Update on Alliance Health’s COVID-19 Response Initiatives

Alliance Health recognizes the ongoing stress that the COVID-19 pandemic has created for our members and their families, our providers, and our communities across our four-county service area (Durham, Wake, Cumberland, and Johnston). Social isolation, loss of routine, and amplified stress associated with in-person school closures, employment uncertainty, and financial concerns present significant risks for individuals already experiencing behavioral health conditions and these circumstances have increased incidents of depression, anxiety, and substance use disorders (SUDs) in our state and across the country.

During this challenging time, it is more critical than ever to sustain and strengthen a behavioral healthcare system to ensure that it is robust and accessible.  We know that people can and do recover from mental illness and SUDs provided they can access the proper treatment. Additionally, promoting stability for individuals with intellectual/developmental disabilities (IDD) and others in their homes and communities of their choice is integral to positive health outcomes and living a full life. Thanks to recent funding made available to Alliance Health by the North Carolina General Assembly, the Governor, and the NC Department of Health and Human Services, Alliance has been able to make significant investments to ensure the availability of local services and supports in our communities.

Considering the increased costs to deliver services during the pandemic, Alliance has committed to both ongoing and new rate increases for certain providers through the remainder of the year. These rate increases are designed to stabilize front-line providers by helping offset their extra costs and time related to obtaining and using personal protective equipment (PPE), high-risk pay for staff working in residential facilities, overtime expenses, and higher pay rates to retain and recruit direct care professional and clinicians. These initiatives, coupled with previous financial stability payments made by Alliance during the initial days of the COVID emergency, have enabled our dedicated provider network to continue to serve members in their care and remain accessible for those newly in need of behavioral health services.

In addition to boosting rates to providers, Alliance is making investments in several key areas to enhance access to much-needed services for our members in their home communities.  These investments include:

  • Developing an array of specialized services to help ensure that individuals who have received inpatient or crisis services are able to link directly with community-based treatment once they are discharged from a facility or residential program. For example, Alliance has partnered with a local community-based behavioral health provider to implement a Peer Bridging Program.  This program enables individuals that are receiving detoxification services from a local crisis provider to meet and engage with a person with similar life experience. These peers provide the individuals with ongoing support and links to other needed services upon discharge.
  • Renovating and starting up a new child crisis center in Wake County to serve youth and families across our four-county region. This facility for children and teens ages 6-17 will include behavioral health urgent care services to address emergency department overcrowding, walk-in access to same-day clinical assessments, psychiatric evaluations, necessary medications, and 24/7 access to assessment, stabilization, and treatment planning.
  • Expanding options for individuals with IDD to live in their home communities. Alliance is designing and funding individualized residential and support services for people who were previously living in an institutional setting.
  • Creating new independent living options for individuals with serious mental illness including a specialized professionally-supported transitional living program that helps adults acquire independent living skills and make the adjustment from receiving treatment in a state hospital to living in the setting of their choice.
  • Local residential service options for individuals with traumatic brain injury.

Making sure that our healthcare system can meet community behavioral health and IDD service needs is crucial now and in the months and years ahead as we deal with the immediate and longer-term impacts of COVID-19. Alliance is committed to continuing to work together with our providers to adapt and innovate in order to effectively serve our members and their families throughout the pandemic and beyond.

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Check Out the October Alliance Health InTouch Newsletter

The latest edition of the Alliance InTouch newsletter is now available! Stay “in touch” with what is going on at Alliance and the important work we do to deliver the best care to the people we serve.

Read the Alliance InTouch newsletter.

Alliance Launches New Bridge Housing Program

Alliance Health’s Community Health and Well-Being team recently launched a new bridge housing program in Durham to help people we serve who are living in homelessness transition to permanent supportive housing.

The initiative provides housing, case management, support and referral services for people exiting homelessness to help them move toward self-sufficiency. Alliance aims to help people transition to permanent supportive housing in three to five months.

The new program, which began in August, is similar to one that Alliance operated in partnership with Resources for Human Development at Harrington Place in Raleigh, where most participants were able to move into permanent housing within 90 days. That program was forced to close when the building was sold to a developer who terminated the lease.

“One of the things that we like about bridge housing is the basic concept of giving people a safe and temporary place to live while they get the services and support they need to move toward permanent housing,” said Ann Oshel, Alliance Senior Vice President, Community Health and Well-Being. “It’s better and easier than trying to do that while someone is living under an overpass.”

The bridge housing is located at the Carolina Duke Inn, where Alliance has a master lease on 8 units in one of the buildings. Through a capital investment project, the rooms have been reconfigured into single-room occupancy dwellings with kitchenettes.

The initiative is in partnership with Durham community development organization Reinvestment Partners, which provides onsite management, and Southlight Healthcare, which provides peer support.

Individuals are referred to the program and supported by Assertive Community Treatment (ACT) or Community Support Team (CST) providers or Alliance’s Transitions to Community Living Initiative (TCLI) team, which provide primary supports to participants. The program is available to people in the Alliance service area of Cumberland, Durham, Johnston and Wake counties.

“We are in the process of developing an array of community living options, and bridge housing is an important step in this array,” Oshel said. “This type of program, which matches case management and peer support to help people to find benefits and employment and to navigate a housing search is really one of the best housing interventions we can offer to help people leave homelessness.”

Oshel said that struggles in the hotel industry as a result of the COVID-19 pandemic provided the opportunity for the initiative. “I’m convinced we would not have had this opportunity had it not been for COVID, so it’s a little bit of a silver lining.”

The current lease at Carolina Duke is for two years, during which time Oshel hopes to find a permanent location to continue and improve the program, as well as a funding model that would support the option in all communities served by Alliance.

A Fresh Approach to Residential Support

Alliance is working towards a recovery-focused system of stakeholders and supports collaborating to provide an effective network of resources for community members and families experiencing emotional distress and disability-related needs, so they can heal, have hope for the future, and live personally meaningful lives. A new series of six Alliance training videos called “Changing Hearts and Minds” shares basic tools needed to support the people we partner with our provider network to serve with the dignity and respect they deserve, to improve our communities by allowing them to experience all of their citizens’ different gifts, and to have inclusive neighborhoods that embrace the value of every member.

SlowCOVIDNC App Available

The North Carolina Department of Health and Human Services has launched a COVID-19 Exposure Notification app called SlowCOVIDNC. The app will help North Carolinians slow the spread of the virus by alerting them when they may have been exposed to someone who has tested positive for COVID-19. It is completely anonymous and does not collect, store or share personal information or location data. We hope you will share this announcement with your networks and encourage people to download the app. The more people that use the app, the better it works.

SlowCOVIDNC leverages Google and Apple’s Exposure Notification System (ENS) to alert users who have the app if they have been in close contact with an individual who later tests positive for COVID-19. It is voluntary to download and use and designed to enhance the state’s existing contact tracing efforts. The app completed Beta testing earlier this month and can now be downloaded for free through the Apple App Store and the Google Play Store. The app is available in English and Spanish.

Here’s how SlowCOVIDNC will work:

  1. Download the free SlowCOVIDNC Exposure Notification app from the Apple App Store or Google Play Store and enable Bluetooth and Exposure Notifications. Bluetooth must be on for the app to work.
  2. After opting-in to receive notifications, the app will generate an anonymous token for the device. A token is a string of random letters and numbers which changes every 10-20 minutes and is never linked to identity or location. This protects app user privacy and security.
  3. Through Bluetooth, phones with the SlowCOVIDNC app work in the background (minimizing battery) to exchange these anonymous tokens every few minutes. Phones record how long they are near each other and the Bluetooth signal strength of their exchanges in order to estimate distance.
  4. If an app user tests positive for COVID-19, the individual may obtain a unique PIN to submit in the app. This voluntary and anonymous reporting notifies others who have downloaded the app that they may have been in close contact with someone in the last 14 days who has tested positive.
  5. PINs will be provided to app users who receive a positive COVID-19 test result through a web-based PIN Portal, by contacting the Community Care of North Carolina call center, or by contacting their Local Health Department.
  6. SlowCOVIDNC periodically downloads tokens from the server from the devices of users who have anonymously reported a positive test. Phones then use records of the signal strength and duration of exposures with those tokens to calculate risk and determine if an app user has met a threshold to receive an exposure notification.

To learn more about SlowCOVIDNC and to download the app, visit covid19.ncdhhs.gov/slowcovidnc, which also includes an FAQ.

Alliance Offers Home-delivered Meals to Innovations and TBI Waiver Members

Under North Carolina’s emergency modifications to Innovations and TBI Waiver services, Alliance is now offering members in those programs home-delivered meals to address food insecurities during the COVID-19 pandemic.

The service is available within the Alliance service area for both Innovations and TBI Waiver members living in their own home or with family. It offers members up to two meals per day, seven days a week. Members can choose which two meals they want from a broad menu of breakfast, lunch or dinner meals.

The home-delivered meals are intended to help ensure that members have access to nutritious food regardless of other family hardships. Alliance LTS Supervisor Keshia Bunch said many members and their families may be experiencing food insecurity as a result of uncertainties brought on by the pandemic. “Any financial impact that they may have experienced as a family could result in food insecurity,” she said. “We may have waiver recipients who have brothers and sisters who used to attend school and now they’re at home, so they may be eating more and putting a heavier burden on the family in terms of food.”

The meals are provided by a vendor, Mom’s Meals®, which delivers refrigerated meals nationwide and can provide meals tailored to meet the needs of common medical conditions, like diabetes, kidney problems, cancer and heart disease.

The service is made available by temporary changes to the waivers through Section 1915 (c) waiver Appendix K, which states may use to ensure that current home and community-based services enrollees continue to receive needed services, support providers, and cover additional people during the emergency. Currently, the flexibilities allowed by Appendix K will remain in place until March 2021.

Alliance members receiving Innovations or TBI Waiver services should speak with their Care Navigators if they are interested in learning more about this service.

Please click here for more information about the home-delivered meals.

Child Crisis Center Plans Back on Track

Alliance Health CEO Rob Robinson announced recently a resumption in the renovation and start-up of our Child Crisis Center, a new child facility-based crisis and urgent care center in Fuquay-Varina to serve youth and families across the four-county Alliance region. The Child Crisis Center has long been a priority component of our multi-year comprehensive reinvestment plan. Lack of this option in our service continuum has resulted in children sitting unnecessarily in emergency departments when many could be diverted and assessed in the more clinically-appropriate environment this facility will provide.

Work on the facility had to be suspended last year due to continued cuts to state single-stream funding. The cumulative impact of these ongoing funding reductions significantly reduced our ability to complete planned reinvestment projects because we had to use savings initially designated for reinvestment to meet service obligations. Thanks to no new single-stream funding cuts this year as well as additional funding for behavioral health and crisis services, Alliance is now in a position to resume the renovation project with a targeted completion date of the second half of 2021 in support of North Carolina’s Medicaid transformation “go-live.”

The 16-bed crisis facility for children and teens ages 6-17 includes behavioral health urgent care services to address emergency department overcrowding, walk-in access to same-day clinical assessments, psychiatric evaluations, necessary medications, and 24/7 access to assessment, stabilization, and treatment planning. No young person will be turned away while in crisis, regardless of insurer or ability to pay.

“The Child Crisis Center will significantly improve access to behavioral healthcare in North Carolina’s fastest growing region by providing children and teens experiencing crisis with a supportive, caring place designed and equipped to respond to their unique needs in a safe environment,” Robinson said.

NC Broadband Survey

The North Carolina Broadband Survey is designed to gather information on locations in the state without adequate internet access and speeds. The information gathered from the survey will provide clear data to guide investment of funds through the state’s Growing Rural Economies with Access to Technology grant program, inform research and policy recommendations, and support strategic targeting of additional funding streams. The survey takes about five minutes to complete and is available in both English and Spanish. Take the survey.

Raising Our Voice to Support Those in Need 

Alliance Health has joined with other Medicaid health plans across the country to encourage the U.S. Congress to increase its support of low-income Americans and the health systems that serve them. We seek to ensure that these same individuals and families, often from low-income communities of color, receive access to the health care they need and deserve during the COVID-19 pandemic and beyond. See the letter sent to Congress below.


Dear Leaders:

The undersigned managed care organizations serve over 17.5 million Medicaid beneficiaries throughout the nation.  We applaud the efforts of Congress to date to support low-income Americans and the health systems that serve them during the COVID-19 pandemic. We write now to encourage you to take additional needed actions to ensure these same individuals, often from low-income communities of color, continue to receive access to the health care they need and deserve.

As a result of the extraordinary consequences of the national emergency, the impacts of the pandemic are expected to increase Medicaid enrollment throughout the country, further straining every state’s budget over the next two years, if not longer.

During the financial crisis of 2008-2011, the 2009 American Recovery and Reinvestment Act (ARRA) provided for $98 billion in much-needed direct fiscal relief over the two-and-a half-year period. We believe that the following steps, taken in concert, will help Managed Care Organizations, Medicaid beneficiaries, and safety net plans across the country maintain stability during this recession.

Stable Medicaid Funding

Increase the federal share of Medicaid spending and commit to at least a two-year period of federal Medicaid funding for states. 

Because of the pandemic, states will experience large declines in revenue just as the need for services, including Medicaid, will significantly increase, resulting in large budget gaps. Not surprisingly, states are already estimating significant revenue declines and unemployment estimates that could easily exceed those experienced during the last recession.

Based on analysis of the provisions included in ARRA to fund a temporary increase in the federal share of Medicaid costs, as well as Medicaid enrollment trends, we calculated an inflation-adjusted, per-enrollee amount of funding currently needed. We then applied this to recent estimates from Health Management Associates (HMA) that predict a national increase in Medicaid enrollment from the current 71 million beneficiaries to 82 to 94 million beneficiaries as a result of growth in unemployment[i].  We found that between $167.6 and $192.1 billion in funding is needed to sustain the Medicaid program at the current level in the midst of the pandemic and the resulting recession.

The national health crisis also will increase demands on Medicaid utilization. By picking up a larger share of the costs of Medicaid, the federal government can make sure that state budget decisions do not constrain the health response needed by the states to address the pandemic. It will also ensure that increased Medicaid costs do not force states to cut spending in other areas (e.g., education or public safety) in ways that could contribute to a further economic downturn or even cause a delay of economic recovery.

Medicaid Fiscal Accountability Proposed Rule

Suspend the proposed Medicaid Fiscal Accountability Proposed Rule (MFAR) during the COVID-19 pandemic, and wait for further analysis from the Centers for Medicare & Medicaid Services to understand the devastating impact MFAR will have on millions of Americans.

In November 2019, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Fiscal Accountability Proposed Rule (MFAR), which would reduce the amount of funding provided to states as part of their Medicaid matching funds when the funding is generated through various supplemental means (e.g., provider taxes, intergovernmental transfers).  Many states use supplemental funding mechanisms to provide the non-federal share of some of its Medicaid funding.

MFAR must not be finalized during the pandemic. Due to the devastating financial impact on states that the Rule would have, we contend the proposed rule be suspended until more analysis is done by CMS. It is vital that the policy and financial impact the proposed rule would have on states and in particular, the Medicaid delivery system and beneficiaries be fully understood.  Moving forward without this information is dangerous to the efficiency and operation of any Medicaid program, and it jeopardizes beneficiary services. Prior to the pandemic, it was estimated that the enactment of MFAR would cause millions of patients to lose access to care in public health care systems alone, and it was projected that many public health care systems would not be financially stable and thus would have to close.

For nearly all states, the reductions that would result from MFAR would unquestionably mean cuts in Medicaid program enrollment and services. The impact in some states could be catastrophic on state Medicaid funding and ultimately reduce access to critically needed health services for Medicaid beneficiaries.

Telehealth Services

Advance telehealth and telephonic policies and payment reform in both the Medicaid and Medicare programs that expanded access to critically needed care to hundreds of thousands of patients. 

Under your leadership, the pandemic response packages have made important strides toward ensuring patients can access covered services via telehealth technology. In part, because of these regulatory and statutory changes, telehealth usage has increased significantly. Although provider visits dropped dramatically at the beginning of the stay-at-home orders, the quick conversion to telehealth visits allowed providers, particularly health centers, to rebound quickly – keeping providers and their office staff safe and leaving no gap in care. The increased use of telehealth has proven to be key in limiting the spread of the virus by keeping people at home, when appropriate, and providing access to those with mobility issues.

It is important that patients do not lose access to telehealth services after the pandemic ends and to ensure our nation is truly prepared for any future public health emergencies. We encourage Congress to advance telehealth policies and payment reform in both the Medicaid and Medicare programs. Properly designed programs will promote access to care while still offering quality assurances and protections from Fraud, Waste and Abuse.    It is also evident that telehealth has removed barriers to treatment for our members, especially in behavioral health.

Suspend Implementation of the Public Charge Rule

Fully suspend the Public Charge Rule (Rule) until the COVD-19 emergency has subsided. 

On February 23, 2020, the U.S. Supreme Court removed the remaining Public Charge injunctions, allowing the policy to go into full effect on February 24, 2020.  The Public Charge rule makes legal immigrants who receive non-cash public benefits, such as Medicaid, food assistance, and housing assistance, potentially ineligible for green cards and visas. Although on July 29th, a federal district judge issued a nationwide injunction preventing the Administration from implementing, enforcing, or applying the Public Charge Rule during the pandemic, we are still requesting congressional action.

Not surprisingly, the Rule has created an environment of fear throughout immigrant communities who were already wary of accessing health care coverage, long before the Rule went into place. In December 2018, the Urban Institute conducted a survey on non-elderly adults in immigrant families and found that one in seven did not participate in non-cash government benefit programs because of their fear it would impact their green card application.

As an effective public health response, it is vital that the federal government fully suspend the Rule for the duration of the emergency, at a minimum.

Presumptive Eligibility

Extend Presumptive Eligibility (PE) to all applicants that appear to be Medicaid eligible (based on initial income screening by a qualified entity); expand the types of entities qualified to perform PE screening; allow qualified entities to utilize online/telephonic applications and online/telephonic signatures for PE applications; and disallow any maximum limitation amounts that would prohibit a person from applying for PE more than once in a twelve-month period. 

Presumptive Eligibility (PE) is a Medicaid policy option allowing states to authorize specific types of entities (e.g., federally qualified health centers, hospitals, and schools) to screen eligibility based on income and temporarily enroll them in Medicaid coverage while their full enrollment application is being considered. The goal of PE is to provide short-term coverage of health care services for those who appear to be eligible for Medicaid but are not currently enrolled. This allows those individuals to receive much needed medical care while they complete the full Medicaid application and counties to conduct the enrollment process. The expected influx of Medicaid applications could prove challenging for counties to process in a timely manner. Thus, we are asking that the federal government allow PE for a period of 90 days while counties and the Medicaid applicants complete the enrollment process, and allow for extensions if counties are experiencing delays in processing Medicaid applications.

As managed care plans, we are prepared to provide expertise, data and ideas as you consider various issues to be addressed in the next relief package.  We stand ready to work with you to craft solutions that will ensure the solvency of the Medicaid program during and after this national emergency. These are trying and uncertain times for all Americans, and more so for our most vulnerable. Taking the above steps will result in better health care outcomes for the vulnerable members of our communities and for the nation as a whole.

[i] https://www.healthmanagement.com/wp-content/uploads/HMA-Estimates-of-COVID-Impact-on-Coverage-public-version-for-April-3-830-CT.pdf

 

Sincerely,

Alameda Alliance for Health

Aloha Care

Alliance Health

AmeriHealth Caritas

Amida Care

Blue Shield of California Promise Health Plan

CalOptima

CalViva Health

CareOregon

CenCal Health

Central California Alliance for Health

Children’s Community Health Plan

Communitycare Plan

Community Health Group

Community Health Plan of Washington

Contra Costa Health Plan

County Care/Cook County Health Plan Services

Gold Coast Health Plan

Healthfirst

Health Net of California & California Health and Wellness

Health Plan of San Mateo

Health Plan of San Joaquin

Inland Empire Health Plan

Kern Health Systems

L.A. Care Health Plan

MetroPlus Health

Partnership Healthplan of California

San Francisco Health Plan

Santa Clara Family Health Plan

UPMC For You

Virginia Premier

Alliance Health Initiates Digital Communications to Improve Member Health

Over the next several months, Alliance Health will be piloting the use of digital communication channels, primarily secure texting, to better engage members about their healthcare needs. This is a population health strategy that focuses on improving health literacy and provides education and outreach to our members. Members may receive text messages related to tobacco cessation resources, medication adherence, and/or the importance of following up with their primary care physician about recommended healthcare screenings and preventative care.

This week members on antipsychotic medications for the treatment of schizophrenia will begin to receive information about the importance of medication as part of their treatment. Members will receive several similar reminders in the coming weeks. All reminders to members will include a statement to call their doctor with any questions. These reminders may increase the number of calls from our members to their treating providers.

Beginning next week, Alliance will be launching a similar direct-to-member campaign that provides our members who are prescribed antipsychotic medications with reminders about the importance of routine follow-up with their doctors for blood sugar monitoring and other routine lab work.