Provider Bulletin #82

• Partners June Provider Webinar Available for Viewing
• FY2018-19 State Funded Contracts
• Registry of Unmet Needs Process and Referral
• Inpatient Requests (Medicaid and Non-Medicaid)
• Eye Movement Desensitization and Reprocessing Therapy-EMDR Training Clarification
• Facilities with Involuntary Commitment Designations
• Behavioral Health EHR Funding Program Update
• Fiscal Year 2017-18 Checkwrite Cutoff
• AlphaMCS Training

• Claims Information
• Changes to Provider Human/Client Rights Committee Documentation
• Provider Self-Audits
• Tips to Assist with Energy Expenses
• Partners Training Academy Opportunities
• Connect with Other Providers at Partners’ Enhanced Child Services Collaborative
• Alerts and LME/MCO Joint Communication Bulletins
• Announcements and Reminders

Thanks to all providers who joined us for our quarterly Provider Webinar on Wednesday, June 13, 2018. Handouts and a recording of the webinar will be available at https://legacy.providers.partnersbhm.org/provider-webinars-forums/.

If you have questions about future Provider Webinars, please contact Roanna Newton at 828-323-8054 or email rnewton@partnersbhm.org. Dates for upcoming webinars will be posted at https://legacy.providers.partnersbhm.org/provider-webinars-forums/ and shared in a future Provider Communication Bulletin.

Partners is currently sending out State Funded Provider Contracts for the 2018-19 Fiscal Year (FY2018-19) using the following parameters:

• If the provider has overutilized their contracted amount, they will start July 1, 2018 at the amount they started at July 1, 2017.
• If the provider has underutilized their contract amount, they will start July 1, 2018 with the amount they have utilized.

As always, this is a starting point for providers. We hope to receive the same level of funding as we did on July 1, 2017; however, we are not sure of that at this time. If you have questions related to State Funded Contracts, please reach out to your Provider Account Specialist.

Effective July 1, 2018, providers of Intellectual and Developmental Disabilities (IDD) State Funded Services will be required to refer individuals receiving a State Funded Service to the Registry of Unmet Needs (RUN).  This process is being implemented to ensure that all individuals currently receiving a State Funded Service and who are potentially eligible for the Innovations Waiver are on the RUN, and waiting for an Innovations slot to become available.  This referral will be a prerequisite for obtaining an initial or continuing authorization of a State Funded Service after July 18, 2018. As a reminder, State Funding is not GUARANTEED.

Request for Referral

If a provider agency is currently serving an individual using state funds, the provider agency will be required to submit the IDD State-Funded Service- Registry of Unmet Needs Referral Form via email to iddwaitlist@partnersbhm.org for a referral to the RUN. This process will result in the individual being referred to the Registry of Unmet Needs for the potential eligibility of the Innovations Waiver.

Referrals to the Registry Process

• Providers will contact Partners Behavioral Health Management using the IDD State-Funded Service- Registry of Unmet Needs Referral Form and complete the form in its entirety.
• Providers will email the completed form to the Registry and Referral Department at iddwaitlist@partnersbhm.org. In the subject line, please enter the word “Receiving State Funds”. An email notification of receipt of referral form will be sent to the referral agency.
• Providers will need to include the Receipt of Referral email when uploading documentation in AlphaMCS to support the Service Authorization Request (SAR).
• A Registry and Referral Specialist will contact the Individual or Legally Responsible Person to begin the referral process.  The RUN referral date/time will be managed in order of the receipt of the IDD State-Funded Service- Registry of Unmet Needs Referral Form.

A Registry and Referral Specialist will contact the Individual and/or LRP and Referral agency annually to update information and confirm continued interest in remaining on the Registry of Unmet Needs (RUN).

More information about the Registry of Unmet Needs can be found on Partners’ Provider Knowledge Base at https://legacy.providers.partnersbhm.org/registry-of-unmet-needs/. Providers should submit questions to the Registry and Referral Team at iddwaitlist@partnersbhm.org.

Partners has reviewed our process related to inpatient authorizations. Based on feedback from the providers, adjustments are being made to that process. There are changes to authorizations that span a weekend day and to authorizations for Involuntary Commitments.

Authorizations that would end on a weekend (Saturday/Sunday) will be processed as follows, effective with Date of Service June 20, 2018 forward.

• Service Authorization Requests (SARs) submitted on Wednesday, with the last authorized day being on Friday will require any continuing requests to be submitted on Friday.
• SARs submitted on Thursday, currently the last date approved would be Saturday. Partners will now allow hospitals to request the authorization through Monday. The hospital will need to submit a SAR on Monday for additional days.
• Requests made on Friday, are limited to a maximum of 3 days.  The provider will need to submit a SAR on Monday for continued stay.
• Utilization Management Inpatient staff will still be available seven days a week including holidays. If a hospital needs or chooses to submit a SAR during that time, Utilization Management staff will be available from 8:00 a.m. until 9:00 p.m.

Involuntary Commitments:  Partners recognizes when an involuntary commitment leads to a consumer being admitted to a psychiatric inpatient unit, the facility needs time to fully assess the need for the commitment to stand or be dismissed. Since the law related to involuntary commitments legally allows the facility to take up to 72 hours to complete their evaluation, Partners will authorize 3 days for these admissions.

If the third day of the authorization falls on a Saturday or Sunday, Partners will allow the request to extend to Monday as outlined above.

Please contact Utilization Management at 704-842-6434 with any questions.

Effective April 1, 2018, Partners began increasing capacity for EMDR Therapy throughout the catchment area.  NC Licensed Practitioners who have completed 20 hours of Emdria approved Basic Training for EMDR Therapy are eligible to apply to provide this service in the Partners Network.

Not all EMDR training is Emdria approved.  Please check your training certificates and verify that the provider and trainer is on Emdria’s list of “Approved EMDR Training Providers.”  This information can be found on the Emdria Training website at https://emdria.site-ym.com/page/484

Billing the EMDR enhanced rate for a clinician without the appropriate training could result in a payback situation for the provider. 

It is also required that all EMDR Providers agree to use A Collaborative Outcome Resource Network (ACORN) as their outcomes measurement tool.  Please contact rnewton@partnersbhm.org for more information on ACORN.

Out of network providers meeting criteria for this service would need to email their interest in providing this service to providers@partnersbhm.org.  To provide this service, all out of network providers will also need to be approved through Partners credentialing process.

In network providers with clinicians who meet criteria for this service would need to submit a Provider Change Form to credentialingteam@partnersbhm.org requesting the service code be added to the specific site(s) where the EMDR code will be provided by those appropriately trained clinicians.

The EMDR service code for Medicaid and IPRS is 90837 EM.  The Partners’ enhanced rate for provision of EMDR Therapy is $125 for 60 minutes.                    

The Division of Mental Health/Developmental Disabilities/Substance Abuse Services is undergoing some realignment to the management of the involuntary commitment (IVC) process. You can view the most current list of IVC designated facilities in the Partners’ catchment by visiting https://legacy.providers.partnersbhm.org/ and clicking on the IVC Designated Facilities link in the Additional Resources category.

The following information has been excerpted from NC HealthConnex Update, published June 14, 2018. Providers are urged to stay abreast of updates regarding the transition to electronic health record technology.

As announced in the HIEA May Update, the N.C. Department of Health and Human Services Office of Rural Health (ORH) and the Division of Medical Assistance (DMA) partnered with the N.C. Health Information Exchange Authority (NC HIEA) to launch a program to assist behavioral health, mental health, and intellectual development and disability practices with purchasing electronic health record (EHR) technology and establishing connectivity to the state-designated health information exchange, NC HealthConnex. Applications closed on May 31 with over 260 applicants. Behavioral health organizations that applied for this program will be notified by the Office of Rural Health Information Technology Team regarding their eligibility and acceptance into the program by early July 2018.

Technology Selection:  Practices selected to participate will need to determine what software works best for their specific organization. The Office of the National Coordinator for Health Information Technology (ONC) developed adoption and implementation documentation that is helpful in the planning and procurement process. BH/IDD practices need to coordinate with other specialties to help their patients. Therefore, practice software must include support for HL7 compliance and enable providers to communicate with various specialties. This capability will allow organizations to connect to NC HealthConnex. For a list of vendors that NC HealthConnex is already engaged with, click here. If you don’t see the vendor you’re working with on that list, please ensure that they can meet the following technical standards.

Funding:  Reimbursements for the Behavioral Health EHR Funding Program will come through NC Tracks after the practice has either connected to NC HealthConnex or has been in the onboarding process for over 30 days. Payment will not exceed the total cost of behavioral health EHR implementation and will go directly to the practice.

For more information, visit the website or contact:

• Lakeisha Moore – Moore@dhhs.nc.gov or 919-527-6473 (for questions about eligibility for the BH EHR Funding Program)
• Kenya Servia- Servia@nc.gov or 919-754-6847 (for questions about NC HealthConnex and connectivity).

Providers are reminded that all approved claims to be considered for Fiscal Year 2017-18 must be submitted by 5 p.m. on Tuesday, June 26, 2018. To view the checkwrite schedule, please visit https://legacy.providers.partnersbhm.org/finance-documents-forms/#June-2018.

Join Partners’ Claims, Access to Care, Utilization Management, and Provider Network staff for an interactive AlphaMCS module training. This open-house style training session will allow each attendee time to work one-on-one with Partners’ staff to discuss unfamiliar or problematic AlphaMCS modules. Participants are encouraged to bring their own laptops to access and review their personal workflow during the training.

Want to attend? The open-house training will be held Tuesday, July 24, 2018 from 9 a.m.-12 p.m. at Partners’ Hickory Office, 1985 Tate Blvd. SE, Hickory, NC 28608. To learn more or to register, please visit https://www.partnersbhm.org/events/alphamcs-training/.

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. 

Timely Filing Override Requests:  Please make sure claims are being submitted according to the timely filing guidelines available at https://legacy.providers.partnersbhm.org/claims-information/.  If claims deny for any of the reasons below, make sure you submit timely filing override requests within the time frames.

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

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.

Effective July 1, 2018, providers are no longer required submit Human/Client Rights Committee meeting minutes or Annual Human/Client Rights Committee Reports to the Partners Human Rights Committee liaison. Partners will continue to monitor all provider Human Rights Committee policies, quarterly meeting minutes, committee rosters, and offer technical assistance on an as needed basis to ensure compliance with Chapter 122C.

As such, Partners will require providers to make Human/Client Rights Committee meeting minutes and rosters available upon request. For questions contact Keshia Sandidge by phone at (704) 884-2698 or by email at humanrightscommittee@partnersbhm.org.

The mission of the Program Integrity Department is to work with providers, consumers and other stakeholders to advance the integrity of our taxpayer-funded Medicaid program. Service providers in our closed Provider Network can demonstrate that they are good stewards of the public funds that have been entrusted to us by performing Provider Self-Audits to identify areas of non-compliance. Self-Audits are just one tool that providers can utilize as part of a robust, internal compliance program.

The Center of Medicare and Medicaid Service (CMS), E-Bulletin (August 2016) defines a self-audit as an audit, examination, review, or other inspection performed by the provider. The Provider Self-Audit should focus on assessing, correcting, and maintaining controls that would promote compliance with applicable laws, rules, regulations and policies.

While conducting a self-audit, if improper payments are discovered, the provider should self-disclose them to Partners. Furthermore, if an outside agency has conducted a review and finds improper payments, the results of that outside review should also be self-disclosed.

To support our providers in their efforts to develop a robust compliance program, Partners has developed a Provider Self-Audit Reporting Process. The process includes:

• A memorandum, disclosing the results of the audit.
• An adverse findings chart, accounting for each claim line that was billed or submitted to Partners.
• A plan of correction, describing actions that will be taken to prevent the violation(s) from occurring again.
• The Provider Self-Audit Refund Attachment with a refund check.

More information about the Provider Self-Audit Reporting Process, and links with required forms can be found on the Partners’ Providers Knowledge Base, Quality Management & Cooperate Compliance, Program Integrity (https://legacy.providers.partnersbhm.org/program-integrity/).

A large part of monthly housing expenses is the energy expenses, which can drastically increase in the winter and summer months. A consumer’s budget can quickly get out of control during these months and the beginning of summer may be a good time to share some energy efficiency tips with them. These tips and more can be found at www.energy.gov.

• Utilize ceiling fans more often
• Open windows in the evening
• Turn off lights and appliances when not in use
• Dry clothes outdoors instead using the dryer
• Close south- and west-facing window curtains during the hottest part of the day
• Set thermostat as high as comfortably possible
• Avoid using the oven on especially hot days and cook on the stove or grill outdoors

Additionally, the Department of Health and Human Services coordinates with local agencies every year to provide fans for older adults and people with disabilities. These fans provide some relief from the heat and reduces heat related illnesses. Here’s a list of agencies in the counties can be contacted:

For more information about the fan program, visit www.ncdhhs.gov/operation-fan-and-heat-relief.com Or contact Bre Griffin, Housing Educator at 704-884-2514 or bgriffin@partnersbhm.org.

Resource Parent Curriculum Training (Registration)

Wednesday, June 27 – Friday, June 29, 2018, 8:30 a.m. – 4:30 p.m., Gastonia, NC

Description: Resource Parent Curriculum provides support and tools for those who care for children in foster or institutional care. This is a three-day training for licensing staff at Gaston DHHS and therapeutic foster care providers.

AlphaMCS Training (Registration)

Tuesday, July 24, 2018, 9:00 a.m. – 12:00 p.m., Hickory, NC

Description: Join Partners’ Claims, Access to Care, Utilization Management, and Provider Network staff for an interactive AlphaMCS module training. This open-house style training session will allow each attendee time to work one-on-one with Partners’ staff to discuss unfamiliar or problematic AlphaMCS modules. Participants are encouraged to bring their own laptops to access and review their individual workflow during the training.

Introduction to Motivational Interviewing

Thursday, August 2 – Friday, August 3, 2018, 8:30 a.m. – 4:30 p.m., Hickory, NC (Registration)
Thursday, October 18 – Friday, October 19, 2018, 8:30 a.m. – 4:30 p.m., Gastonia, NC (Registration)

Description: Motivational Interviewing (MI) is an evidence-based treatment that addresses ambivalence to change. MI is a conversational approach designed to help people with the following:

• Discover their own interest in considering and/or making a change in their life (e.g., diet, exercise, managing symptoms of physical or mental illness, reducing and eliminating the use of alcohol, tobacco, and other drugs)
• Express in their own words their desire for change (i.e., “change-talk”)
• Examine their ambivalence about the change
• Plan for and begin the process of change
• Elicit and strengthen change-talk
• Enhance their confidence in taking action and noticing that even small, incremental changes are important
• Strengthen their commitment to change

Attendance Fee: $0.00 – Attendees of this training will receive 13 contact hours for completing this session.

Trainer: Laurie Conaty, MSW, LCSW, LCAS

Documentation/Person Centered Planning

Thursday, August 16 – Friday, August 17, 2018, 9:00 a.m. – 4:30 p.m., Gastonia, NC (Registration)
Thursday, October 4 – Friday, October 5, 2018, 9:00 a.m. – 4:30 p.m., Hickory, NC (Registration)

Description: This training is an instructional course on the essential elements of documentation. Participants will develop awareness and skills to enhance documentation competence as behavioral healthcare providers. Participants will learn the components to writing accurate service notes using the PIE format. Additionally, participants will learn the values and core concepts of being person centered thinkers. This training will teach the instructional elements of completing the person-centered plan.

Attendance Fee: $0.00 – Attendees of this training will receive 12 contact hours for completing this session.

Trainer: Danielle Coleman, MSW, LCSW, ACSW

Introduction to Dialectical Behavior Therapy (Registration)

Thursday, August 23 – Friday, August 24, 2018, 8:30 a.m. – 4:00 p.m., Gastonia, NC

Description: Dialectical Behavior Therapy (DBT) treatment is a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT is a support-oriented, cognitive-based, and collaborative method for teaching people how to cope with sudden, intense surges of emotion.

Attendance Fee: $0.00 – Attendees of this training will receive 12 contact hours for completing this session.

Trainer: Laurie Conaty, MSW, LCSW, LCAS

NCTOPPS 101 & SuperUser Training (Registration)

Wednesday, September 26, 2018, 9:00 a.m. – 12:30 p.m., Webinar

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.

Attendance Fee: $0.00 – Attendees of this training will receive 12 contact hours for completing this session.

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

Cognitive Behavioral Therapy (Registration)

Wednesday, September 26 – Friday, September 28, 2018, 9:00 a.m. – 4:30 p.m., Gastonia, NC

Description: Cognitive Behavioral Therapy, also known as CBT, is a type of therapy that helps a person focus on his or her current problems and how to solve them. This 3-day training program teaches the essentials of CBT, and prepares treatment providers to begin or continue the appropriate use of this evidence-based practice.

Attendance Fee: $0.00 – Attendees of this training will receive 18 contact hours for completing this session.

Trainer: Danielle Coleman, MSW, LCSW, ACSW

The first meeting of the enhanced children’s services providers collaborative was held Thursday, May 10, 2018 at Partners in Gastonia.  Twenty-seven people attended.  We discussed issues such as how to better collaborate with other providers through intake. We also discussed issues about the system of care, all providers being present at the child and family teams and all having input and ownership of the Person-Centered Plan. We also heard about some services provided by Family Preservation Services and about the System of Care Expansion Grant.

Everyone agreed that our time is well spent if we can make a difference in improving the processes we use to serve children and youth. If you would like to be a part of this group, the next meeting will be at Children’s Hope Alliance, Little Joe’s Chapel, 107 Grannis Lane, Statesville, NC, 10:00-12:00, July 26, 2018.   To learn more or to RSVP, please contact Jeanne Patterson by emailing jpatterson@partnersbhm.org by July 24.

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:

June 5, 2018 – Perception of Care, Reverification, Medicaid Transformation; Reminders
May 30, 2018 – June 1, 2018 Deadline to Initiate Connection to NC HealthConnex
May 24, 2018 – Checkwrite Cutoff, RFI for NADD Certification, Needs Assessment, Provider Webinar
June 7, 2018 – Review of Block Grant-funded Programs; Provider Webinar

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

Joint Communication Bulletins issued since the last Provider Bulletin:

#J288 Changes to NC-TOPPS interview items

• NC-TOPPS Initial Interview SFY 18-19
• NC-TOPPS Recovery Follow-up Interview SFY 18-19
• NC-TOPPS Update_EC Interview SFY 18-19

#J289 2017 MH/DD/SAS Mental Health and Substance Use Services Consumer Perception of Care Report

• 2017 Consumer Perception of Care Report

#J290 Annual Quality Strategy and Quality Improvement Projects/Performance Improvement Projects

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.

Medicaid Transformation:  All providers are urged to stay abreast of the information shared by DHHS regarding Medicaid transformation and the impact it can have on their operations. Information regarding this effort can be found at https://www.ncdhhs.gov/medicaid-transformation. In addition, Partners will also highlight white papers, comment periods, and additional information in future Provider Communication Bulletins.