July 20 NCMGMA-NCMSF Free Webinar: Health Equity in Context

July Lunch & Learn Webinar
Health Equity in Context

Tuesday, July 20, 2021 | 12:00 PM – 1:00 PM EDT | Zoom

This presentation provides a foundational overview and educational outlook of the principles of health equity, health inequities, health disparities, and drivers and determinants of health. The historic and contemporary context of these issues and barriers help to shape much-needed discussions and conversations on eliminating barriers, sharing resources, and building trust.

Webinar Speaker

Cornell P. Wright, MPA
Executive Director
DHHS Office of Minority Health and Health Disparities

Cornell P. Wright, MPA, serves as the Executive Director of the DHHS Office of Minority Health and Health Disparities. He is a subject-matter expert around the areas of health equity and disparities, minority health, and community engagement.

Wright, an active member in the health community, serves various groups, organizations, and boards including the Patient-Centered Outcome Research Institute where he serves on the Clinical Effectiveness and Decision Science Advisory Panel, and the Southeastern Health Equity Council, as part of the National Partnership for Action to End Health Disparities, serving as the Co-Chair to the Social Determinants of Health Committee.

He has received awards and recognition for his contributions to health from the National Institutes of Health, Leukemia and Lymphoma Society, North Carolina Central University, and the National Minority Quality Forum.

Registration

This webinar is free but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.

Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.

Questions

For questions or more information please contact the NC Medical Society Foundation offices at ncmsfoundation@ncmedsoc.org.

NCDHHS Deploys 300 Free Testing Sites in Underserved Communities

The NC Department of Health and Human Services announced a new effort to deploy up to 300 free testing sites in underserved communities. This targeted testing initiative seeks to confront historical health disparities by increasing access to no-cost COVID-19 testing for African American, Latinx/Hispanic and American Indian communities across the state.

A disproportionately high percentage of North Carolina’s confirmed cases of COVID-19 have occurred among historically marginalized populations. Mounting evidence shows the members of these populations experience higher rates of COVID-19 mortality and serious complications.

As many as 300 temporary testing sites will be deployed throughout the month of July, including drive-thru and walk-up sites. The initiative will increase testing capacity in more than 100 ZIP codes, providing testing access for 2.2 million African American, Latinx/Hispanic and American Indian individuals. Two vendors have been identified to begin this work, Vidant Health and Orig3n, Inc.

The initiative emphasizes a community testing approach. The awarded vendors are required to connect individuals with medical homes and provide services with culturally and linguistically appropriate standards, working within existing trusted community partnerships; additionally, no payment from the individual will be needed for the testing. Insurance, if available, will be billed but no co-pays or cost-sharing will be asked of anyone seeking testing. Those who are uninsured will have full access to free testing at these sites.

Communities were selected based on low testing capacity and high African American, Latinx/Hispanic and/or American Indian populations. Higher concentration of elderly populations with multiple chronic conditions and higher rates of construction and seasonal farm work were also factors.

For more information on testing, please see the Frequently Asked Questions about Testing. For more information about North Carolina’s response to COVID-19, visit nc.gov/covid19.

 

Changes to Section 1557 nondiscrimination rule

On June 12, the Department of Health & Human Services (HHS) issued a final rule revising Affordable Care Act Section 1557’s nondiscrimination regulations. The final rule, which goes into effect on August 18, 2020, modifies certain policies and also eliminates the following requirements that existed under 2016 regulations:

  • The requirement for group practices and other covered entities to issue nondiscrimination notices and non-English taglines in the top-15 languages spoken by individuals with limited English proficiency in their state;
  • The requirement that each covered entity appoint a compliance director and adopt grievance procedures to handle complaints; and
  • Nondiscrimination protections based on sex stereotyping and gender identity.

MGMA frequently receives questions about language access requirements to provide translation/interpretation services and prepared an overview of changes under the 2020 rule. In our comments on the proposed version of the rule, MGMA urged HHS to establish a reimbursement mechanism for practices that care for individuals that require language assistance services. Although HHS responded that this recommendation was outside the scope of the 2020 rule, MGMA will continue to recommend that practices receive financial assistance or reimbursement to assist with these costs.

MGMA to HHS: Disburse remaining Provider Relief Funds

MGMA is urging the Department of Health & Human Services (HHS) to expeditiously provide financial relief to group practices by disbursing the remaining Provider Relief Funds. Congress appropriated $175 billion to HHS to deliver financial relief to healthcare providers in order to cover expenses and lost revenue attributable to COVID-19. HHS is making disbursements through a $50 billion General Distribution, however some providers that submitted applications for additional funding have yet to receive payments, despite applying over a month ago. MGMA is encouraging HHS to quickly deliver funds pursuant to those applications.

After accounting for disbursements to date, HHS still has approximately $95 billion in unallocated Provider Relief Funds. Since eligibility for payments under the $50 billion General Distribution was contingent upon Medicare enrollment, MGMA is urging HHS to support group practices underrepresented in this distribution, such as providers that do not accept Medicare.

Provider Relief Fund attestation deadline approaching

Group practices who received a payment from the Department of Health and Human Services (HHS) under the Provider Relief Fund must sign an attestation confirming receipt of funds and agreeing to conditions of payment within 45 days of payment. That means groups who received funding from the initial distribution on April 10 have until May 24 to attest. Notably, not returning the payment within 45 days of receipt will be viewed as acceptance of the funds and associated terms and conditions.

HHS also announced this week that providers have until June 3 to submit revenue information to be considered for an additional payment from the $50 billion general distribution. While HHS automatically disbursed payments from the first tranche ($30 billion) starting on April 10, most group practices must submit a request to receive additional funds from the second tranche ($20 billion).

Finally, HHS updated and clarified FAQs on the Provider Relief Fund general distribution. With the Department updating their FAQs and website periodically without any formal announcement or notification, MGMA recommends that group practices review this new guidance. See MGMA’s resource on financial relief programs for more information.

Join Us for Our April 21st Webinar on NC Medicaid’s Response to COVID-19

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NC Medicaid Response to COVID-19:
The State of Things

April 21, 2020 | 12:00 PM – 1:00 PM EDT

Join us on April 21st from 12:00 PM to 1:00 PM as Dr. Shannon Dowler, FAAFP, CPE, of the Department of Health and Human Services (DHHS), presents “NC Medicaid Response to COVID-19: The State of Things.”

Our Speaker

dowler1Dr. Shannon Dowler, FAAFP, CPE
Chief Medical Officer, North Carolina Medicaid
Department of Health and Human Services
Dr. Shannon Dowler, FAAFP, CPE, is the Chief Medical Officer for North Carolina Medicaid in the Department of Health and Human Services. Her past experience with Medicaid includes chairing the Physician Advisory Group for Medicaid (an independent legislated non-profit whose sole purpose is advising Medicaid on clinical policy) for several years. She is a Past President of the NC Academy of Family Physicians and recently completed a four-year term on AAFP and ACOG commissions. In 2017 she received her Certified Physician Executive degree from the American Academy of Physician Leaders.

Dr. Dowler obtained her medical degree from East Carolina (Brody) School of Medicine and completed a Family Medicine Residency and Fellowship in Asheville at MAHEC. She has spent her career in the service of non-profits in public and community health including: the local health department, providing full spectrum care (OB without deliveries) as well as a long standing role in the STD clinic; as CMO for a large FQHC in WNC; and most recently as Associate Chief Quality Officer and Chief of Community Medicine and Population Health for Mission Health System, focusing on integration of healthcare and reducing unnecessary care variation across a health system.

Registration

This webinar is complimentary but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.

Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.

Questions

For questions or more information please contact the NC Medical Society Foundation offices at ncmsfoundation@ncmedsoc.org; or by phone at 919-833-3836.

April 21st NCMGMA-NCMSF Webinar: NC Medicaid Response to COVID-19

NCMGMA-Webinar-Header3

NC Medicaid Response to COVID-19:
The State of Things

April 21, 2020 | 12:00 PM – 1:00 PM EDT

Join us on April 21st from 12:00 PM to 1:00 PM as Dr. Shannon Dowler, FAAFP, CPE, of the Department of Health and Human Services (DHHS), presents “NC Medicaid Response to COVID-19: The State of Things.”

Our Speaker

dowler1Dr. Shannon Dowler, FAAFP, CPE
Chief Medical Officer, North Carolina Medicaid
Department of Health and Human Services
Dr. Shannon Dowler, FAAFP, CPE, is the Chief Medical Officer for North Carolina Medicaid in the Department of Health and Human Services. Her past experience with Medicaid includes chairing the Physician Advisory Group for Medicaid (an independent legislated non-profit whose sole purpose is advising Medicaid on clinical policy) for several years. She is a Past President of the NC Academy of Family Physicians and recently completed a four-year term on AAFP and ACOG commissions. In 2017 she received her Certified Physician Executive degree from the American Academy of Physician Leaders.

Dr. Dowler obtained her medical degree from East Carolina (Brody) School of Medicine and completed a Family Medicine Residency and Fellowship in Asheville at MAHEC. She has spent her career in the service of non-profits in public and community health including: the local health department, providing full spectrum care (OB without deliveries) as well as a long standing role in the STD clinic; as CMO for a large FQHC in WNC; and most recently as Associate Chief Quality Officer and Chief of Community Medicine and Population Health for Mission Health System, focusing on integration of healthcare and reducing unnecessary care variation across a health system.

Registration

This webinar is complimentary but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.

Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.

Questions

For questions or more information please contact the NC Medical Society Foundation offices at ncmsfoundation@ncmedsoc.org; or by phone at 919-833-3836.

NCDHHS Suspends Implementation of Managed Care

Legislators Adjourn Without Taking Actions Required
for Medicaid Managed Care;
DHHS Suspends
Implementation of Managed Care Raleigh

The North Carolina Department of Health and Human Services today announced that because the NC General Assembly did not take needed action, managed care implementation and open enrollment for NC Medicaid must be suspended. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Managed care will not go live on Feb. 1, 2020.

With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the department. Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Behavioral health services will continue to be provided by Local Management Entities/Managed Care Organizations. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks.

Open enrollment had begun for part of the state in July and launched statewide in October. The North Carolina Enrollment Broker Call Center (833-870-5500) will stay open through Dec. 13, 2019 to answer questions but will no longer enroll beneficiaries in a health plan. Beneficiaries can continue to contact the Medicaid Contact Center (888-245-0179). Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans.

The suspension of work and the wind-down process will begin tomorrow. Once suspended, managed care cannot easily or quickly be restarted. The department will not decide on a new go-live date until it has program authority within a budget that protects the health and safety of North Carolinians and supports the department’s ability to provide critical oversight and accountability of managed care.

Both the conference and transformation mini budgets passed during this year’s legislative session and vetoed by Governor Roy Cooper left the department vulnerable to an unprecedented cut that would have had a crippling effect on its ability to provide services that protect people’s health and safety and moved the department out of Raleigh to Granville County. In addition, neither expanded Medicaid so that hardworking North Carolinians could afford access to health coverage.

Background
In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. The department was on track to go live Feb. 1, 2020. New funding and program authority was required from the General Assembly to meet this timeline. 

View Press Release

DHHS Support Due to Hurricane Dorian

The Department of Health and Human Services is committed to ensuring beneficiaries and health care professionals can continue receiving and providing services during Hurricane Dorian. On Sept. 4, 2019, the Department received federal authority to make temporary changes to some Medicaid services and processes that will make it easier for beneficiaries to get the services they need.

Below are highlights of the temporary flexibilities and other special procedures in place now due to Hurricane Dorian. IMPORTANT: Please read the Sept. 5, 2019, Medicaid Special Bulletin for details about effective dates, re-evaluation timing, provisions and processes.

  • Reimbursement for medically necessary services. NC Medicaid will reimburse providers for medically necessary drugs and services, and equipment and supplies, provided during the Hurricane Dorian emergency without prior approval from Sept. 4-11, 2019.
  • NC Health Choice flexibilities. NC Health Choice flexibilities are temporarily added to several key policies and procedures through Nov. 3, 2019.
  • Innovations waiver flexibilities. Approved Innovations waiver flexibilities includes temporarily exceeding certain time and benefit limits; postponement or relaxation of timing for annual reassessments, service plan approvals and face-to-face meetings; and no prior approval for services provided out-of-state. Please note: Innovations waiver flexibilities have specific uses and circumstances, and are time limited. Please refer to the Medicaid Special Bulletin for details.
  • Behavioral health services are available. Anyone in need of or receiving behavioral health care who are uninsured or are a Medicaid beneficiary can access care by calling their regional behavioral health Local Management Entity/Managed Care Organization (LME/MCO). They can also call the Disaster Distress Helpline at 1-800-985-5990. It is available year-round, 24 hours a day, seven days a week to provide immediate crisis counseling for people who are experiencing emotional distress related to natural or human-caused disasters.
  • CAP/C and CAP/DA emergency and disaster plan activation. Preparation steps, coordination and reporting for case management entities to serve CAP/C and CAP/DA beneficiaries.
  • Medication prior approval and prescription refills. Pharmacy providers are approved to override prior approval requirements and to early fill medications effective Sept. 3, during the Governor’s state of emergency order.
  • Medications for HIV shipped early. Walgreens shipped medications for HIV early to patients living in coastal communities. They are also authorized to fill emergency prescriptions.
  • Medication assisted treatment is available. Individuals receiving medication assisted treatment from an opioid treatment program may take home additional doses for treatment or receive guest-dosing at another licensed opioid treatment program. Other locations can be found in the Central Registry.
  • Shelters have naloxone. Naloxone for opioid-related overdose was sent to shelters today.
  • Shelter for medically fragile patients is open. A 50-bed State Medical Support Shelter (SMSS) for medically fragile patients is now open in Clayton. Individuals who need active monitoring, management or intervention from a medical professional to maintain their health must contact their county emergency management office to request placement in the SMSS.
  • Shelters are accessible and supportive of those with behavioral illnesses or intellectual and developmental disabilities. DHHS is working with its partners so that shelters have, for example, calming rooms to support individuals with autism or other disabilities, when a congregant setting may not be conducive for their wellbeing.
  • Food benefits will be available early for WIC participants. In addition, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants in storm-affected counties who were scheduled to receive their benefits should have had those benefits automatically added to their eWIC card by their local WIC agency. WIC participants can confirm that benefits have been added by calling the eWIC customer service line at 844-230-0813 or by accessing their account at www.mybnft.com. This automatic renewal will continue through the weekend in storm-affected counties.
  • Critical access hospital bed limits. The limit of 25 beds is lifted Sept. 4-11, 2019.
  • Nursing home admissions. Temporary PASSR procedures are not required for new admissions for 30 days, and transfers between nursing facilities due to Hurricane Dorian will not require a PASSR. Also, from Sept. 4-11, 2019, the 3-day qualifying hospital stay requirement is waived for beneficiaries how requires a short-term stay in a nursing facility due to Hurricane Dorian.
  • Health care professionals not enrolled as an NC Medicaid provider. Providers not enrolled in NC Medicaid can apply to temporarily provide service to Medicaid beneficiaries through an expedited process.
  • Personal care services. Assessments scheduled Sept. 4-6 in certain counties have been cancelled. A list of counties is available in the Medicaid Special Bulletin. An expedited assessment process may be available for evacuees placed in an Adult Care Home by DSS due to shelter needs.
  • Durable medical equipment replacement. Documentation that will be accepted for equipment loss or damage due to Hurricane Dorian.

The Department is in the process of:

  • Recruiting volunteer teams of Environmental Health Specialists (EHSs) to come into storm-impacted counties to conduct inspections of restaurants, other food establishments, private septic systems and private drinking wells so that they can quickly return to normal operations.
  • Securing assistive technology devices and equipment to help individuals who are displaced due to the storm or who have devices or equipment that is destroyed or lost.Updates will be shared as they become available. In addition to messages like this one, information will be delivered through Medicaid Hurricane Dorian webpage posts, future Medicaid Special Bulletins on the Medicaid website, NCTracks Provider Portal posts and NCTracks Alert emails.

Resources

Medicaid Transformation Update – Open Enrollment Extension

The Department of Health and Human Services (DHHS) announced today that it will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on February 1, 2020.

Managed care in North Carolina was scheduled to roll out in two phases, with Medicaid beneficiaries in part of the state beginning managed care services on November 1, 2019, and most of the state beginning on February 1, 2020. With today’s announcement, managed care will now go-live in one phase for the whole state beginning on February 1, 2020.

The timeline has been adjusted because DHHS cannot implement critical actions to go-live with managed care under the current continuing resolution budget. The updated timeline only impacts counties that were in Phase 1; it does not impact counties that were scheduled for Phase 2. The date of February 1, 2020 for statewide implementation remains unchanged.

Why does DHHS need to revise the timeline for Managed Care?

The transition to managed care is the most significant change ever undertaken by NC Medicaid. For the past four years, the Department has achieved significant milestones to keep the state on track for launch of the program.

The next set of activities that must be implemented depend upon budget action, including finalizing the rates to pay health plans and providers, ensuring health plans have enough providers in their networks to meet the needs of beneficiaries, deploying a complex algorithm to assign beneficiaries who do not self-select plans and doctors, and obtaining federal approval to launch. Since July, DHHS has advised its partners and the General Assembly that the timing of the budget would impact the state’s schedule for moving to managed care.

Furthermore, ongoing budget uncertainty has been an impediment to health plans finalizing contracts with doctors and health providers. An essential component of a well running managed care system is the strength of the health care network available to beneficiaries.

What will happen next for those beneficiaries and clinical providers who had been planning to launch in November?

The Department remains committed to transitioning Medicaid and NC Health Choice from fee-for-service to managed care as directed by the NC General Assembly (Session Law 2015-245). DHHS will continue to move forward with activities that are not tied to budget action, including supporting open enrollment.

Managed care will now launch in one phase. Open enrollment will be extended for the 27 counties in Regions 2 and 4 until December 13, 2019. Nothing changes for the remaining 73 counties. As planned, open enrollment will begin for those 73 counties on October 14, 2019 and run through December 13, 2019.

All stakeholders should continue to work towards the February 1, 2020 implementation date. It is critical that the managed care companies (PHPs) and doctors and health systems continue to work together on contracting.

The 27 counties where open enrollment will be extended include: Alamance, Alleghany, Ashe, Caswell, Chatham, Durham, Davidson, Davie, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson and Yadkin counties.