NC adapatations -THREAD

This thread will be added to as new adaptation and support examples emerge.  We believe now is the time to highlight changes we believe will only serve to help providers, and in turn, service recipients, families, and broader community/system of care.

CMS issued 1135 waivers: www.cms.gov/newsroom/press-releases/cms-approves-medicaid-section-1135-waivers-11-additional-states-response-covid-19

NC DHHS issued an announcement to allow for telehealth and telephonic contacts in lieu of in-person contacts.  They backdated to capture previous contacts.

NC has 7 Local Management Entity-Managed Care Organizations (LME-MCOs) operating across the state.  Below we will capture MCO-specific modifications and supports that will only help address challenges in this unusual time.

Cardinal Innovations - Applications to access funds from a COVID Relief Fund (max $20k per award):

Cardinal Innovations issued the following ACT provider announcement on April 2nd, 2020 (this will be hugely beneficial to teams!)

ACTT and ACTT Step Down Service Support
April 2, 2020
To: ACTT Providers
From: Network Management

To further support providers through the new coronavirus (COVID-19) pandemic, Cardinal Innovations Healthcare will pay Assertive Community Treatment Team (ACTT) and ACTT Step Down service providers the full Per Member Per Month (PMPM) for each authorized member effective April 1, 2020.

This temporary adjustment has been made to ensure that members receiving ACTT and ACTT Step Down services receive the intensity and frequency of service necessary to maintain stability with minimal use of crisis services (e.g., Emergency Department, inpatient psychiatric).

Cardinal Innovations hopes that this pre-payment methodology will mitigate anxiety related to securing reimbursement in a fee-for-service manner in uncertain times. This pre-payment methodology will be considered each month and most likely will continue until the state of emergency is canceled by the governor of North Carolina or by July 1, 2020.

Providers will receive the PMPM payment of $1,295.92 per ACTT member and a PMPM payment of $648 for ACTT Step Down members. The payments will be based on distinct member counts from February 2020 claims. Cardinal Innovations will communicate directly with each provider regarding the number of members for which they received PMPM pre-payment.

A reconciliation will occur each month the PMPM occurs to determine if the distinct count of members served increased or decreased from the originally projected amount. This will account for discharges and/or new admissions. Cardinal Innovations plans to issue these pre-payments on or before April 8, 2020.

Providers will submit non-reimbursable encounter claims for services using only the codes listed below. Contracts and CI will be updated as needed by April 8, 2020. Existing authorizations will not have to be changed. Initial or concurrent authorization requests should continue to reflect a request for H0040. Discharge Treatment Authorization Requests (TARs) should still be submitted on any member that teams are not continuing to serve so that Cardinal Innovations can ensure appropriate supports are in place for those members.

ACTT – minimum of four encounters per month in any combination of the below:

· H0040 for face-to-face encounters for up to the first four dates of service in the month
· H0040 GT CR for sessions delivered with audio and visual telehealth – Note: Any member of the team can provide using technology only if the member’s record supports that this is clinically appropriate. Use the Place of Service (POS) for telehealth (02) on these encounters
· H0040 CR for telephonic only encounter (no video) – Records should support why this is the appropriate/only available method of treatment delivery
· H0040 TS encounter claim would be used to capture additional face-to-face encounters beyond the first four if these do occur

It is still expected that members receive the same frequency of services that would typically be provided based on the needs of the member. It is also expected that the rationale for frequency is documented in the medical record. Post-payment reviews may occur for any providers submitting only four encounters for a member within the month.

As ACTT remains a comprehensive, all-inclusive service, members receiving ACTT are not eligible to receive Case Support services. The ACTT team should provide any additional supports and/or coordination a member may need including increasing the frequency of contacts if this is necessary to meet the needs.

ACTT Step Down – minimum of three per month in any combination of the below:
· H0040 TS U5 for face-to-face encounters
· H0040 TS U5 GT CR for sessions delivered with audio and visual telehealth – Note: Any member of the team can provide using technology only if the member’s record supports that this is clinically appropriate. Use the Place of Service (POS) for telehealth (02) on these encounters.
· H0040 TS U5 CR for telephonic only encounter (no video) – Records should support why this is the appropriate/only available method of treatment delivery for telephonic only interventions (no video)
· H0040 TS U5 U1 encounter claim would be used to capture additional face-to-face encounters beyond the first three if these do occur

Note: The GT and CR modifiers are effective as of March 10, 2020, and should be used for service claims as of March 10, 2020, for any treatment sessions that were delivered via telehealth or telephonically and will be paid up to the typical monthly limits. The April 2020 pre-payment will require the use of a combination of the codes listed above – none of which will generate reimbursement as they will have already been covered in the pre-payment; however, please indicate the usual rate on the claims for the service rendered.

It is essential that providers submit claims for every encounter and document services accordingly to support the receipt of the PMPM pre-payment.