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May 2019 Newsletter

Medicaid Managed Care

Department of Health Benefits (DHB) has a new web portal for Medicaid Managed Care which can be found here: https://medicaid.ncdhhs.gov/providers

The NC Department of Health and Human Services (NC DHHS) has contracted MAXIMUS to serve as North Carolina’s independent Enrollment Broker. The Enrollment Broker is responsible for educating Medicaid members and enrolling Medicaid members into a Medicaid Prepaid Health Plan (PHP).

Q: How will Medicaid beneficiaries be enrolled into the Medicaid PHPs?

Current Medicaid beneficiaries will select a plan through NC’s independent Enrollment Broker. The Enrollment Broker will contact current Medicaid enrollees and assist them in selecting a Medicaid PHP and PCP.
New Medicaid enrollees will select their Medicaid PHP at application.
Medicaid beneficiaries who do not choose a Medicaid PHP will be auto-assigned to one. The NC DHHS is finalizing the algorithm for the auto-assignment process.
A member has 90 days after their enrollment effective date to change their PHP without cause.
At Medicaid redetermination a member can remain with their current PHP or change to a different PHP.

Q: How will members choose PCPs?

During Managed Care Open Enrollment, NC’s Enrollment Broker will help current Medicaid members select a PCP. If the member does not select a PCP they will be auto-assigned a PCP.
After Managed Care Open Enrollment, members will contact their PHP to change their PCP.
New Medicaid members will select their PCP at application. If they do not choose a PCP they will be auto-assigned a PCP.

Great tip sheets & tools for review:

Here is more information on enrollment including the auto-assignment process from Community Care Physician's Network (CCPN).
Here is a map of the regions, rollout dates, and AMH Tier statstics including number of beneficiaries.
And here is a tip sheet for what you can be doing today to prepare!

Managed care contracting
Here is a list of questions to consider before signing a contract.
Here is the contact list for each PHP.
*See learning opportunities below to sign up for a free "Contracts 101" webinar on May 2nd! A recording will be made available following the event.

Do you have questions about contracting with prepaid health plans as you transition to NC Medicaid Managed Care?

NC DHHS is hosting Meet and Greet sessions across the state, where you can meet with health plan representatives and ask specific questions about provider network participation and the transition to managed care. Health plans and NC Medicaid subject matter experts, including SEAHEC Practice Support team members will be on hand to respond to provider inquiries.

Attendance is free and registration is not required.
Come when you can; stay as long as you like.

SEAHEC
2511 Delaney Ave., Wilmington
Tuesday, May 21, 2019 | 12-3pm

MIPS 2019 - Promoting Interoperability (PI)

Throughout the year, we'll continue to reinforce how important it is to continually work on and monitor your progress for PI since it is much more challenging this year.

There are 4 objectives and 11 total measures, 2 of which are optional for bonus points. MIPS eligible clinicians will be scored based on their performance for each objective and related measure.

That is, the higher the percentage of achievement, the higher number of points earned.

The chart below shows how the points will be calculated based on performance. Note that 80% of the score will be based on performance in 2 of the 4 objectives: Health Information Exchange and Electronic Access To Health Information.

Cost accounts for 15% of the total MIPS score in 2019.

Here is more information on how cost is calculated and the importance of Hierarchical Condition Categories (HCC) coding.

Do you know about the complex patient bonus (up to 5 points)? This also ties in with your cost score. Be sure and check this out!

Medicaid Stage 3 Promoting Interoperability
Objective 5 - Patient Electronic Access

Did you know...
For Measure 1, eligible providers (EPs) must offer all four functionalities (view, download, transmit, and access through an Application Programming Interface or "API") to their patients, and PHI needs to be made available to each patient for view, download, and transmit within 48 hours of the information being available to the EP for each and every time that information is generated."

The "48 hour timer" for the information to be posted starts when the “information is available” to the EP.

For those of you who are BQPP participating practices and plan to submit your application/renewal this Spring, please note that the deadline is May 31st!
If any of you have questions related to your potential participation in the BCBS & Aledade ACO, which will impact your BQPP participation, please contact either Joy Simmons or Provider.APC@bcbsnc.com.

Since originally passed, the HIE Act has seen additional changes in two subsequent legislative sessions, and additional legislation has been introduced this session (HB70) that could impact connectivity requirements.

Many providers who fall under the June 1, 2019 connectivity deadline could be impacted by this legislation.You can find more information here.
Providers given an extension in 2018 who are not yet live, will automatically be given an additional extension of time to complete onboarding.

Learning Opportunities

Free webinar - Contracts 101 (primary care legal education)
May 2, 12:30-1:30
Have you been asked to review insurance payer, shared savings or ACO contracts lately? If the answer is yes, Greensboro and Northwest AHEC invite you to attend a 1-hour free webinar event featuring Heather Skelton ESQ. She will review common language that may be found in insurance payer, shared savings, or ACO contracts. For more information and to register, click here.

Advance Care Planning & The Annual Wellness Visit Lunch & Learn
May 23, 12:30-1pm (webinar) *rescheduled from April 24
The opportunity for advance care planning (ACP) in primary care is significant, especially during the Medicare Annual Wellness Visit (AWV). This webinar will review how to incorporate ACP into the AWV workflow and get reimbursed.
To learn more and to register, click here.

Safe Opioid Prescribing Guidelines for PAs & NPs
May 11, 9-11am at SEAHEC, 2511 Delaney Ave., Wilmington
The North Carolina Medical Board (NCMB) requires CME for all who prescribe opioids: "Beginning on July 1, 2017, a physician assistant who prescribes controlled substances shall complete at least two hours of CME from the required 50 hours, designed specifically to address controlled substance prescribing practices." Are you compliant with the current requirements? Are you prepared for the newest requirements starting January 2020? This free CME event will satisfy two hours of AMA PRA Category 1 Credit(s)TM on opioid prescribing required by the NCMB.
|or more information click here, and to register, click here.

Beyond the Opioid Epidemic: Putting Guidelines into Practice
May 21, 5:30-8pm, Hotel Ballast, 301 N. Water St., Wilmington
June 18, 5:30-8pm, Burgaw Train Depot, 115 S. Dickerson St., Burgaw
These evening education sessions will help providers educate their patients on new ways to view and manage their pain, explore tools and techniques for de-escalating patients seeking opioids, and offer solutions for implementing prescribing guidelines into their everyday workflow and practice.
To learn more and register for the Wilmington event, click here.
And click here to register for the event in Burgaw.

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