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Implementation of Managed Care Suspended

NC DHHS shared its plan yesterday to suspend implementation of Medicaid managed care due to the continuing state budget impasse. Alliance has been informed by DHHS that the Tailored Plan Request for Application (the procurement process for the Tailored Plan) remains on schedule for release in February 2020. Access the DHHS statement.

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“Microaggression as an Ethical Issue in Clinical Practice” Training Scheduled

Microaggressions have been defined as brief everyday exchanges, often unintentional and automatic, that send negative messages to individuals because of their group membership (e.g., due to race, gender, sexual orientation, age, disability). This training will:

  • Describe and review microaggressions across a spectrum of differences (e.g., race, gender, sexual orientation);
  • Discuss sections of major clinical codes of ethics relevant to the importance of understanding and attending to microaggressions;
  • Identify the benefits of becoming more attentive to microaggressions occurring in the therapeutic setting; and
  • Discuss possible strategies for creating a greater awareness of microaggression as clinicians and possible responses when the clinician has engaged in a microaggression.

December 11, 2019
Registration: 8:30 am, Program: 9 am to 1:15 pm
5200 W Paramount Parkway, Morrisville, NC 27560
Registration restricted to Alliance Health staff and providers. Registration is $20 for Alliance providers; free for Alliance Health staff.

Click on or copy and paste this link:
Sign in with your MyAHEC account. Don’t have one, or not sure? Call us first!
To register, complete this form and  email to: [email protected].

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Person-Centered Planning – Crisis Intervention Training Scheduled

This  3½ -hour supplemental training focuses on the instructional elements of completing a Person-Centered Plan and the Crisis Plan, including the Comprehensive Crisis Plan. This training will address the core elements of the Person-Centered Plan document, the new elements in the crisis plan, and Alliance’s expectations for communicating with crisis facilities, as well as provide an overview of Alliance’s PCP review process. Representatives from local crisis facilities will be present to provide an overview of their facilities and facilitate discussions about collaborating on consumer crisis plans.

Thursday, December 5, 2019
Registration: 8:30 am,
Program: 9 am  to 12:45 pm
5200 Paramount Parkway, Suite 200, Morrisville, NC 27560.

Registration restricted to Alliance Health staff and providers. To register, please complete and send this form to [email protected].

Changes to Medicaid-Funded Peer Support

Effective November 1, 2019, Peer Support Services will be available in the Medicaid B Benefit Plan. Peer Support will not be offered as a B3 Service.

The new codes for this service are:

  • H0038-Peer Supports Individual
  • H0038 HQ-Peer Supports Group

The following codes will be discontinued as of October 31, 2019:

  • H0038 HQU4
  • H0038 U4

Providers will receive a contract amendment to reflect the current codes.

The new codes are in the process of being set up in Alpha-please hold billing in order to reduce denials, until you receive notification the new codes are set up in Alpha.

The rates for the service are:

  • H0038 $11.97
  • H0038HQ $2.88

Clinical Coverage Policy 8G and Alliance’s Benefit Plan indicate that:

  • The program is under the direction of a full-time Qualified Professional (QP).
  • Maximum program staff ratios are the following: QP to Certified Peer Support Specialist (CPSS) is 1:8; CPSS to beneficiary is 1:15; CPSS Group Facilitator to beneficiary is 1:12 for Peer Support Group.
  • The Peer Support Specialist must be certified by the NC Peer Support Specialist Certification Program.
  • By November 1, 2020 achieve national accreditation with at least one of the designated accrediting agencies.
  • Beneficiaries are eligible for 24 unmanaged units once per episode of care in a state fiscal year.
  • Prior approval is required for Peer Support Services provided beyond the unmanaged unit limitation.
  • A service order must be signed by a physician or other licensed clinician, per his or her scope of practice, prior to or on the first day service is rendered.
  • A Comprehensive Clinical Assessment is required to determine medical necessity of service prior to initial authorization request.
  • Clinical information must be obtained and documented in the beneficiary’s Person-Centered Plan prior to initial authorization request.
  • Peer Support may be provided in the beneficiary’s place of residence, community, in an emergency department or in an office setting.
  • Peer Support is not a first responder service. Peer Support service providers shall coordinate with other service providers to ensure “first responder” coverage and crisis response.
  • Active authorizations that cross over 11/1/19 will be transferred by the Utilization Management Department. The remaining days and units, will transferred under the new code for Peer Support Services. Providers will not need to submit SARs for this action. Concurrent authorizations after this process will need to be submitted by the provider for a MN review by the Utilization Management Department. Please refer to benefit plan and Clinical Coverage Policy 8G for authorization guidelines.
  • Utilization Management will require a CCA and PCP to be submitted for Medical Necessity review for initial authorization after the use of unmanaged units. Providers may request up to 270 units per 90 days Initial Authorization and up to 270 units per 90 days during subsequent reauthorization periods, if medically necessary. Additional units may be authorized if clinically appropriate.

Community Forums to Focus on Upcoming Changes

There will be several community forums in the Alliance service area focusing on new laws and policies that will impact our communities. Sponsored by each community’s Consumer and Family Advisory Committee (CFAC) and Community Collaborative in partnership with Alliance Health,the forums will discuss Medicaid Transformation, Rylan’s Law, Family First Prevention Services Act, and Raise the Age.

Representatives from private health plans participating the new Standard Plans and other community partners will be in attendance at the events.

Following are the dates and times for each community’s event:

Cumberland County
Wednesday, November 20, 2019, 5:30pm
Cumberland County DSS, 1225 Ramsey Street, Fayetteville, NC, 28301.

Johnston County
Saturday, December 7, 2019, 10am – 1pm
Johnston Medical Mall, 514 N. Brightleaf Blvd., Smithfield, NC 27577.

Wake County
Tuesday, December 10, 2019, 4-6:30 pm
Healing Transitions, 1251 Goode Street, Raleigh, NC 27603.

Durham County
Thursday, December 12, 2019, 5:30-7:30pm
Nehemiah Christian Center, 514 N Mangum St, Durham, NC 27701


Mandatory E-Prescribing of Targeted Controlled Substances

This is a reminder that the STOP Act mandates that all prescriptions for targeted controlled substances – a designation that includes all Schedule II and Schedule III opioids and narcotics – that are issued on or after January 1, 2020, be e-prescribed. Learn more.

Alliance Health Claims Technical Assistance Available

Challenged with denied claims and not sure how to correct? Struggling to utilize AlphaMCS for claims submission or denial management? Alliance Health offers Claims Technical Assistance sessions each Tuesday morning from 9:30 am to noon. These are individualized sessions for providers to meet with an experienced Claims Research Analyst for assistance with claims submissions, AlphaMCS, denial management, and any Alliance Health claims-related issue you may be experiencing.

Providers may contact their assigned Claims Research Analyst or the general Claims queue (919-651-8500, option 1) to schedule a Claims Technical Assistance session. The sessions are also available on a drop-in basis Tuesdays from 9:30-12, but scheduling is appreciated. When you attend a Claims Technical Assistance session, please bring: your laptop, your AlphaMCS provider login (username and password), and any claims information you want to review.  We look forward to assisting you!

Tailored Plan Eligibility Training

NC DHHS is hosting a webinar that will focus on member eligibility.  Specifically this webinar will address eligibility for Behavioral Health/Intellectual and Developmental Disability (BH-I/DD) Tailored Plans and how beneficiaries can request to transition between the Standard Plan and BH-I/DD Tailored Plan.  The webinar will take place on November 6, 2019 from 2pm to 3pm. Registration is required.


DHHS Prevention Services Survey

All providers are requested to complete an online Provider Readiness Assessment Survey is to help the North Carolina Department of Health and Human Services (NC DHHS) understand the array of prevention services (mental health treatment provided by a clinician, substance use disorder prevention and treatment services provided by a clinician, and in-home, parenting skill-based programs) across the state, identify gaps in services, and inform decisions about what evidenced-based programs should be in the Title IV-E five year prevention plan to meet the needs of North Carolina’s children and families. Access a webinar that explains the survey. Access the online survey.

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Social Determinants of Health Training

Alliance will offer a “Social Determinants of Health” training with CEUs through SR-AHEC on October 28, 2019.

The workshop will explore social determinants of health (SDOH), highlighting what is known about the impact of these macro-level issues on health outcomes. Issues to be addressed include health literacy, the impact of social disenfranchisement, and understanding social capital. The workshop presents options for community-level interventions to address social determinants, and invites participants to explore strategies in individual encounters to maintain mindfulness of these important issues.

Click here to view or download more information about the training and a registration form. Email completed forms to emailed to [email protected]. Contact Carla Alston-Daye at [email protected] with questions.