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September 2019 Newsletter

Medicaid Managed Care Enrollment FAQs

Q: On the NC Medicaid Plans website, where a beneficiary can go to enroll online, it takes the user through online registration to the NCID login page. Why are they redirected to the NCID login page? A: When the member selects "Enroll" it is expected that the member is taken to the NCID login page to enter their NCID to authenticate using their NCID and password. Once the member creates and/or logs in with their NCID, they will be redirected back to ncmedicaidplans.gov to complete their enrollment.

Q: What is an NCID? A: The NCID is a username and password that allows members to log in to the enrollment website and mobile app to make enrollment changes. The NCID will link to the member’s Medicaid ID and provisions them to take actions related to their Medicaid account (i.e., making selections via the app and web).

Q: Does everyone with Medicaid have an NCID? A: No, but if a member wants to take actions online, they need to create an NCID. All Medicaid members can create an NCID using a valid email address if needed.

Q: When will enrollment packets be sent out in our region? A: Packets will be sent beginning October 1st and auto assignment will begin December 13th.

Q: What happens if a beneficiary does not enroll in a plan and/or select a PCP? A: The enrollment broker will auto assign the beneficiary to a plan and the plan will auto assign the beneficiary to a provider using an algorithm. Beneficiaries have 90 days from start of managed care coverage date to switch without cause.

The Division of Health Benefits (DHB) recently estimated that only 6% of Medicaid managed care eligible beneficiaries in regions 2 & 4 have self-selected their PCP. Therefore, auto-assignment will likely strongly drive PCP assignment. Remember: the more PHP networks a provider is in, the more likely the provider is to retain their current Medicaid/HealthChoice patients.

Q: Will beneficiaries in Standard Plans have the same co-pays as Medicaid Direct (fee for service)? A: Yes!
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Here you can find the enrollment materials and resources, and here you can find beneficiary outreach materials.

If you need to contact a Prepaid Health Plan, here is the contact list for providers.

To register for the NC Medicaid Bulletins and other provider communication, visit NCTracks.nc.gov and select "Click here to join mailing list" under the Sign Up for NCTracks Communications tab in the upper right-hand corner.

It's never to early to begin preparing!

There are several key proposed changes to both the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP).
You can read about the proposed changes to the MPFS here. And here is the QPP proposed rule fact sheet with request for information.

Proposed changes to include:

To reduce the quality category to 40% in 2020, 35% in 2021 and 30% in 2022.
To increase the weight of the cost category to 20% in 2020, 25% in 2021 and 30% in 2022.

Also, beginning with the 2021 performance year (2023 payment year), CMS is proposing to create the MIPS Value Pathways (MVPs) that would connect measures and activities across three categories in MIPS: quality, cost, and improvement activities.

MIPS Cost Category
Tips for Reviewing Your Performance

When reviewing your 2018 performance on cost, here's some tips to keep in mind:

Download your beneficiary-level data, which is available in your performance report under the cost category.
Once downloaded, add filters to the top row.
Filter your highest-costing beneficiaries and look them up in your EHR using their Medicare ID.
Review the services that were billed for those patients that made them costly, then drill down on some of the most expensive patients to determine if the costs associated were billed by your practice (more often than not, the case will likely be "no"). If the answer is yes, brainstorm ways to reduce costs in that area.
If any on the list have not been in for their Annual Wellness Visit, work to schedule them before the end of the year.
Remember to code to the highest level of specificity.
Avoid repeat testing if possible (e.g., imaging, labs, etc.)

Here are the 2018 MIPS Performance Feedback FAQs to reference along with this helpful MIPS Cost Performance Category presentation.

Behavioral Health Integration

As payment models shift from a fee-for-service to value-based care, it's increasingly important for primary care providers to be able to identify and assist in treating behavioral health disorders. Those with chronic medical disorders and major depression generate substantially higher medical costs than those with a chronic medical disorder alone.
NC MGMA discusses here integration models that show promise in bringing behavioral health care to the primary care setting.

The Strengthen Opioid Misuse Prevention (STOP) Act of 2017 combats the opioid epidemic in North Carolina, and contains several provisions that apply to North Carolina Medical Board licensees prescribing controlled substances (schedule II or III opioids and narcotics). Provision currently are in place, such as quantity limitations on prescriptions for acute pain. Other provisions, such as the requirement to e-prescribe controlled substances, will go into effect January 1, 2020.
Check out our Controlled Substance Prescribing Tip Sheet to make sure your practice is prepared!

If your practice is still struggling in the aftermath of Hurricane Florence, applications for relief funds from the North Carolina Medical Society Foundation Disaster Relief Program continue to be accepted.
Review the guidelines and consider applying.

Congratulations to the following practices who applied for and were recently awarded funds!

Delaney Radiology awarded $12,500
Coastal Children’s Services awarded $12,500
Hoke Pollock, MD, of Hanover Pediatrics awarded $7,500

Here are some recent articles about the state of Medicaid transformation and related initiatives underway in North Carolina.

Learning Opportunities

Motivational Interviewing I
September 19 & 20, SEAHEC, 2511 Delaney Ave.
This 2-day workshop is designed for practitioners either new to MI or wanting a full refresher to the concepts and an opportunity for supervised practice of skills. Participants will be introduced to this evidence-based approach through an interactive, fast-paced workshop focusing on knowledge-building and fundamental skill practice.To learn more about the event and register, click here.

Cardiovascular & Stroke Conference
September 18-20, Wilmington Convention Center
This conference provides healthcare professionals with the most current evidence-based medical information for diagnosing, treating and preventing cardiovascular and cerebrovascular disease. Our goal is leading our community to outstanding health by providing highly advanced provider education to include interaction with expert faculty through a variety of learning and networking opportunities. To learn more and to register, click here.

CME by the Sea
September 26-28, Bald Head Island Club, Bald Head Island
This educational event is designed to enhance the medical knowledge, competence, and professional practice of physicians and advanced care providers. Over the course of two days, providers will learn about relevant clinical updates and advances in primary care and across a variety of specialties. Click here for more info and to register.

Welcome Danielle Delponte!

The SEAHEC Practice Support team is thrilled to welcome Danielle Delponte to our team as a Project Specialist. She'll be supporting our team part-time on a variety of projects, and keeping us organized!
Danielle's most recent experience is with Coastal Horizons Center, where she served the last 3 years as a residential counselor at the Open House Youth Shelter. She has a BA in Psychology and Masters of Social Work, both from North Carolina State University.

Need to contact the Practice Support Services team?
You can reach us at Practice.Support@seahec.net or
the Director, Jessica Williams at (910) 667-9350

Copyright © 2019 South East Area Health Education Center, All rights reserved.
Practice Support Services Newsletter

Our mailing address is:
2511 Delaney Ave., Wilmington, NC 28403

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SEAHEC · 2511 Delaney Ave · Wilmington, NC 28403-6003 · USA