse in the publicly funded programs we administer. Fraud and abuse can negatively impact our ability to provide vital services to those in our communities who are most in need, by making fewer dollars available for the purpose(s) they were intended. It can also negatively impact the reputation of the programs we all work so hard to administer. When the public hears about unchecked fraud and abuse in taxpayer funded programs they begin to lose confidence and their desire to continue paying for those programs.

How can I tell if the activity I observed is fraud or abuse? The United States Department of Health and Human Services has defined fraud and abuse in 42 Code of Federal Regulations, Part 455.2. When you look at that regulation you will see that the definitions are very legalese, so let’s boil it down. Fraud and abuse are very similar, the primary difference is that fraud is the intentional deception or misrepresentation (a LIE) while abuse is generally associated with poor business practices without the intent to lie. Though we generally associate abuse with unintentional acts, poor business practices based on negligence or a wanton disregard for the truth can subject one to administrative, civil or criminal liability.

Abuse can occur when:

• Clinical notes are improperly prepared. This may involve notes that lack signatures, no credentials with signatures, not dated, and/or not individualized to the specific consumer–sometimes referred to as “cloned” or “canned” notes.
• Missing documentation (consumer charts, staff and/or financial documentation).
• No supporting documentation demonstrating compliance with personnel requirements (i.e.; training, education, qualifications, supervision and/or team composition).
• Not using Medicaid as a payor of last resort when coordinating benefits for consumers that have Medicare and/or private insurance.

Medicaid fraud can occur when a provider intentionally:

• Bills for services that are not properly supported by the documentation (i.e.; unbundling, group vs individual, excessive units), unnecessary services or services not rendered, for unnecessary equipment, or for services performed by an unqualified person.
• Uses an improper procedure code to bill for a higher priced service when a lower priced service was provided (i.e.; upcoding, unbundling or code gaming).
• Failing to maintain accreditation for services that require it and then billing for those services.
• Gives or receives payments based on the number of referrals, also known as kickbacks.
• Falsifies required records.

It is everyone’s duty to be good stewards of the public health care funds we are responsible for administering and to be able to identify and report any suspicion of fraud or abuse. Our Code of Conduct/Ethics Agreement requires all Partners employees, contract providers and board/committee members to report any unethical activity, fraud or abuse.

Still not sure if what you have observed is fraud or abuse? Not to worry, Partners Program Integrity can help. Other than contacting a team member directly, there are two ways to report your concerns. The first is the Alert Line at 1-866-806-8777, where a live person can assist. Another is online at https://partnersbhm.alertline.com.

If you have any questions about Partners Training Academy events, or would like to be added to the waiting list for a training that is already full, please contact Kali Sbalbi, Public Relations Training Coordinator, by emailing Training@PartnersBHM.org or calling 704-884-2669.  For more information about attending Partners Training Academy sessions, visit our Frequently Asked Questions page.

Overview of Personal Outcome Measures

Thursday, April 26, 2018, 10:00 a.m. – 4:00 p.m., Elkin, NC (Registration)

Description: Personal Outcome Measures® are a tool developed by the Council on Quality and Leadership (CQL) to ensure supports and services are truly person-centered. This one-day overview will provide a basic understanding of the Personal Outcome Measures® as you prepare to use them in planning.

Trainers: Michelle Stroebel, Intellectual Developmental Disabilities Assessment Team Supervisor, Partners, and Tammy Wellman, Intellectual Developmental Disabilities Systems Manager, Partners

WRAP^® 

Thursday, April 26 – Friday, April 27, 2018, 8:00 a.m. – 5:00 p.m., Gastonia, NC (Registration)

Description: The Wellness Recovery Action Plan (WRAP®) is a personalized wellness and recovery system rooted in the principle of self-determination. Participants of this training will create their own WRAP^® to be used as a tool throughout their recovery.

Trainer: Patty Schaeffer and Stephanie Rhodes, Certified WRAP Facilitators

NEW! Building Blocks of the ASAM Severity Profile 

Tuesday, May 1, 2018, 9:00 a.m. – 4:30 p.m., Gastonia, NC (Registration)

Description: Participants of this training will learn how to build an ASAM Severity Profile to help develop and enhance their treatment plan. Training also includes several case vignettes that we will practice scoring together to assist with teaching the learner how to identify the most appropriate level of care placement.

Pending approval for 6 NC Substance Abuse Professional Practice Board (NCSAPPB) certification hours.

Trainers: Mental Health/Substance Use Care Managers in the Utilization Management Department, Partners BHM

Motivational Interviewing in Group Therapy 

Wednesday, May 9, 2018, 8:30 a.m. – 4:30 p.m., Hickory, NC (Registration)

Description: This training is appropriate for any direct service provider who provides client care in a group setting (or plans to provide client care in a group setting) and who has completed Introduction to Motivational Interviewing.

Trainer: Laurie Conaty, MSW, LCSW, LCAS

NC TOPPS 101 & Super User

Wednesday, May 9, 2018, 9:00 a.m. – 12:30 p.m., Webinar (Registration)

Description: NC TOPPS 101 is an introduction to NC TOPPS and includes a demonstration of the NC TOPPS online system for the provider agency’s staff user. The NC TOPPS Super User training outlines the roles and responsibilities of the NC TOPPS Super User.

Trainer: Veronica Somerville, MHA, MBA, Quality Management Analyst, Partners

NEW! Advanced Peer Support Specialist 

Tuesday, May 22 – Thursday, May 24, 2018, 8:30 a.m. – 5:00 p.m., Hickory, NC (Registration)

Description: This is an advance practice class for use with peer support specialists for training credits, and continued learning.

Trainer: RI International

Certified Peer Support Specialist 

Monday, June 11 – Friday, June 15, 2018, 8:00 a.m. – 5:00 p.m., Gastonia, NC (Registration)

Description: Peer Support Specialists are people living in recovery with mental illness and/or substance use disorder who provide support to others who can benefit from their lived experiences. The North Carolina Certified Peer Support Specialist Program certifies that the peer has met a set of requirements necessary to support other individuals with mental health or substance use disorder.

Trainer: Monroe Consulting, LLC – Take Your Heart to Work® Curriculum

Person Centered Thinking 

Tuesday, June 19 – Wednesday, June 20, 2018, 9:00 a.m. – 4:30 p.m., Gastonia, NC (Registration)

Description: Person Centered Thinking (PCT) training serves as a foundation and philosophical framework for everyone who is involved in supporting people with disabilities. This activity-filled, two-day training consists of applied stories, guided exercises, group work and discussion, wherein the participants acquire core skills in person centered thinking.

Trainer: Evelyn McGill, MA, LPC, LCAS, CSI, NCC, Certified Person Centered Thinking Trainer with The Learning Community

Partners Selected for and Participates in National Quality Efforts

As reported in December, Partners was the first LME-MCO in North Carolina accepted into the membership of the National Quality Forum (NQF), an organization that leads efforts to improve health and healthcare quality throughout the country. Partners underwent an application and selection process to be a part of the NQF’s 400-plus membership, which includes national public and private entities with a common goal of improving healthcare.

Barbara Hallisey is part of NQF’s Opioid Stewardship Action Team, a group of 25 members who shared knowledge and resources to develop the recently-published National Quality Partners Opioid Stewardship Playbook. The NQP Playbook highlights seven fundamentals that organizations can use to help combat the opioid epidemic.  Barbara will present at a workshop geared to clinicians and healthcare quality leaders who want to learn how to implement the tools outlined in the NQP Playbook. The Playbook is available for purchase at http://www.qualityforum.org/nqf_store.aspx, and a summary of the guide is available on NQF’s website.

Also, Partners has been selected to join the National Quality Forum’s National Quality Partners Leadership Consortium. This group, comprised of leaders from 30 organizations, identifies actionable strategies and national policy measures to drive change for individuals and families.  Selenna Moss is representing Partners in the leadership consortium.

The National Quality Forum brings together diverse organizations and individuals from across the country dedicated to improving health and healthcare through quality measurement. Over 430 organizations, including hospitals, physicians and other clinicians, healthcare systems, patient and consumer groups, insurers, employers, and biopharmaceutical and life sciences companies are members of the National Quality Forum.

Partners Becomes First i2i Champion Supporter

On April 4, 2018, i2i Center for Integrative Health (formerly the NC Council of Community Programs) announced that Partners is the first Champion Supporter of the i2i Center for Integrative Health. The i2i Center is a convener organization for healthcare leaders

to work together to solve the most important issues affecting behavioral healthcare, intellectual and developmental disabilities, and primary healthcare and support service systems within a comprehensive system of whole person care in North Carolina.

“As a Champion supporter, Partners Behavioral Health Management will be included in the i2i Advisory Circle – a group that will serve as a resource to Center leadership on policy and will be available to offer subject matter expertise and feedback on i2i Center activities as needed,” said Mary Hooper, i2i Center Executive Director. “Partners is increasingly recognized for its strength in community linkages and implementation of whole person care through its provider network and activities around social determinants of health. I am so pleased that the Partners team endorses i2i, and I am particularly excited to invite CEO Rhett Melton to join our Advisory Circle.”

“Partners continues to improve lives and strengthen communities through vital collaboration with network providers, government agencies, and community organizations. Our focus is to produce positive, measurable outcomes for those in need by establishing community-based projects and effective services through quality professional health care providers,” said Rhett Melton, CEO for Partners. “Being a Champion Supporter of the i2i Center for Integrative Health allows Partners to directly impact state policies, legislation, and resources to ensure the best health care system possible for North Carolinians.”

To learn more about the i2i Center for Integrative Health, visit www.i2icenter.org.

Alerts and LME/MCO Joint Communication Bulletins

Provider Alerts are sent to all providers subscribed to receive Partners’ Provider Communications. Published alerts are available on the Provider Knowledge Base at https://legacy.providers.partnersbhm.org/provider-alert-archive/.

Alerts issued since the last Provider Bulletin:

• March 23, 2018 – Revised DMA Super Measures Specifications Released
• March 27, 2018 – NPI and Health Plans in NC Tracks, Alpha System Updates
• April 10, 2018 – New AlphaMCS Link; Medicaid Transformation Update
• April 13, 2018 – Opioid Implementation Funds Available; Community Support Team Listening Sessions

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

Joint Communication Bulletins issued since the last Provider Bulletin:

• #J282 Update regarding Columbus County Realignment
• #J283 New Medicare Beneficiary Identifier Effective April 1, 2018
• #J284 Medicaid and Health Choice Enrollment defect
• Maintain Provider Eligibility list of providers with encounters

Providers are encouraged to review the monthly NC Division of Medical Assistance Medicaid Bulletin. Bulletins are posted at https://dma.ncdhhs.gov/documents/2018-medicaid-bulletin-and-index

Some articles of interest are:

• NPI Exemption List Extension to Aug. 31, 2018 – Update
• NCTracks Provider Training Available in April 2018
• Accepting and Billing Medicaid Beneficiaries
• Change in Edit Disposition: Claims Pended for Incorrect Billing Location

Announcements and Reminders

Iredell County Family Fest 2018:  May is Mental Health Awareness Month and we are kicking it off with a community event! Join us at the second Annual Iredell County Family Fest for a day of fun, food and family. There will be information about local services that address mental health, substance abuse, and other support for our families.

Time & Date: April 28, 2018, 10 a.m.-1 p.m.
Location:  Fairview Baptist Church, 349 Turnersburg Hwy, Statesville, NC

No registration required. To learn more, contact Stephanie Funderburk at sfunderburk@partnersbhm.org or call 704-301-1281.

Our goal is to provide a day to bring families and our community together and to raise awareness of the services and activities available in Iredell County. We will have over 30 vendors, local performers, a DJ, bounce houses, and giveaways, food trucks and more! Family Fest is a community collaboration sponsored by the Iredell County Adult and Children’s Collaboratives.

Youth Mental Health First Aid:  A young person you know could be experiencing a mental health or substance use problem; learn an action plan to help. Youth Mental Health First Aid is highly recommended for teachers, coaches, social workers, faith leaders & other individuals who regularly have contact with young people ages 12-18. Sometimes first aid isn’t a bandage or CPR or calling 911, sometimes, first aid is YOU. *Must be at least 18 years of age to take this training. Multiple opportunities are available:

Time & Date:  Monday, April 26, 2018 from 8:30 a.m.-5 p.m.
Location:  First Plaza (Partner’s Hickory Office) – Multipurpose Room – 1985 Tate Blvd. SE Hickory, NC 28602
Registration:  Click here to Register Online

Time & Date:  May 31, 2018, 8:30 a.m. – 5:00 p.m.
Location:  Foothills Higher Education Center Room 211, 2128 S Sterling St., Morganton, NC 28655
Registration:  Call or email Kim Rhoads 828-323-8049, krhoads@partnersbhm.org for information. (Deadline to register is May 29, 2018)

Spring Fling Dance:  Individuals with Intellectual Developmental Disabilities (IDD) ages 16 and up and their guests are invited to dance the night away at our Spring Fling Dance on Saturday, May 5, 2018 from 7 p.m.-10 p.m. at Bethel Presbyterian Church, 19920 Bethel Church Rd., Cornelius, NC. Enjoy a night out featuring music, dancing, and light refreshments. Please sign up online at www.bethel-pc.org.  Go to “Events” and click link below Spring Fling flyer to register. For more information contact Lisa Hunter at 704-491-7869 or lisarenehunter@gmail.com.

NCACAY 2018 Legislative Conference:  The North Carolina Association of Community Alternatives for Youth (NCACAY) will hold its Legislative Conference May 15-17, 2018 at the Holiday Inn Raleigh Downtown, 320 Hillsborough St., Raleigh, NC 27603. To register, visit https://www.eventbrite.com/e/ncacay-legislative-conference-a-new-age-for-north-carolinas-youth-tickets-44115430440. If you have questions, please contact Teresa Price at teemyprice09@gmail.com.

Training Symposium:  The UNC Center for Excellence in Community Mental Health will host its eight annual Symposium for community psychiatrists on May 19, 2018 at the UNC William and Ida Friday Continuing Education Center, Chapel Hill, NC.  Click here for registration information.

As North Carolina’s public mental health system reorganization begins its eighth year, medical directors/psychiatrists and other physicians have assumed leadership roles in these provider agencies and must continue to manage a clinical team and ensure that care delivery in that agency is evidence-based, appropriate for the clinical needs of each patient, and cost-effective. With Managed Care Organizations (MCOs) moving to a private model and North Carolina public mental health system changing to a value-based system, reimbursement will be related to successful patient outcomes. This program is designed to assist medical directors and other psychiatrists in their leadership role in NC’s changing public mental health system.

For specific questions about content and target audience, please contact Alice Lockhart with the UNC Center for Excellence in Community Mental Health at alice_lockhart@med.unc.edu or 919-445-0504.

Training from the Division of MH/DD/SAS:  Registration is being accepted for the next round of Mental Health/Substance Use 101, Crisis Response and Critical Time Intervention Trainings, being held May 22-25 in Raleigh. Please register using the links below.

Mental Health Substance Use 101 – May 22, 2018, 9 a.m.-12 p.m.
Crisis Response Training – May 22, 2018, 1 p.m.-4 p.m.
Critical Time Intervention – May 23-24, 2018, 9 a.m.-4 p.m.

NAMI South Mountains Behavioral Health Conference:   NAMI South Mountains is hosting its annual Behavioral Health Conference on Monday, May 21, 2018 at Foothills Higher Education Center, Morganton, NC  28655. To learn more, visit https://namirutherfordclevelandburke.org/2018-behavioral-health-conference/