Advocacy and Practice Updates | North Carolina Psychological Association

Advocacy and Practice Committee Members:
Karen Kirk (Chair); Tonya Armstrong, PhD; Lisa Cloyd, PhD; Charles Cooper, PhD; Sonja Frison, PhD;
Phil Icard, PhD; Cristin Saffo, PsyD; Zulma Sella Nieves, PhD; Mark Stein, PhD; Pamela Trent, PhD
Martha Turner-Quest (staff liaison)

APC Updates

APA Telehealth Waiver - What Psychologists Need to Know (2/19/25)

"Answers to your questions about the evolving Medicare in-person telehealth requirement and upcoming expiration deadline"

Click here to read the article

APA Five Ways to Take Action (2/19/25)

APA publishes the Advocacy Washington Update, which is "a newsletter that highlights how APA Services is working to advance the discipline and practice of psychology on Capitol Hill and beyond". This week's edition highlights five ways that psychologists can take action.

Click here to read more

NC HIEA Teletown Hall February 26 (2/19/25)

The NC Health Information Exchange Authority (HIEA) will hold an online town hall for providers to learn more about the state-designated health information exchange.

Click here to learn more and register

APA Action Alert (2/12/25)

Please take 2 minutes today to ask Congress to take steps to stop funding cuts at the National Institutes of Health (NIH).

Click here to learn more and contact your legislators here.

APA Letter to Members and Psychologists (2/12/25)

On February 7, APA sent a letter to members and psychologists addressing recent and proposed policy changes.

Click here to read the letter.

APA Response Center Website (2/12/25)

APA/APA Services has launched a Response Center website which includes regular updates on policies, APA's advocacy efforts, and actions that psychologists can take. In addition, APA is hosting a live advocacy update on February 25 at 7 PM Eastern.

Click here to learn more.

Aetna and the Clear Pricing Project (CPP) (2/5/25)

Effective January 1, 2025, Aetna became the Third Party Administrator (TPA) for the NC State Health Plan (SHP). For the past two years, NCPA leadership has been working in collaboration with Aetna representatives in preparation for this transition. Information has been shared with members via the Listserv and the weekly APC Updates.

A summary of key points previously shared regarding this transition:

1. Aetna continues to support and administer the Clear Pricing Project (CPP), which was developed by the SHP
2. The CPP fee schedule is separate and distinct from a psychologist's Aetna fee schedule
3. Providers must participate in the Aetna network to serve SHP members as of 1/1/25
4. Providers must elect to join the CPP with Aetna (even if they were currently enrolled in the CPP)
5. If providers don’t enroll in the CPP, Aetna contract rates will apply
6. The CPP fee schedule is determined by the SHP and will continue to function as it did prior to the 1/1/25 transition
7. CPP professional fees are based on 160% of current year Medicare fees
8. Aetna providers were required to enroll in the CPP using a specific Aetna website link. After signing the State Health Plan (SHP) participation agreement on the website, providers would get an immediate receipt and a link to the CPP fee schedule

NCPA is aware that questions regarding enrollment with Aetna and the CPP have arisen subsequent to the January 1 transition. In response to these questions, we reached out to our Aetna contacts and received this information:

Regarding the CPP, the state has decided to close enrollments for all providers regardless of if they are new or existing Aetna providers. This also applies to if they were part of the CPP with BCBS. They were required to re-enroll through the website to continue CPP participation. Re-enrollment requirements were provided on the CPP website for the last year. If the provider did not previously use the online page to enroll, they will not be able to join the CPP in 2025.

If a provider enrolled into CPP via the online Amendment, and is not showing as a participating CPP provider, they can reach out to our designated inbox to inquire on their participation. Please let them know they can reach out to: NorthCarolinaNetwork@aetna.com

Additional Resources:

NC State Health Plan network website - Click here

State Health Plan CPP webpage - Click here

Aetna CPP webpage - Click here

APC Updates - Click here to access
Please note: these updates are archived on the NCPA wesbite behind the member paywall. Refer to the updates dated: 12/13/23; 12/20/23; 1/10/24; 1/31/24; 11/20/24; 12/4/24

CMS (2/5/25)

"To safeguard beneficiaries from Medicare fraud, the Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 13754, instructing Medicare Administrative Contractors (MACs) to disable beneficiary eligibility information from their Interactive Voice Response (IVR) systems by March 31, 2025...Palmetto GBA has removed this feature effective January 31, 2025, at 7 p.m. ET. This means eligibility information is no longer accessible via the IVR...This pilot program involves most MACs, including Palmetto GBA."

Click here to see the announcement.

Click here to read the CR.

NC HIEA (2/5/25)

Click here to read the January newsletter.

Change Healthcare (1/28/25)

From the Change Healthcare HIPAA Website Substitute notice - updated January 24, 2025:

"The review of personal information potentially involved in this incident is substantially complete. Since June 20, 2024 CHC has been providing this notice to help individuals understand what happened, let them know that their information may have been impacted, and give them information on steps they can take to protect their privacy, including enrolling in two years of complimentary credit monitoring and identity theft protection services if they believe that their information may have been impacted...

The last round of impacted customers with attributed individuals was notified to confirm whether they want CHC to handle notifications on their behalf. Notices were sent to impacted customers on June 20, 2024, August 8, 2024, September 16, 2024, November 21, 2024, and December 4, 2024. At this time, CHC does not anticipate that it will identify any additional customers."

Click here to read more.

From the United Health Group Change Healthcare Cyber Response webpage - updated January 27, 2025

"Change Healthcare clearinghouse services are now restored and the repayment phase of the Temporary Funding Assistance Program is in process. As of October 15, recipients of program funding have repaid $3.2B."

Click here to read more.

Becker's Health IT article- January 16, 2025 - Click here to read more.

APA (1/22/25)

The Department of Health and Human Services (HHS) issued an amendment to the HIPAA privacy rule specifically designed to enhance privacy protections for reproductive health care. APA Services published an article on January 9 addressing the new amendment and what it means for psychologists. Some key takeaways:

1. "The new HIPAA rule aims to safeguard patient privacy by restricting the disclosure of sensitive health information related to reproductive health care, which is defined broadly under the rule to include not just abortion care but also contraception, fertility treatments, and other related services."

2. "Compliance with the Final Rule is required starting on December 23, 2024, for every aspect of the Rule except for the Notice of Privacy Practice (NPPs), which is not required until February 16, 2026."

3. "HHS clarifies that requests for PHI made by patients,their authorized representatives, HHS, or other third parties for purposes of treatment, payment, or health care operations are not considered prohibited. Therefore, providers, including psychologists, can continue to disclose PHI in those situations as they did before this new rule."

4. "When receiving requests for PHI that may relate to reproductive health care, the new rule requires providers to obtain an attestation confirming that the PHI is not used for a prohibited activity and signed by the requesting party before any reproductive health information is disclosed pursuant to certain HIPAA exceptions, including: (1) health oversight activities; (2) judicial and administrative proceedings; (3) law enforcement purposes; and (4) disclosures to a medical examiner about a decedent."

The article includes links to the HIPAA Privacy Rule amendment, the APA's FAQs about abortion laws and psychology practice, and a model attestation form.

Click here to read the full article.

NCPA will continue to share updates about this new amendment as we receive the information.

Substance Abuse and Mental Health Services Administration (SAMHSA) (1/22/25)

"Substance Use Disorder Treatment Month (Treatment Month), which will launch in January 2025, serves to support:

People contemplating or seeking help for their substance use
Practitioners treating or considering treating substance use disorder
Friends, family, and loved ones of those with substance use conditions"

Click here to learn more and access the events calendar and social media toolkit.

BCBSNC (1/15/25)

1. "Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to improving collaboration with providers / ACOs in our value-based reimbursement programs – Blue Premier℠ and Medicare Advantage Quality Incentive Program (MAQIP). As a part of this effort, Blue Cross NC will be implementing our annual provider satisfaction survey.

In early January 2025, Quality Provider Engagement Analysts will email the 2025 Annual Provider Satisfaction Survey to designated provider quality contacts with a survey completion deadline of February 28, 2025. This 15-minute survey will serve as a road map to enhance 2025 Quality Provider education and strengthen collaboration with our provider / ACO partners."

Click here to read more.

2. "Providers in the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network recently received a Provider Relationship Survey in their email. We would like to know about your experience as a partner of Blue Cross NC. Please share your honest feedback on your satisfaction level as a participating Blue Cross NC network provider. We value your response, and it will help to inform internal improvements."

Click here to read more.

NC Health Information Exchange (HIE) (1/15/25)

Click here to read the latest newsletter.

UHC (1/15/25)

Updated 2025 Care Provider Administrative Guide - Click here to view.

APA (1/8/25)

1. Important Information for Psychologists Regarding the Blue Cross Blue Shield Settlement

"Psychologists who treated patients insured by any Blue Cross Blue Shield company (collectively, BCBS) between July 24, 2008, and October 4, 2024, may be eligible for compensation from a significant antitrust litigation settlement. This article provides preliminary information about the BCBS settlement and the claims process, and to inform you that the deadline for submitting claims is July 29, 2025."

Click here to read the full article.

2. Medicare and Telehealth

The following was shared by Diane Pedulla, JD from APA's Office of Health Care Financing:

"The American Relief Act 2025, signed into law by President Biden on December 21, 2024, keeps the federal government running and extends key telehealth flexibilities in Medicare until March 31, 2025. Most important to psychologists, this extension continues the delay of the in-person visit requirement for behavioral telehealth services in Medicare. Other flexibilities extended under the Act, such as the geographic and originating site requirements and the use of audio only technology, only concern medical services as these flexibilities were made permanent for behavioral health in previous legislation.

Regarding Medicare payments, a provision to add 2.5% to the 2025 conversion factor to help offset the projected 2.83% decrease was dropped from the final version of the bill. This results in a decrease from $33.29 in 2024 to $32.35 in 2025. Psychologists will see different changes in their payments depending upon the services they provide. Because CMS increased the work values for psychotherapy services, psychologists billing for psychotherapy will receive a slightly higher payment, despite the lower conversion factor. To illustrate, a psychologist in Seattle, WA will see payments for 90834 rising from $111.31 in 2024 to $112.45 in 2025. When that same psychologist bills 96130 for a psychological testing evaluation in 2025, the payment will be $127.05, a reduction from $129.65 in 2024. Exact payment amounts will differ depending on geographic location.

APA and other specialty societies will continue their advocacy efforts when Congress returns for the next round of government funding."

Additional resources for members:

HR 10545, American Relief Act, 2025 - Click here
(Section 3207 addresses telehealth flexibilities)

HHS Telehealth provider resource page - Click here

CMS Physician Fee Schedule Search page - Click here

ProPublica (1/8/25)

Two new articles in the ProPublica series:

Insurers Continue to Rely on Doctors Whose Judgments Have Been Criticized by Courts
Click here to read

Her Mental health Treatment was Helping. That's Why Insurance Cut Off her Coverage
Click here to read

CMS 2025 Physician Fee Schedule (1/2/25)

The Calendar Year 2025 Physician Fee Schedule (PFS) Final Rule, which addresses Medicare payments and policies, will be in effect as of January 1, 2025.

Resources:

CMS 2025 PFS Fact Sheet - Click here

CMS PFS webpage - Click here

PFS Look-up Tool Overview page - Click here

Place of Service Codes for Professional Services (updated May 2, 2024) - Click here

North Carolina Executive Order: Bereavement Leave for State Employees (1/2/25)

On November 1, Governor Ray Cooper issued Executive Order 325 which provides bereavement leave for state employees who lose a family member or a coworker.

From the press release:
"Employees will be eligible for up to 40 hours of paid leave following the loss of an immediate family member, including a spouse, child, sibling, parent, or grandparent. Step, half, and in-law family members are included as well as any dependent living in the employee’s home.

The bereavement leave covers the loss of a loved one for any reason and is retroactive to September 27, 2024 due to Hurricane Helene. Any eligible employee who suffered a loss after September 27, whether due to the storm or other causes, will have access to the leave. Eligible employees have up to six months after the death to take bereavement leave.

Employees who lost a colleague will be eligible for up to eight hours of bereavement leave to attend a funeral or memorial service for their coworker."

Click here to read the full press release.

Additional Resources:

Link to Executive Order 325 - Click here

Bereavement Leave FAQs - Click here

APA (12/26/24)

APA has released the results of the 2024 Practitioner Pulse Survey. This webpage includes a summary as well as links to the full report, methodology, survey questions, and more:

https://www.apa.org/pubs/reports/practitioner/2024

BCBS (12/26/24)

State Health Plan Third-Party Administrator Transition Information

From the November 14 update: "The State Health Plan (SHP) is transitioning from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to a new third-party administrator (TPA) effective January 1, 2025. Blue Cross NC will continue to support providers and members during this time, and we are working to make it as smooth a transition as possible."

Click here to read more.

Reminder to members: Effective January 1, 2025, Aetna will be the TPA for the SHP. Members may refer to past APC Updates, especially the Updates from November 20 and December 4, for more information about Aetna and the SHP.

Beneficial Ownership Information (BOI) Reporting (12/18/24)

The Corporate Transparency Act (CTA) is a federal law requiring certain corporations and LLCs to report information about their “beneficial owners"- the individuals who ultimately own or control the company- to the Financial Crimes Enforcement Network (FinCEN), a bureau of the U.S. Treasury. Owners are required to file a Beneficial Ownership Information (BOI) report.

Click here to learn more about BOI reporting.

On December 3, a federal district court in Texas issued a nationwide preliminary injunction which temporarily halts enforcement of the CTA. While this preliminary injunction is in place, business owners are not required to comply with the CTA reporting requirements.

Click here to read more about this from APA.

According to Rachael Soule, JD at APA: "DOJ did appeal the preliminary injunction shortly following the ruling; APA is watching for any updates. Still, for the latest updates, you may want to monitor FinCEN’s website https://www.fincen.gov/ If you do not want to risk missing an update, it is pretty easy to submit the beneficial ownership information report, and you may choose to voluntarily submit your report. FinCEN has said that while reporting companies are not obligated to file BOI reports while the injunction stands, they are still accepting reports for those who choose to voluntarily submit them.”

NCPA will continue to share updates as they become available.

APA Updated Corporate Transparency Act (CTA) Article (12/11/24)

"On December 3, a federal district court in Texas issued a nationwide preliminary injunction temporarily halting enforcement of the Corporate Transparency Act (CTA), a federal law requiring certain corporations and LLCs, including psychology practices structured as such, to disclose information about their owners."

Click here to read more.

Palmetto GBA December 20 Webinar (12/11/24)

"This webinar is designed to provide pertinent updates, changes, and reminders to assist the provider community in staying compliant with Medicare rules and regulations".

Click here to read more and register.

ProPublica (12/11/24)

Article about health insurance directories and "ghost networks"

Click here to read.

Corporate Transparency Act (12/5/24)

Breaking news from APA:

"A significant development has occurred regarding the Corporate Transparency Act (CTA). A federal court in Texas issued a nationwide preliminary injunction on December 3^rd, temporarily halting the CTA’s enforcement. What this injunction effectively means is the federal government cannot penalize businesses for non-compliance or demand that they submit reports until a final ruling is made on the law’s constitutionality.

This means that reporting entities, including reporting psychology practices, are currently exempt from the reporting requirements – while the injunction is in place."

APA staff note that this new ruling from the Texas court differs from the March ruling in Alabama (discussed in APA's October 24 Practice Update article) which only blocked enforcement for specific plaintiffs. APA staff plan to update the article to reflect this recent development. Read the Practice Update article here: https://www.apaservices.org/practice/business/legal/corporate-transparency-act

APA staff also note: "while yes, reporting companies no longer need to comply with the CTA’s upcoming deadline, this recent ruling is a preliminary injunction, which pauses enforcement of the CTA.The situation may change if the Court’s order is reversed or the Government ultimately prevails in the case, which would then resume enforcement."

Please see the APC Updates from January 17, July 17, and October 30 for more information about the CTA and BOI reporting. APA and NCPA staff will continue to monitor developments and share information as it becomes available.

NC Health Information Exchange (HIE) (12/4/24)

As NCPA has previously reported, according to a 2015 law, providers who receive state funds for the provision of health services (e.g. funds from the State Employee Health Plan (SHP), Children’s Health Insurance Program (CHIP), Medicaid) must comply with the North Carolina Health Information Exchange (HIE) law. This law mandates submission of clinical and demographic data from health care providers to the NC HIE known as NC HealthConnex.

Click here to read the law.

Click here to find more information on the NC HIE website.

HIE Deadline Changes

1. The original deadline for providers to connect to the HIE was June 1, 2020, but due to Covid-19, the deadline was extended to January 1, 2023.

2. Governor Cooper signed the 2022 Appropriations Act (Session Law 2022-74) into law on July 11, 2022. While this law did not change the January 1, 2023 deadline to connect, it did temporarily suspend enforcement of the statutory mandate for providers to connect and submit data to NC HealthConnex as a condition of receiving state funds. From the HIE Health Care provider FAQs: "The statutory provision that would prevent "unconnected" providers and entities from receiving state funds for treating Medicaid recipients and State Health Plan members is currently suspended as a matter of law. Providers – even those not yet connected to NC HealthConnex – may continue to see state-funded patients without fear that the state will enforce the "condition of receiving state funds" provision of the Statewide Health Information Exchange Act at this time."

Click here to see the FAQs.

Click here to read more on the HIE webpage "What Does the Law Mandate?"

Compliance With The Law
According to the HIE website, "signing a participation agreement demonstrates a good-faith effort to meet the connection mandate". This means that the provider has filled out and submitted a Participation Agreement, which could be a Full Participation Agreement or a Submission Only Participation Agreement.

Full Participation Agreement allows a two-way exchange of information about patient information between the provider and the HIE.
Submission Only Participation allows only one-way communication from the provider to the HIE. The Submission Only Agreement does not ensure that only state-funded health care patient data is submitted. The onus is on respective providers and their electronic health record (EHR) vendors to clarify which patient data is submitted.

Click here to learn more about Participation Agreements.

The HIE webpage "What Does the Law Mandate?" further states:

"Once you have an executed agreement, meaning that both your practice and the NC HIEA have signed, you are placed in the onboarding queue where your organization will wait for an invitation to begin your technical connection.
Actively engaging in the onboarding process with your technical vendor and the NC HIEA also demonstrates a good-faith effort to meet the connection mandate."

Additional resources:

Click here - HIE Provider page

Click here - NCPA (we have both an HIE page and an HIE section in the Practice Toolkit)

Aetna and the State Health Plan (SHP) (12/4/24)

Effective January 1, 2025, Aetna will be the third party administrator (TPA) for the SHP. You must be an Aetna participating provider in the Choice POS II network to be in network for NC SHP members starting 1/1/25.

Aetna will continue to support and administer the Clear Pricing Project (CPP). Aetna providers who wish to join the CPP must go to this website and sign the NC State Health Plan (SHP) participation agreement: Click here

Important note: The Aetna NC SHP participation agreement includes the following requirement: “Provider agrees to fully comply with the Statewide Health Information Exchange Act set forth in Article 29B of Chapter 90 of the North Carolina General Statutes.”

If an Aetna provider chooses not to join the CPP, Aetna contract rates will apply. Providers who are out of network (OON) for both Aetna and the SHP, who provide services to SHP members, are not required by Aetna to participate in the NC HIE.

Additional resources:

SHP Network Information for Providers page - Click here

Aetna's CPP FAQs - Click here

APA (11/27/24)

"New research and a formal definition of Long COVID from the National Academies of Sciences, Engineering, and Medicine can guide psychologists in helping patients battling the condition".

Click here to read more.

Palmetto GBA (11/27/24)

Cotiviti is the Recovery Audit Contractor (RAC) for Palmetto GBA. Palmetto GBA and Cotiviti are offering a webinar on December 18, 2024, at 10 AM. Providers "will have the opportunity to hear directly from the RAC as they share insight into Cotiviti's roles, responsibilities, and general RAC activities as a CMS RAC".

Click here to learn more and register.

ProPublica (11/27/24)

ProPublica continues to publish articles addressing behavioral health care and insurance. The most recent article entitled "How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk" was posted on November 19: Click here to read.

Click here to see the ProPublica page addressing various topics related to mental health care.

NCPA Member Advocacy: Meeting with Aetna Representatives (11/20/24)

On Tuesday November 12, NCPA leaders, along with representatives of other North Carolina behavioral health associations, met with Aetna representatives for the second in a series of biannual meetings. NCPA leaders had the opportunity to put forth member-identified concerns and questions as part of the agenda for discussion. The following is a summary of key highlights from that meeting:

Network

1. Since November 2023, the Aetna network has had a 50% increase in behavioral health providers.

2. The provider networks for Aetna marketplace plans are more narrow, based on physical location and county.

Clear Pricing Project (CPP)

1. The CPP fee schedule is separate and distinct from the Aetna fee schedule.

2. Aetna providers who wish to join the CPP must go to this website and sign the NC State Health Plan (SHP) participation agreement - Click here

Once you sign the agreement, you will get an immediate receipt and a link to the CPP fee schedule. Aetna advised that members should not fax or mail requests to join the CPP; the only way to enroll in the CPP is to go through the website link.

**Important note**

The Aetna NC SHP participation agreement includes the following requirement:

“Provider agrees to fully comply with the Statewide Health Information Exchange Act set forth in Article 29B of Chapter 90 of the North Carolina General Statutes.”

Resources related to the NC Health Information Exchange (HIE) are included below.

Fee Schedules

Aetna requires all renegotiate requests to be in writing and sent through their designated provider fax line 859-455-8650. The fax generates a ticket, and the ticket is assigned to an Aetna rep who will reach out to the Aetna provider. Requests should be on company letter head and include the provider's name, TIN, NPI, business address, reason for rate increase request, and the proposed rates.

Clinical Policies

1. Aetna clinical policies (including the following) apply to all Aetna plans, including the SHP:

Neuropsychological and Psychological Testing

https://www.aetna.com/cpb/medical/data/100_199/0158.html

Provider Manual - Click here

2. The Summer 2024 Provider Education Bulletin (click here to view) reviews “updated behavioral health medical record documentation standards”, including “documentation of the application of a standard assessment tool(s) (examples include PHQ-9, GAD-7)”. Aetna representatives clarified that:

a) use of such assessments is “hoped for…not required” and is “not highly prescriptive”; the expectation is that clinicians provide “measurement-informed care” and use clinically appropriate “standardized assessment(s)” for diagnosis, formulation and treatment purposes.

b) frequency is not specified; the expectation is that standardized assessment tool(s) will be used initially and then afterward as clinically appropriate.

c) for telehealth services, assessments may be conducted verbally and responses noted in the clinical file.

d) CPT code 96127 (brief emotional/behavioral assessment with scoring and documentation) may be billed for these assessments if this is a covered benefit on the member’s plan.

Out of Network (OON) Providers

1. OON providers who do not have access to the Availity portal can call Aetna directly to learn if a member’s plan includes OON benefits.

2. The SHP does include OON benefits that members may access; plans offered on the exchange include OON coverage for emergencies only.

3. Providers who are OON for both Aetna and the SHP, who provide services to SHP members, are not required by Aetna to participate in the NC Health Information Exchange (HIE).

Additional Resources

Aetna
Aetna for Health Care Professionals - Click here

Clinical Policy Bulletins - Click here

OfficeLink Updates newsletters - Click here

Helping you get ready for the NC State Health Plan - Click here

NC Health Information Exchange (HIE)
Home page - Click here
Provider page - Click here
What Does the Law Mandate? - Click here
How to Connect - Click here

BCBSNC (11/13/24)

1. Changes in prior authorization for Blue Cross NC Medicare Advantage members

"Effective January 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will require prior authorization for some codes related to the following services for Medicare Advantage members:

Laboratory / Genetic Testing
Codes associated with Gender Affirmation Services
Behavioral Health / Mental Health services

The complete list of codes requiring prior authorization are below and will be added to the Blue Medicare HMO / PPO and Experience Health Medicare Advantage℠ (HMO)".

Click here to read more.

2. New Functionality within Provider Portal Care Affiliate

a) Prior Authorization Process

"Effective December 2, 2024, Blue Cross NC is introducing new functionality within our Provider Portal, Care Affiliate, to enhance the existing prior authorization process that providers are accustomed to using."

Click here to read more.

b) Provider Appeals

"Effective December 2, 2024, Blue Cross NC is happy to announce we are introducing new functionality within our Provider Portal, Care Affiliate, to automate post service provider appeals requests and to reduce the need for faxes and phone calls."

Click here to read more.

NC Psychology Board - Temporary Waivers (11/13/24)

On October 10, the NC Psychology Board issued the following notice of temporary waivers in response to Governor Cooper’s Executive Order No. 318:

"Under N.C. Gen. Stat. §90-270.148(f), a license to practice psychology in North Carolina which was not renewed by the October 1, 2024, renewal deadline remains active until November 30, 2024. A license may be renewed until November 30, 2024, without a late renewal fee. If a North Carolina psychologist’s primary residence is in any of the below 27 designated disaster area counties (set forth on Page 3 below) and they are not able to renew their license by November 30, 2024, in order to continue to provide mental health services in the designated disaster area counties, they may practice in-person or by telehealth only in the 27 designated area counties under the temporary waiver authorized by EO 318. There will be no automatic suspension due to failure to renew of any psychologist’s license whose primary residence is in any of the 27 designated disaster area counties while the temporary waiver is in place. A license not renewed within thirty (30) days of the expiration of the temporary waiver, as described below, shall be suspended for nonrenewal."

Click here to read more and see the list of the 27 designated disaster area counties.

Spotlight: NCPA Online Toolkit (11/13/24)

NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas. The Toolkit is consistently updated by the Advocacy and Practice Committee (APC).

New resources have recently been added to multiple sections, including:

Telehealth and PsyPact: this page addresses topics such as telepsychology guidelines, PsyPact, and telehealth risk management. It also includes links to resources addressing the laws, rules and regulations relevant to interjurisdictional practice.

APA - Seeking Comments on Professional Practice Guidelines on Measurement-Based Care (11/6/24)

"The Working Group on Measurement Based Care (MBC WG) in consultation with the Board of Professional Affairs (BPA) and Committee on Professional Practice and Standards (COPPS), seek member and public comments on the Professional Practice Guidelines on Measurement -Based Care. The public comment period closes on December 3rd, 2024."

Click here to read more.

CMS - Additional Documentation Request (ADR) Webinar on December 10, 2024 (11/6/24)

"This live webinar session will provide a clear understanding of the ADR process and explain the appropriate process when responding to an ADR. The subject matter expert will describe examples of medical record documentation for submission in response to an ADR and clarify steps to take upon collection and preparation of medical record documentation prior to submission for review. This session will also deliver information regarding the Targeted Probe and Education (TPE) process, the Comprehensive Error Rate Testing (CERT) program, and offer valuable resources regarding the topics discussed."

Click here to read more and register.

CMS Prohibition on Billing Qualified Medicare Beneficiaries (11/6/24)

"All Medicare providers and suppliers, including pharmacies, must not bill Medicare beneficiaries in the Qualified Medicare Beneficiary (QMB) eligibility group for Medicare Part A or Part B cost-sharing. This includes Medicare Part A and Part B deductibles, coinsurance, and copayments...

The QMB eligibility group is a Medicaid eligibility group through which states pay Medicare premiums and cost-sharing for certain low-income Medicare beneficiaries (QMBs). The QMB eligibility group is one of the Medicare Savings Programs."

Click here to read more and find additional resources in this Medicare Learning Network (MLN) publication.

NC Health Information Exchange Authority (HIEA) (11/6/24)

Click here to read the October 30 newsletter.

APA - Optum Pauses Prepayment Reviews (10/30/24)

"The company advised that it halted the problematic reviews after coordinated advocacy from APA Services and the American Psychiatric Association."

Click here to read more.

APA - Pushing to Prevent 2025 Medicare Payment Cuts (10/30/24)

"APA Services joins the health care community in calling for Medicare payments to keep pace with inflation, and a majority of House members endorse preventing a 2.8% cut in Medicare provider payments as part of end-of-year package."

Click here to read more.

APA - Corporate Transparency Act and Beneficial Ownership Information (BOI) (10/30/24)

"The reporting deadline is fast approaching for the Corporate Transparency Act (CTA), a federal law requiring certain corporations and LLCs, including psychology practices structured as such, to disclose information about their owners. If you’re a psychologist who owns or controls such a practice, it’s crucial to understand what this may mean for you. While a ruling in a lawsuit this past spring created some confusion, the reporting requirements still remain in effect."

Click here to read more.

CMS/US DHHS (10/30/24)

Announced on October 16:

"Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program (CHIP) coverage of traditional health care practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations (UIO). Today’s action is expected to improve access to culturally appropriate health care and improve the quality of care and health outcomes for tribal communities in Arizona, California, New Mexico, and Oregon, and will support IHS, Tribal, and UIO facilities in serving their patients."

Click here to read more.

APA Advocacy Regarding Optum Prepayment Reviews (PPRs) (10/17/24)

In August, APA Services began hearing numerous complaints about Optum’s prepayment reviews (PPRs). Without warning or explanation, Optum had sent psychologists letters telling them that claims they submitted (or that patients submitted) would not be paid until the psychologist faxed or mailed Optum extensive patient records. Optum would then take up to nine weeks to review those records and decide whether to pay the claims.

APA Services sent Optum the attached letter asserting its legal and policy concerns about the PPRs. They include parity, access to mental health services, HIPAA and patient privacy, and financial and administrative burdens on clinicians. The letter also conveyed the extreme anger and confusion that the PPRs caused our members. (APA collaborated with the American Psychiatric Association on the letter since psychiatrists were the other main targets of the reviews.)

Click here to view the letter.

On October 10th, Alan Nessman, JD and Stephen Gillaspy, PhD of APA Services/Practice met with Optum to discuss those issues, and additional complaints about claim denials.

Optum acknowledged those concerns and advised them that it had paused the PPRs of psychologists. The company does plan to reintroduce some review of mental health claims at some point in the future, but claimed they want to work with us so that psychologists are aware of the company’s documentation expectations well in advance of further reviews. APA urged that any future reviews should be nothing like the “chaos at every level” nature of the recent PPRs.

APA Services is pleased that Optum claims to have ceased the abhorrent PPRs for now, and will continue to keep pressure on the company to ensure that any future reviews of psychologists’ claims are much more transparent, reasonable and fair.

NCPA members: If you or your patients receive any further PPRs from Optum, please backchannel our Director of Professional Affairs, Cristin Saffo, PsyD, at dpa@ncpsychology.org

APA Digital Therapeutics (10/16/24)

"FDA clears two research-backed mental health digital therapeutics for psychologists’ use, and CMS proposes three new reimbursement codes for mental health digital therapeutics".

Click here to read more.

NC Psychology Board (10/16/24)

Consistent with Executive Order 318, the NC Psychology Board released a notice of temporary regulatory waivers:

"Under N.C. Gen. Stat. §90-270.148(f), a license to practice psychology in North Carolina which was not renewed by the October 1, 2024, renewal deadline remains active until November 30, 2024. A license may be renewed until November 30, 2024, without a late renewal fee. If a North Carolina psychologist’s primary residence is in any of the below 27 designated disaster area counties (set forth on Page 3 below) and they are not able to renew their license by November 30, 2024, in order to continue to provide mental health services in the designated disaster area counties, they may practice in-person or by telehealth only in the 27 designated area counties under the temporary waiver authorized by EO 318. There will be no automatic suspension due to failure to renew of any psychologist’s license whose primary residence is in any of the 27 designated disaster area counties while the temporary waiver is in place. A license not renewed within thirty (30) days of the expiration of the temporary waiver, as described below, shall be suspended for nonrenewal."

Board website: https://www.ncpsychologyboard.org/

Click here to read the full notice.

BCBSNC (10/9/24)

"Effective October 10, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a change to our fee schedule functionality on the Blue e portal which allows ancillary and professional providers to pull a fee schedule by selecting an individual practitioner NPI from their registered list."

Click here to read more.

UHC/Optum (10/9/24)

Telehealth claims require Place of Service (POS) code

Click here to see the Telehealth Billing Guide Updates

NC Medicaid: End dates corrected on some prior authorizations - Click here

APA (10/2/24)

2024 Psychological and Neuropsychological Testing Billing and Coding Guide

Click here to read more and access the guide

NC Health Information Exchange Authority (HIEA) (10/2/24)

Click here to read the September newsletter

Palmetto GBA Webinars (10/2/24)

Palmetto GBA is the Medicare Administrative Contractor (MAC) for North Carolina. The following webinars are being offered in October:

Medicare Part B Quarterly Updates Webinar October 10, 2024 1 PM ET
"This webinar is designed to provide pertinent updates, changes, and reminders to assist the provider community in staying compliant with Medicare rules and regulations".
Click here to learn more and register

Medicare Part B Basic Billing Overview Webinar October 16, 2024 1 PM ET
"Part B providers are invited to join Palmetto GBA for a 90-minute Medicare Basic Billing Overview Webinar...This session would be of interest to new providers, their billing staff and those seasoned billers that would like a refresher on Medicare Billing Basics."
Click here to learn more and register

ProPublica (9/25/24)

ProPublica has been publishing a series of articles looking at mental health treatment, insurance, and the barriers to obtaining mental health care.

Click here to see the main page and list of articles

Articles include:

Why I Left the Network (August 25) - Click here

Ghost networks (September 8) - Click here

APA (9/25/24)

APA Services pushed for new rule strengthening mental health care access- Click here to read the full article

New Mental Health Parity Rule (9/18/24)

On September 9, the U.S. government released a new rule to strengthen the federal mental health parity law. According to the press release: "As part of the Biden-Harris administration’s effort to ensure more than 150 million people with private health coverage have greater access to mental health and substance use disorder care, the departments of Labor, Health and Human Services and the Treasury took significant action today by issuing final rules to clarify and strengthen protections to expand equitable access to these benefits as compared to medical and surgical benefits and reduce barriers to accessing these services."

From Jared Skillings, APA Chief of Professional Practice: "The rule improves equitable access to mental health services. It will help to hold insurance companies accountable when patients cannot get mental health care as easily as medical care. It also recognizes that low pay for psychologists and mental health clinicians is a major cause of network inadequacy and low access to care."

Click here to read the full press release.

Click here to view the Fact Sheet.

Click here to view the Highlights page.

Change HealthCare (9/11/24)

Change Healthcare updated its HIPAA Website Substitute Notice on July 29 and August 8. The update reads in part:

"This substitute notice contains the information CHC can provide at this time while CHC continues working through data review to identify affected individuals. CHC plans to mail written letters on a rolling basis...Notices were sent to impacted customers on June 20, 2024 and August 8, 2024."

"While CHC cannot confirm exactly what data has been affected for each impacted individual, information involved for affected individuals may have included contact information (such as first and last name, address, date of birth, phone number, and email) and one or more of the following:

Health insurance information (such as primary, secondary or other health plans/policies, insurance companies, member/group ID numbers, and Medicaid-Medicare-government payor ID numbers);
Health information (such as medical record numbers, providers, diagnoses, medicines, test results, images, care and treatment);
Billing, claims and payment information (such as claim numbers, account numbers, billing codes, payment cards, financial and banking information, payments made, and balance due); and/or
Other personal information such as Social Security numbers, driver’s licenses or state ID numbers, or passport numbers.

The information that may have been involved will not be the same for every impacted individual. To date, we have not yet seen full medical histories appear in the data review."

Click here to read the full notice.

NC Psychology Board (9/11/24)

The Board is now sending out emails regarding licensure renewal. As a friendly reminder, in order to renew your license by the October 1, 2024 deadline, you must do the following:

1. Complete the Ethics Refresher

2. Submit all required CE through CE Broker

3. Complete any required Supervision Reports

4. Pay the renewal fee

NC Psychology board website: https://www.ncpsychologyboard.org/

CE Broker https://cebroker.com/

CMS (9/4/24)

Calendar Year 2025 Physician Fee Schedule (PFS) Proposed Rule- Fact Sheet

"On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2025."

Click here to read more.

*Also, see this week's edition of Association Matters for the APA Advocacy Action Alert related to the CY 2025 PFS.

National Academies of Sciences, Engineering and Medicine (NASAM) (9/4/24)

Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans

"The Centers for Medicare & Medicaid Services and the Substance Abuse and Mental Health Services Administration asked the National Academies to convene an expert committee to examine current challenges in ensuring broad access to evidence-based behavioral health care services through Medicare, Medicaid, and Marketplace programs and propose strategies to address those challenges." The report includes nine recommendations for improving provider participation in Medicare, Medicaid, and Marketplace plans.

Click here to learn more.

APA (8/28/24)

Navigating the legal landscape: FAQs on gender-affirming care for minors.

Click here to read the full article.

Federal Trade Commission (FTC) - Non-compete Clause (8/28/24)

In the August 7 APC Update, we reported that the FTC had issued a final rule broadly banning non-compete clauses, scheduled to take effect September 4, 2024. Last week, the United States District Court for the Northern District of Texas blocked the ban from going into effect. It's possible that the FTC will appeal this ruling to the Fifth District Court of Appeals.

Click here to see where NPR reported on the recent ruling.

NC Psychology Board (8/28/24)

The Psychology Board has notified NCPA that the licensee portal is not yet accepting renewal fees. At this time, psychologists can upload their CE into cebroker (https://cebroker.com/) and take the ethics refresher by using the Licensee Login on the Board's website (https://www.ncpsychologyboard.org/)

The Psychology Board will send an email to licensees when the portal is ready to accept renewal fees.

APA Five Guidelines Passed (8/21/24)

At the recent APA 2024 convention in Seattle, the Council of Representatives passed five sets of guidelines:

Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Guidelines for Working with Adults with Complex Trauma Histories
Guidelines on Key Considerations for Working with Adults with PTSD and Traumatic Stress Disorders
Guidelines for the Practice of Telepsychology
Guidelines for Psychological Evaluations in Child Protection Matters

According to APA, these guidelines will be posted on the APA website soon. Click here to read more.

APA Informed Consent Guidance and Templates (8/21/24)

New Informed Consent Guidance and Templates for Psychologists

Click here to read the full July 29 article.

BCBSNC Behavioral Health Program Expands (8/14/24)

"Beginning August 1, 2024, the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Behavioral Health Total Care (BH Total Care) program for members with serious mental illness (SMI) and/or substance use disorder (SUD) will expand to the entire state of North Carolina.

The program provides comprehensive care that addresses both the physical and mental health needs of members with SMI and/or SUD, ensuring that they receive the holistic care they deserve. It is available to Commercial, Federal Employee Program, and Medicare Advantage lines of business."

Click here to read more.

NC Health Information Exchange Authority (HIEA) (8/14/24)

Click here to read the most recent HIEA newsletter.

CMS Guidance re: Billing and Reimbursement for Telehealth Services (8/8/24)

NCPA is aware that members have questions regarding recent CMS guidance related to billing and payment for telehealth services. The recent guidance was included in the July 25 APC Update and read, in part:

On June 6, CMS published Change Request 13582 addressing telehealth claims and reimbursement. The effective date is January 1, 2024 and the implementation date is July 8, 2024. Excerpts include:

(page 18) "Beginning in CY 2024, practitioners may receive either the facility or the non-facility payment rate for an otherwise eligible Medicare telehealth service, depending on whether the billing practitioner selects POS code 02 or POS code 10. The only two valid POS codes for Medicare telehealth billing in CY 2024 are POS 02 and POS 10. As appropriate, POS 02 or POS 10 may be used and must be paired with the appropriate telehealth modifier (modifier 93 for audio-only and modifier 95 for audio/video). The payment rate for POS 02 is the facility payment rate (F); the payment rate for POS 10 is the non-facility rate (NF). Use of audio-only (93) or audio-video (95) does not change rate of payment, only the POS code determines the non-facility or facility payment rate."

Click here to read the full text of Change Request 13582.

The guidance in this June 2024 Change Request does seem confusing when compared to previous CMS information. For example, the Medicare Learning Network (MLN) 901705 update (as quoted in our January 10 APC Update) read in part:

"After December 31, 2023, use POS 02-Telehealth to indicate you provided the billed service as a professional telehealth service when the originating site is other than the patient’s home. Use POS 10-Telehealth for services when the patient is in their home." Modifier 95 is now for those working in a facility: "Use modifier 95 when the clinician is in the hospital and the patient is in the home."

On July 23, the Center for Connected Health Policy (CCHP) issued a "POS 10 Non-facility Rate Payment and Modifiers Clarification": Click here to read.

The article addresses the new edition to the CMS processing manual and says:

“Beginning in CY 2024, practitioners may receive either the facility or the non-facility payment rate for an otherwise eligible Medicare telehealth service, depending on whether the billing practitioner selects POS code 02 or POS code 10. As appropriate, POS 02 or POS 10 may be used and must be paired with the appropriate telehealth modifier (modifier 93 for audio-only and modifier 95 for audio/video). The payment rate for POS 02 is the facility payment rate (F); the payment rate for POS 10 us the non-facility rate (NF). The use of audio-only (93) or audio-video (95) does not change rate of payment only the POS code determines the non-facility or facility payment rate.” (Emphasis Added)

The article continues: "Additionally, please note the bolded section of the new manual citation above regarding the use of modifiers 93 and 95 to ensure billing is completed as instructed. Previous guidance had seemed to limit the continued use of these modifiers to institutional provider claims only, therefore this is also an important clarification to highlight. For more information on the Change Request review the updated manual."

NCPA will continue to seek updated information about Medicare telehealth billing and reimbursement and share this information with members. APA is reaching out directly to CMS for clarification; we will share this information as soon as it becomes available.

APA Advocacy Updates (8/7/24)

From APA Services:

Kids Online Safety and Privacy Act Passed in Senate

"On July 30, 2024, the Kids Online Safety and Privacy Act (S. 2073) passed the U.S. Senate with an overwhelming majority. This legislation combines the Kids Online Safety and the Children and Teen Online Privacy and Protection Act 2.0, both of which APA Services has been foundational in crafting and supporting. This success comes after years of efforts by APA Services, our elected leaders, divisions, and our grassroots network. Our efforts to protect children from the potential harms associated with social media use go back to 2022, when we worked with members on both sides of the aisle to craft legislation to meet the needs identified by the APA health advisory on kids and social media and its follow-on report. As always, we led with the science, testifying at congressional hearings, meeting with federal officials, forming a broad coalition, and collecting letters of support... This is a clear example of psychology creating impact. We will keep you informed as the bill continues to move forward and remain hopeful that the bill will pass the House before the end of the year."

ADAPT Act Introduced in House

"Last week, the `Accelerating the Development of Advanced Psychology Trainees Act’ or ADAPT Act was introduced in the House. Led by Representatives Troy Balderson (R-OH), Suzan DelBene (D-WA), Annie Kuster (D-NH), and Carol Miller (R-WV), the ADAPT Act (H.R. 9138) would reduce psychology workforce shortages by supporting reimbursement in Medicare for supervised services provided by "advanced psychology trainees," which includes doctoral interns and post-doctoral residents. The ADAPT Act is a companion bill to S.2511, which was introduced in the Senate last year by Senators John Barrasso (R-WY) and Michael Bennet (D-CO)."

Federal Trade Commission (FTC) Noncompete Clause Rule (8/7/24)

Federal Trade Commission (FTC) Noncompete Clause Rule

In April, the FTC issued a proposed final rule banning noncompetes nationwide. "In the final rule, the Commission has determined that it is an unfair method of competition, and therefore a violation of Section 5 of the FTC Act, for employers to enter into noncompetes with workers and to enforce certain noncompetes." The final rule was published in the Federal Register on May 7 and is scheduled to take effect September 4, 2024.

Resources:

FTC April press release - Click here to read

FTC Fact Sheet - Click here to read

Links to May 14 FTC compliance webinar and transcript - Click here to read

FTC Noncompete Clause Rule: A Compliance Guide for Businesses and Small Entities - Click here to read

Federal Register Non-Compete Clause Rule published 5/7/24 - Click here to read

According to the APA, the final rule does apply to psychologists, including 1099 employees. In terms of impact on psychologists, the APA has advised that:

1. For employed psychologists (hospital, clinics, etc): existing non-competes will likely be unenforceable (except for senior executives meeting requirements)

2. For psychologists running small practices: non-competes will be largely unenforceable; psychologists will need to look for alternative ways to protect patient base and business interest (such as confidentiality agreements, limited non-solicitation agreements)

3. The rule is facing legal challenges, so there is a chance of the rule being enjoined before it goes into effect in September.

NCPA will continue to monitor news about the noncompete clause rule and update members accordingly.

NCPA will continue to monitor news about the noncompete clause rule and update members accordingly

State Health Plan (SHP) Rate Increase for ABA Services (8/7/24)

Breaking news from NCPA's contacts at Aetna: The State Health Plan (SHP) has made adjustments to the Clear Pricing Project (CPP) rates for Applied Behavior Analysis (ABA) services. Effective 1/1/2025, the CPP rates for ABA codes will reimburse 100% of NC Medicaid Rates- this represents an increase from the previous 75%. Aetna has not yet posted this information on their website, but their representatives asked us to pass this information along to our members.

APA (7/31/24)

Key Updates on 2025 Physician Fee Schedule Proposed Rule

"The Centers for Medicare and Medicaid Services (CMS) released the CY2025 Physician Fee Schedule Proposed Rule on July 10, 2024...APA Services, Inc. (APASI) is analyzing the proposed rule and will submit a comment letter to CMS by September 9, addressing the agency’s proposed changes."

Click here to read more.

The article also includes a call to action regarding HR 2474, which changes the way Medicare payment rates are updated:
"Separate from our comments on the proposed rule, we need you to ask your representatives in Congress to cosponsor H.R. 2474. This legislation would address CF reductions and payment updates this year and in the future by pegging increases to the Medicare Economic Index, a measure of health care cost inflation."

Opposing Radical Reorganization of the National Institutes of Health

APA Services joined 223 NIH stakeholders in a letter "expressing alarm that the Fiscal Year 2025 Labor, Health and Human Services (Labor-HHS) appropriations bill includes a proposal to restructure the National Institutes of Health (NIH)". APA is drafting a response by the August 16 deadline and welcomes input.

Click here to read more and share your input.

Spotlight: NCPA Online Practice Toolkit (7/31/24)

Billing and Coding: Includes resources for CPT and Place of Service code sets, CMS 1500 Claim Form instructions, and fee adjustment/sliding scale fee information

HIPAA: Contains resources related to the HIPAA Privacy and Security rules, de-identification of PHI, and breach notifications

Risk Management (including Audits): Includes resources addressing topics such as record keeping, managed care and risk adjustment audits, and client termination.

BCBSNC: Additional Autism Services Allowed as Telehealth (7/24/24)

"Starting August 21, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin reimbursing additional behavioral health inpatient and outpatient services performed via Telehealth visits."

Click here to read more.

BCBSNC: New Effective Date for Behavioral Health Medical Policy Changes (7/24/24)

"On April 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) posted a Notification of Policy Revision announcing that prior authorization for all Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP) would be required effective July 1, 2024...The new effective date for this policy revision is August 1, 2024."

Click here to read more.

CMS: Billing and Payment for Telehealth Services with Place of Service (POS) 10 (7/24/24)

On June 6, CMS published Change Request 13582 addressing telehealth claims and reimbursement. The effective date is January 1, 2024 and the implementation date is July 8, 2024. Excerpts include:

(page 1) "The purpose of this Change Request (CR) is to inform MACs that Claims for covered Telehealth services using POS 10, if payable by Medicare, shall be paid at the Medicare Physician Fee Schedule non-facility rate"

(page 5) List of settings where telehealth is paid at the facility rate- includes "Telehealth Provided Other than in Patient’s Home (POS code 02)"

(page 6) list of setting where telehealth is paid at the non-facility rate- includes "Telehealth Provided in Patient’s Home (POS code 10)"

Click here to read the full text.

Change Healthcare Cybersecurity Breach (7/18/24)

APA

On July 12, APA Services published an update regarding the Change Healthcare cybersecurity breach that focuses on breach notification issues. The update addresses: "the breach notices that Change plans to start sending in late July to patients whose information was breached in the cyberattack, as well as Change’s investigation and preliminary notice leading up to those notices; and clarification from the Centers for Medicare and Medicaid Services (CMS) indicating that few, if any, psychologists in independent practice would also be required to send breach notifications."

The article includes guidance about responding to patient questions and clarification about independent practice breach notifications. Click here to read the full update.

Change Healthcare HIPAA Website Substitute Notice

The APA Services update references the June 20 "substitute breach notification" issued by Change Healthcare. The notification reads in part:

"CHC is posting this substitute notice to provide customers and individuals with information about the criminal cyberattack on CHC systems and to share resources available to people who believe their personal data potentially being impacted.

The review of personal information potentially involved in this incident is in its late stages. CHC is providing this notice now to help individuals understand what happened, let them know that their information may have been impacted, and give them information on steps they can take to protect their privacy, including enrolling in two years of complimentary credit monitoring and identity theft protection services if they believe that their information may have been impacted.

This substitute notice contains the information CHC can provide at this time while CHC continues working through data review to identify affected individuals. CHC plans to mail written letters at the conclusion of data review to affected individuals for whom CHC has a sufficient address. Please note, we may not have sufficient addresses for all affected individuals. The mailing process is expected to begin in late July as CHC completes quality assurance procedures."

The notification describes what types of information are involved and includes a Reference Guide detailing the steps that individuals may wish to take to protect their private information. Click here to read the entire notification.

NC HIEA (7/17/24)

Click here to read the most recent NC HIEA Update.

UHC Annual Federal Audit of Commercial Plans (7/17/24)

"In compliance with the Health and Human Services-Risk Adjustment Data Validation (HHS-RADV) program, we are required to provide supporting medical documentation to support the review of the medical encounter(s) for UnitedHealthcare members. UnitedHealthcare members who are covered under individual and/or small group plans are included in this audit.

Beginning in July, we will be reaching out to randomly selected providers to gather the medical records for members selected within a specific range of 2023 service date(s). Since only a select number of members are randomly selected for the audit, not all providers will receive this request."

Click here to read more.

NC Psychology Board Scam Alert (7/10/24)

From the Spring 2024 edition of "The Bulletin Board":

"It has come to our attention that individuals posing as representatives of the “North Carolina Psychology Clinical Board” are making scam phone calls to NCPB licensees. These calls may display on your caller ID as coming from the NCPB office number (828-262-2258), as they are using the Board’s telephone number as a disguise. If you receive a call that you suspect might not be genuine, please refrain from sharing any personal or payment information with the caller. Instead, you may contact the Board directly at info@ncpsychologyboard.org to verify the authenticity of the call. Alternatively, you can report scam calls to the North Carolina Attorney General’s Consumer Protection Division at 1-877-5-NO-SCAM."

NC Psychology Board Spring 2024 Newsletter (7/10/24)

Click here to read the entire Spring 2024 newsletter.

NC HIEA (7/10/24)

Click here to read the most recent NC HIEA Update.

UHC Annual Federal Audit of Commercial Plans (7/10/24)

Click here to read more.

CMS Medical Records Request Scam (7/3/24)

"CMS identified phishing scams for medical records. This may include scammers faxing you fraudulent medical records requests to get you to send patient records in response".

Click here to read more in the most recent edition of MLN Connects.

NC DHHS 988 Warm Line (7/3/24)

In February, the North Carolina Department of Health and Human Services launched a new statewide Peer Warmline. "The new Peer Warmline will work in tandem with the North Carolina 988 Suicide and Crisis Lifeline by giving callers the option to speak with a Peer Support Specialist. Peer Support Specialists (or “peers”) are people living in recovery with mental illness and/or substance use disorder who provide support to others who can benefit from their lived experience."

Click here to read more.

NC DHHS Strategic Pan (6/26/24)

"The Draft 2024-2029 Strategic Plan for the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMH/DD/SUS) shares our Division’s mission, vision, guiding principles, priorities, and goals for the next five years.

Before finalizing the plan, we are posting it for public comment and look forward to receiving your feedback." Deadline for feedback is July 1.

Click here to read more.

NCPA Online Practice Toolkit (6/26/24)

Technology and Electronic Records: this page includes resources related to topics such as email and texting, social media, apps, vendor reviews, cyber security, and electronic health record templates.

Telehealth and PsyPact: this page addresses topics such as telepsychology guidelines, PsyPact, and telehealth risk management. It also includes links to resources addressing the laws, rules and regulations relevant to interjurisdictional practice.

APA CMS Physician Fee Schedule (PFS) (6/19/24)

"Each year, psychologists have a tremendous opportunity to share their thoughts with the Centers for Medicare and Medicaid Services (CMS) on new policies, access to new services, ways to improve coverage, and protect provider reimbursement in Medicare, by submitting comments on the physician fee schedule proposed rule... Released annually between June and August and followed by a 60-day comment period, the proposed rule outlines the agency’s new policy proposals, suggested changes to services, and provider payments for the coming year. After reviewing the public comments, CMS releases a final rule in November explaining which proposed changes will become final and take effect on January 1."

Click here to read more.

NCPA will alert members when this year's proposed rule is released.

APA Call for Comments (6/19/24)

The APA is seeking member and public comments on two proposals:

1. Proposed Guidelines for Working with Adults with Complex Trauma Histories- deadline June 19

2. Proposed Guidelines for Psychological Practice in Health Care Delivery Systems - deadline August 3

Click here to read more and log in to make comments.

APA Services (6/11/24)

Click here to see the APA's webpage highlighting the current advocacy actions.

CMS/Palmetto GBA (6/11/24)

"Palmetto GBA will host the Medicare Administrative Contractor Part B Quarterly Updates webinar on Thursday, June 27, 2024, at 1 p.m. ET. This webinar is designed to provide pertinent updates, changes, and reminders to assist the provider community in staying compliant with Medicare rules and regulations and will include: Current Medicare Learning Network (MLN) updates; Hot topics that impact provider billing; CMS news and resources; Palmetto GBA resources".

Click here to learn more here.

APA Measurement-based Care (MBC) (6/5/24)

APA Services, Inc. has a webpage with resources related to measurement-based care and routine patient monitoring systems. Click here to see the page.

APA Services, Inc. also has a "Let's Get Technical" column which reviews apps and tools for practicing psychologists. Click here to see this edition which reviews three MBC platforms.

BCBSNC - Paper/EFT Payments (6/5/24)

"Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a requirement for providers that currently receive payment electronically via EFT AND by paper check. Under the requirement, only one form of payment can be selected. This requirement only applies to providers that are currently being paid electronically via EFT but also receive some payments via paper check. Note: providers that joined the Blue Cross NC network after 2018 were required to set up payment via EFT."

Click here to read more.

BCBSNC - Change Healthcare (CHC) and Claims Submissions (6/5/24)

Providers affected by the CHC issue may choose from the following during any period that they are unable to send claims using CHC...Blue Cross NC does not provide other services that CHC may provide for your organization (e.g. claims scrubbing or other value-added services). As a result, use of alternative filing methods could lead to a higher-than-normal error rate."

Click here to read more.

75th Anniversary of National Institute of Mental Health (NIMH) (5/29/24)

APA

"On May 2, 2024, the Friends of the National Institute of Mental Health (NIMH) coalition, which APA cochairs, sponsored a Capitol Hill event, “The Evolution of Mental Health Research: Better Science, More Effective Treatments, and Broader Impacts,” to celebrate the 75th anniversary of NIMH...Now funded at over $2 billion, NIMH-supported research has played a pivotal role in advancing understanding of the brain, developing groundbreaking treatments and therapies, and improving the quality and availability of evidence-based mental health care."

Click here to read more.

NIMH

"For 75 years, the National Institute of Mental Health (NIMH) has transformed the understanding and treatment of mental illnesses through basic and clinical research—bringing hope to millions of people. As we commemorate our 75th Anniversary, we invite you to participate in this yearlong celebration."

Click here to read more.

National Institute on Aging (NIA) (5/29/24)

"NIA was established to improve the health and well-being of older adults through research. For 50 years, the institute has led a broad scientific effort research to understand the nature of aging and to extend the healthy, active years of life. It is also the lead federal agency for Alzheimer’s disease and related dementias research... As we commemorate NIA’s 50th Anniversary, we hope to inspire future generations of aging researchers. We invite you to join us in this yearlong celebration".

Click here to read more.

Federal Trade Commission (5/29/24)

Press release: BetterHelp Customers Will Begin Receiving Notices About Refunds Related to a 2023 Privacy Settlement with FTC

"BetterHelp agreed to pay $7.8 million to settle FTC allegations that the online therapy provider used and shared consumers’ health data for advertising"

Click here to read more.

NC State Privilege Tax Repealed (5/29/24)

The North Carolina 2023-2024 fiscal year state budget includes a section called “Repeal State Privilege Tax on Professionals” which repeals General Statute (G.S.) 105-41. G.S. 105-41 addresses the privilege license tax and states "Every individual in this State who practices a profession or engages in a business and is included in the list below must obtain from the Secretary a statewide license for the privilege of practicing the profession or engaging in the business." Psychologists are included under the "professional art of healing" category of the statute.

Since G.S. 105-41 was repealed, effective July 1, 2024, many professionals in private practice, including psychologists, will no longer need to apply for and pay for the State Privilege License tax.

Click here to see the NC Department of Revenue Privilege License Tax page.

Click here to read the State of North Carolina Privilege Tax Bulletin, updated November 2023.

Update: Change Healthcare Cyber Attack (5/22/24)

NCPA and APA continue to monitor the consequences of the Change Healthcare cyber attack.

1. On April 25, APA Services sent a letter to Secretary Xavier Becerra of the US Department of Health and Human Services. In the letter, APA requested the following actions:

1. Quickly ensure that patients and providers are notified of their exposure to breaches of PHI
and PII.

2. Confirm that Change Healthcare is responsible for issuing notifications of PHI/PII breaches
associated with the cyberattack, rather than individual health care providers.

3. Require Change Healthcare to provide simple, clear mechanisms for providers to request
information about potential breaches of their patients’ protected health information.

Click here to read the full letter.

2. On May 1, Andrew Witty, Chief Executive Officer, UnitedHealth Group provided testimony to the
House Energy and Commerce Committee Subcommittee on Oversight and Investigations.

Excerpt: “Given the ongoing nature and complexity of the data review, it is likely to take several months of continued analysis before enough information will be available to identify and notify impacted customers and individuals, partly because the files containing that data were compromised in the cyberattack. Our teams, along with leading external industry experts, continue to monitor the internet and dark web to determine if data has been published.

We will, of course, comply with legal requirements and provide notice to affected individuals, and have offered to our customers and clients to provide notice on their behalf where it is permitted. We are working closely with HHS’s Office of Civil Rights to make sure our notice is effective, useful and complies with the law.

Rather than waiting to complete this review, we are providing free credit monitoring and identity theft protections for two years, along with a dedicated call center staffed by clinicians to provide support services. Anyone concerned their data may have been impacted should visit changecybersupport.com for more information.”

Click here to read the full “Examining the Change Healthcare Cyberattack” statement.

3. Sensitive data, including PHI, may still be vulnerable. In response, some providers are considering placing a credit freeze and/or fraud alert on their credit report with the three main credit bureaus (Equifax, Experian, TransUnion). Click here to learn more.

4. NCPA continues to advise members to check with their respective billing and data systems for more specific information about filing insurance claims. We will continue to keep members informed about new developments and guidance regarding this issue.

Additional Resources:

DHHS Letter to Health Care Leaders 3/10/24 - Click here

DHHS Press release 3/13 - Click here

Letter from Congress to HHS 3/19/24 - Click here

DHHS Letter to providers 3/25/24, including resource list - Click here

DHHS FAQ page updated 4/19/24 - Click here

Biden-Harris Administration’s Follow-up Meeting with Insurers 3/19/24 - Click here

APA response - Click here

Palmetto GBA (Medicare) updated 5/20/24 - Click here

United Healthgroup Information page - Click here

https://www.unitedhealthgroup.com/ns/changehealthcare.html

NCPA Member Advocacy: Meeting With Aetna Representatives (5/17/24)

On April 16, NCPA leaders, along with representatives of other North Carolina behavioral health associations, met with Aetna representatives for the first in a series of biannual meetings. NCPA leaders had the opportunity to put forth member-identified concerns and questions as part of the agenda for discussion. The following is a summary of key highlights from that meeting:

Network Adequacy and Credentialing

1. Aetna reported that they are currently onboarding 1800 providers in North Carolina, 1200 of whom are mental health providers

2. Generally, Aetna recommends that providers allow a full 120 days to be credentialed; however, Aetna is escalating NC applications due to the transition to being the third party administrator (TPA) for the State Health Plan (SHP) in 2025

3. Clinicians can apply to join Aetna and the Clear Pricing Project (CPP) past the previously-announced 5/31 deadline

Contracts and Fee Schedules

1. Provider contracts and fees may vary based on information such as geographic area and specialty

2. Contracts automatically renew after the initial term; the initial term used to be 3-4 years but was recently shortened to one year

3. Aetna must honor the terms and dates of each individual provider’s contract; providers can send a fax near the end of their contract term to request a renegotiation of rates

4. Aetna requires all renegotiate requests to be in writing and sent through their designated provider fax line 859-455-8650. The fax generates a ticket, and the ticket is assigned to an Aetna rep who will reach out to the Aetna provider. Requests should be on company letter head and include the provider's name, TIN, NPI, business address, reason for rate increase request, and the proposed rates.

Telehealth

Effective December 1, 2023, audio-only telehealth services were no longer covered for Aetna self-insured commercial plan members. Providers may contact Aetna to request an exception if a member requests audio-only services. Click here to read the Aetna telemedicine policy.

We look forward to a continued collaboration with Aetna in order to
best support our NCPA members.

APA Call for Comments (5/15/24)

APA is inviting comments on the following:

Proposed Revision of Guidelines for the Practice of Telepsychology- deadline is May 20, 2024
Click here

Proposed Revision of Guidelines for Psychological Evaluations for Child Protection Matters- deadline is June 3, 2024
Click here

Proposed Revisions to the Guidelines on trauma Competencies for Education and Training- deadline is May 31, 2024
Click here

Proposed Guidelines on Key Considerations for Working with Adults with PTSD and Traumatic Stress Disorders- deadline is June 16, 2024
Click here

US DHHS - New Rule to Support Reproductive Health Care Privacy Under HIPAA (5/15/24)

In April, "the Biden-Harris Administration, through the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) announced a Final Rule, entitled HIPAA Privacy Rule to Support Reproductive Health Care Privacy. The Final Rule strengthens the Health Insurance Portability Act of 1996 (HIPAA) Privacy Rule by prohibiting the disclosure of protected health information (PHI) related to lawful reproductive health care in certain circumstances...This Final Rule will bolster patient-provider confidentiality and help promote trust and open communication between individuals and their health care providers or health plans, which is essential for high-quality health care...

The Department is issuing a Final Rule that:

Prohibits the use or disclosure of PHI when it is sought to investigate or impose liability on individuals, health care providers, or others who seek, obtain, provide, or facilitate reproductive health care that is lawful under the circumstances in which such health care is provided, or to identify persons for such activities.
Requires a regulated health care provider, health plan, clearinghouse, or their business associates, to obtain a signed attestation that certain requests for PHI potentially related to reproductive health care are not for these prohibited purposes.
Requires regulated health care providers, health plans, and clearinghouses to modify their Notice of Privacy Practices to support reproductive health care privacy."

The new Rule goes into effect in “60 days after publication in the Federal Register, and regulated entities will have 180 days after that to comply.” The Rule requires covered health care providers to revise their Notice of Privacy Practices (NPP); the deadline for making this change is February 16, 2026. NCPA will continue to monitor this news and share updated information with members as it becomes available.

APA Telehealth Legislation (5/8/24)

"APA Services informs House Energy and Commerce Health Subcommittee hearing on telehealth legislation"

Click here to read more.

APA Revision of Telepsychology Guidelines - Comments (5/8/24)

APA is inviting comments on the Proposed Revision of Guidelines for the Practice of Telepsychology- deadline is May 20, 2024.

Click here to read more.

PsyPact (5/8/24)

In April, Mississippi became the 40th PsyPact participating state. There are currently 42 enacted and 40 effective PsyPact participating states.

Click here to see the map.

US DHHS (5/8/24)

The following was announced on April 23:

"Today, the Biden Harris Administration, through the U.S. Department of Health and Human Services (HHS) released the 2024 National Strategy for Suicide Prevention (National Strategy) and accompanying Federal Action Plan. The Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers for Disease Control and Prevention (CDC), in partnership with the National Action Alliance for Suicide Prevention (Action Alliance), led the development of these critical deliverables...The National Strategy outlines concrete recommendations for addressing gaps and meeting the needs of at-risk populations. It is accompanied by the first-ever Federal Action Plan, which identifies 200 discrete actions to be initiated and evaluated over the next three years."

Click here to read the full press release.

Mental Health Parity Report (5/1/24)

A major mental health parity report conducted by health economists at RTI International was released in April. The report was commissioned by The Bowman Family Foundation; APA was one of the funders of the study. The report was based on commercial insurance claims databases from 2019 to 2021 and documents major discrepancies in access to care and reimbursement for psychologists versus medical providers at both the national and state level.

Click here to read the APA press release.

Some key findings:

1. Patients were 10.6 times more likely to go out of network to find psychological care than to find specialty medical care.

2. Lower reimbursement was a major cause of inadequacy for mental health networks.

3. Lack of access is due to a shortage of in-network providers, not an overall shortage of providers.

Both APA and NCPA plan to use the findings of this report in advocacy efforts moving forward.

Additional resources:

RTI International webpage - Click here

RTI Behavioral Health Parity Report - Click here

Executive summary begins on page 6. Specific North Carolina data is shown in Appendix C-33 beginning on page 209.

CNN interview with Dr. Jim Diaz Grados, APA deputy CEO - Click here

APA (4/24/24)

Psychology Week April 21-27 "Celebrate psychology, the science of everything"

Click here to view.

Change Healthcare (4/24/24)

Change Healthcare Cyber Attack

NCPA and APA continue to monitor the consequences of the Change Healthcare cyber attack.

From Marnie Shanbhag, PhD, Senior Director, Office of Independent Practice:

“APA is monitoring the ongoing developments associated with the Change Healthcare cybersecurity breach. While many providers have resumed claims processing utilizing alternate clearinghouses, privacy concerns remain regarding the nature and scope of the data that has been compromised. We are aware of media reports that data stolen in the initial ransomware attack may have changed hands to a second ransomware group. To date, Change Healthcare has not provided information about whose personally identifiable information and/or protected health information may have been compromised and if so, what specific data has been impacted.

APA continues to follow the situation closely and is advocating strongly that Change Healthcare is solely responsible for notifying all affected parties under HIPAA Breach Notification Rule. At this time, because Change Healthcare has not identified whose data might have been compromised, psychologists could not notify affected patients, even if they had such an obligation. In our view, however, the responsibility to give breach notification remains with Change Healthcare.”

As mentioned above, recent news reports indicate that sensitive data, including PHI, may still be vulnerable. In response, some providers are considering placing a credit freeze and/or fraud alert on their credit report with the three main credit bureaus (Equifax, Experian, TransUnion). Click here to learn more.

NCPA continues to advise members to check with their respective billing and data systems for more specific information about filing insurance claims. We will continue to keep members informed about new developments and guidance regarding this issue.

Additional Resources:

DHHS Letter to health care leaders 3/10/24 - Click here to view

DHHS Press release 3/13/24 - Click here to view

Letter from Congress to HHS dated 3/19/24

DHHS Letter to healthcare providers dated 3/25/24, including resource list

DHHS FAQ page updated 4/19/24 - Click here to view

Biden-Harris Administration’s Follow-up Meeting with Insurers dated 3/19/24 - Click here to view

APA response - Click here to view

Palmetto GBA (Medicare) - Click here to view

United Healthgroup Information page - Click here to view

APA (4/17/24)

Proposed Revision of Guidelines for the Practice of Telepsychology

Click here to see the public comment site. The deadline is May 20, 2024.

BCBSNC (4/17/24)

"Starting April 10, 2024, Blue Cross NC will begin reimbursing additional behavioral health inpatient and outpatient services performed via Telehealth visits...These additional behavioral health services include inpatient or outpatient daily care evaluative and/or discharge management services."

Click here to read more.

United Healthgroup (4/17/24)

Click here to view all updates related to the Change Healthcare cyber attack.

Mid-Atlantic Telehealth Resource Center (4/10/24)

The Mid-Atlantic Telehealth Resource Center (TRC) is a federally funded regional telehealth training and technical assistance center...Telehealth Resource Centers (TRCs) are federally funded to assist with the development of sustainable telehealth programs as a way to increase access to quality care, with a focus on rural and other traditionally underserved and/or vulnerable populations." Click here to learn more.

NC HIEA (4/10/24)

Click here to read the March 2024 newsletter here, including information about the Change Healthcare cyber attack.

APA Proposed Revision of Guidelines for the Practice of Telepsychology (4/3/24)

"The Working Group to Revise the Guidelines for the Practice of Telepsychology (TP PPG) in consultation with the Board of Professional Affairs (BPA) and Committee on Professional Practice and Standards (COPPS), seek member and public comments on the revision of Guidelines for the Professional Practice of Telepsychology (APA, 2013)."

Click here to read more and submit comments.

BCBSNC (4/3/24)

1. Medicare Advantage
“Blue Cross NC has resolved the provider configuration issue impacting some providers’ participation status in our Medicare Advantage network”.

Click here to learn more.

2. Change Healthcare Financial Assistance
From the March 26 update: “independent providers in need of financial assistance as a result of the Change Healthcare outage that meet the criteria below may apply for an interest-free loan through Blue Cross NC.”

Click here to learn more.

CMS (4/3/24)

1. New "Stay of Enrollment" Status

On March 1, CMS issued information regarding a new enrollment status: "Stay of enrollment is a CMS action that’s less burdensome on providers and suppliers than a deactivation or revocation of your Medicare enrollment. A stay of enrollment (or “stay”) is a preliminary, interim status representing a pause in enrollment." This affects providers who are "non-compliant with at least 1 Medicare enrollment requirement".

Click here to learn more, including examples of when a stay might be imposed and how to respond.

2. CERT Program

The following information was taken from the Palmetto GBA website and was reviewed in the 3/27 Palmetto GBA updates webinar:

"CMS established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. Palmetto GBA uses CERT reports to identify areas of focus for our Provider Outreach and Education efforts. One of the major outcomes of these CERT reports is the paid claims error rate (percentage of dollars paid incorrectly)."

"The CERT contractor reviews a sample of processed claims. If a claim doesn’t meet Medicare’s coverage, coding, and billing rules or the provider fails to submit medical records, it’s counted as a total or partial improper payment".

Click here to learn more.

3. Consolidated CMS 855I/ CMS 855R

“Medicare has merged the CMS-855R into the CMS-855I paper enrollment applications… The CMS-855R will no longer be used to report reassignment information”.

Click here to find more information about the May 2023 revision of the CMS-855I form.

APA Partial Government Funding Bill Restores Half of Medicare Rate Cut (3/27/24)

"Legislation finalizing fiscal year 2024 funding levels for six federal agencies was signed into law by President Biden on March 9, 2024, following its passage over the preceding days by wide bipartisan margins in both the House and Senate. Importantly for psychologists, the legislation included a 1.7% increase in Medicare payment rates, effective March 9, 2024, mitigating the 3.4% reduction in the Medicare conversion factor that took effect on January 1. The newly adopted increase is not retroactive to the beginning of the year. APA Services strongly supported efforts to get this across the finish line." Click here to read the full article.

CMS Electronic Funds Transfer: Revised CMS-588 Required on May 1 (3/27/24)

Medicare Administrative Contractors (MACs) will accept current and revised versions of the CMS-588 form through April 30, 2024. Starting May 1, 2024, providers must use the revised CMS-588 form. Click here to learn more.

Change Healthcare News (3/27/24)

1. Palmetto GBA - Click here to read the March 25 update.

2. United Healthgroup From the March 22 update:

"On March 15, the company restored Change Healthcare’s electronic payments platform and is proceeding with payer implementations. On March 7, the company restored 99% of Change Healthcare pharmacy network services, and continues to work on remaining issues." Click here to read the full update.

3. US Department of Health and Human Services (US DHHS)

Biden-Harris Administration 3/18 Meeting with Insurers Concerning Cyberattack on Change Healthcare

Excerpt: "On March 13, HHS’ Office of Civil Rights (OCR) issued a “Dear Colleague” letter addressing the cybersecurity incident impacting Change Healthcare, a unit of UnitedHealthcare Group (UHG), and many other health care entities. Given the unprecedented size of the attack and public interest, OCR announced in the letter that it opened an investigation of the cyberattack on Change Healthcare and United Health. The letter also made clear to the thousands of other covered entities affected by the breach that they are not OCR’s target. OCR enforces the HIPAA Security Rule which is the Department’s law enforcement tool to protect protected health information from cyber attacks."

Click here to read the full summary.

Change Healthcare (3/20/24)

As many of you are likely already aware, on February 21, Change Healthcare, a health care technology company, disclosed that it had experienced a cyber attack. This company merged with Optum (owned by UnitedHealth Group) in 2022, and is a provider for healthcare billing and data systems across the country. This March 12 document contains more detailed information and resources. Click here to view.

NCPA advises members to check with their respective billing and data systems for more specific information.

Additional updates:

BCBSNC
The Change Healthcare outage "has prevented providers and hospitals who use CHC as a vendor for their operations from being able to receive their remittance from Blue Cross North Carolina (Blue Cross NC) as processed through CHC." Click here to read more.

Change Healthcare Cybersecurity Update for Healthy Blue and Medicare HMO D-SNP - Click here to read more.

Palmetto GBA
The March 15 update includes: "Revised request forms and FAQ were added to the Accelerated and Advance Payment Request section. Information was added to the Additional Internet Resource section." Click here to see the webpage.

UnitedHealth Group March 18 update, including claims and payment information - Click here.

UHC Medicaid Rate Increases for Some Services (3/20/24)

Providers will see increased rates for some behavioral health services provided to North Carolina Medicaid enrollees. Click here to learn more.

APA (3/13/24)

Per APA: "To treat a Medicare patient across state line CMS requires that you be a Medicare provider practicing in the state where you enrolled in Medicare. You also cannot be excluded from practicing in any applicable states. However, meeting the federal requirements is not enough. You also have to satisfy any applicable requirements under state or local law in the states where you or your patients are located.

You would bill your Medicare Administrative Contractor, i.e., the one in the state in which you are enrolled as a Medicare provider."

Change Healthcare (3/13/24)

As many of you are likely already aware, on February 21, Change Healthcare, a health care technology company, disclosed that it had experienced a cyber attack. This company merged with Optum (owned by UnitedHealth Group) in 2022, and is a provider for healthcare billing and data systems across the country. NCPA has been posting information about this situation on the member Listserv and will continue to do so as more information becomes available.

Please click here to see this document for a summary of information and resources regarding this situation.

UnitedHealth Group is currently targeting the week of March 18 to "begin testing and reestablish connectivity to our claims network and software". Flexibilities, including alternative means of claim submission, are being allowed to assist healthcare providers. Optum launched a Temporary Funding Assistance Program to help bridge the gap in short-term cash flow needs for providers (although anecdotal reports indicate that the payments issued so far are quite low). We continue to advise members to check with their respective billing and data systems for more specific information.

APA (3/6/24)

Emerging Trends 2024 report: "What’s ahead for clinical practice? Many key issues in the practice of psychology center around technology and telehealth"

Click here to read the full article.

NC HIEA (3/6/24)

Click here to read the February 2024 newsletter.

NC Department of Health and Human Services (DHHS) (2/28/24)

"The North Carolina Department of Health and Human Services is launching a new Statewide Peer Warmline on Feb. 20, 2024. The new Peer Warmline will work in tandem with the North Carolina 988 Suicide and Crisis Lifeline by giving callers the option to speak with a Peer Support Specialist. Peer Support Specialists (or “peers”) are people living in recovery with mental illness and/or substance use disorder who provide support to others who can benefit from their lived experience."

Click here to read the full press release.

NC Psychology Board Continuing Education Requirements (2/28/24)

2024 is a renewal year for psychologists licensed in North Carolina.

Click here to see the Psychology Board's website for more information.

CE requirements: From the Board website: "During each biennial renewal period, a licensee must complete a minimum of 24 continuing education hours, a minimum of 15 of which must be completed under a Category A program sponsor. The remaining required hours of continuing education may be completed in either Category A or Category B. Included in the 15 hours under a Category A program sponsor, a minimum of 3 continuing education hours in the area of ethics in the professional practice of psychology must be completed."

From the Board's Continuing Education Reference Guide (Click here to view the CE Reference Guide)

"Category A Ethics requirement: Included in the 15 hours of Category A continuing education, a minimum of 3 continuing education hours in the area of ethics in the professional practice of psychology must be completed. To be credited as fulfillment of this requirement, the word "ethics" or a derivative of the word "ethics" must be in the title of the program, and the program must include such content."

Ethics Refresher: From the Board's April 2022 newsletter (Click here to view The Bulletin Board April 2022)

"The ethics refresher will be an educational, no-fail review, and you will have an unlimited number of attempts to complete it...Licensees will only be charged the ethics refresher fee of $50 once per renewal cycle, regardless of the number of attempts needed to complete it.

The ethics refresher will include topics covered by the NC Practice Psychology Act, the Board’s rules (Rule 21 NCAC 54), and the APA’s Ethical Principles of Psychologists and Code of Conduct. Completion of the ethics refresher will also count for one hour of Category A per renewal cycle."

The ethics refresher is required for each license renewal cycle.

CE Broker: The Psychology Board began using CE Broker as the official CE reporting system in 2022. The Board's Fall 2022 newsletter has a CE Broker FAQ. (Click here to view The Bulletin Board Fall 2022)

CMS Behavioral Health Initiatives (2/21/24)

CMS has released new guidance related to three Behavioral Health Initiatives: Collaborative Care Model (CoCM), Psychotherapy for Crisis, and Opioid Use Disorder Screening and Treatment.

Resources:
CMS Behavioral Health Strategy - Click here to view

FAQs- Billing Medicare for Behavioral Health Integration Services - Click here to view

The following information was provided by CMS and Palmetto GBA, the Medicare Administrative Coordinator (MAC) for Jurisdiction M Part B (which includes North Carolina).

1. Psychiatric Collaborative Care Model (CoCM).

"This model enhances usual primary care by adding two key services to the primary care team, particularly patients whose conditions aren’t improving: Care management support for patients receiving behavioral health treatment (and) Regular psychiatric inter-specialty consultation. A team of three individuals deliver CoCM: Behavioral Health Care Manager; Psychiatric Consultant; Treating (Billing) Practitioner." Read more here:

May 2023 Behavioral Health Integration Services Booklet - Click here to read

2. Psychotherapy for Crisis

The 2024 Physician Fee Schedule "establishes new HCPCS codes for psychotherapy for crisis services (HCPCS codes G0017 and G0018) that are furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting). Payment for these psychotherapy for crisis services is equal to 150% of the fee schedule amount for services furnished in non-facility sites of service."

CMS Psychotherapy for Crisis webpage - Click here

3. Opioid Use Disorder Screening and Treatment

"Medicare pays for opioid use disorder (OUD) screenings performed by physicians and non-physician practitioners. If you diagnose your patient with OUD, we also pay for treatment services."

CMS Opioid Use Disorder Screening and Treatment web page - Click here

CMS Mental Health Coverage (2/21/24)

Medicare Learning Network (MLN) issued an updated Mental Health Coverage booklet in May 2023 (MLN 1986542). The booklet addresses provider information topics such as Medicare covered services, "Incident to" billing, and commonly used CPT codes. Click here to see the booklet

BCBSNC - Telehealth Coding and Reimbursement (2/14/24)

"Blue Cross NC will continue to reimburse properly reported telehealth Covered Services claims at the non-facility rates. Providers must continue to report telehealth Covered Services with a Place of Service (POS) code 02 or 10...Blue Cross NC’s updated Pricing Policy will reflect language reflecting the decision to not follow the 2024 CMS reimbursement changes regarding POS 02. Blue Cross NC’s pricing source hierarchy for non-facility telehealth rates published by CMS with POS 02 and 10 will be used to calculate reimbursement for telehealth Covered Services."

Click here to read the full update.

NC Health Information Exchange Authority (HIEA) (2/14/24)

Click here to read the January update.

NC Psychology Board The Bulletin Board (2/14/24)

Click here to read the Winter 2024 newsletter.

The Bulletin Board includes this announcement:

"Department Of Revenue Privilege License Requirement Repealed
Effective July 1, 2024, the requirement for professionals, including psychologists, to obtain a statewide license from the NC Department of Revenue (NCDOR) for practicing their profession in North Carolina will be repealed. This means that professionals, including psychologists, will no longer be required to obtain a new privilege license or renew an existing one. The last period for the privilege license will end on June 30, 2024. If you have any questions about the privilege license, please contact NCDOR at (877) 252-3052 and not the NCPB office.

It is important for psychologists to understand that the requirement for a privilege license from the NCDOR is different and separate from the requirement to obtain a license from the NCPB in order to practice psychology in the state. The obligation to have a license from the NCPB to practice psychology in North Carolina is still in effect and is not affected by the repeal of the NCDOR privilege license requirement."

APA (2/7/24)

Changes to Medicare Quality Reporting in 2024

"Psychologists who see Medicare beneficiaries should be aware of reweighting changes made to the Merit-based Incentive Payment System for 2024, but there are still things you can do to ensure successful participation and prepare for the future."

Click here to read more.

BCBSNC (2/7/24)

1. Issue affecting Medicare Advantage Participation Status:

"A provider configuration issue is impacting some providers’ participation status in our Medicare Advantage network, which also includes our vendor Carelon℠. Currently, the issue is limited to facility type providers that may share a type 2 NPI within their health care system (i.e., hospitals, labs, and professional groups), which is displaying providers as out-of-network. As a result, Blue Cross NC will not require prior authorizations for Medicare through Carelon for Medicare claims for the month of January 2024."

Click here to read more.

2. No Surprises Act for ERISA- Retiree only Plans

On December 28, Blue Cross NC sent an update about the No Surprises Act (NSA) and ERISA plans. It says: "the No Surprises Act (NSA) applies to individual health plans and fully insured and self-insured group health plans, including grandfathered plans" and "Blue Cross NC will include the required NSA and Qualified Payment Amount (QPA) disclosure on any explanation of payment for claims to which the NSA applies based on the plan classification and claim information."

Click here to read the full update.

IMPORTANT NOTE: To help avoid any confusion, we checked with staff in the APA Legal and State Advocacy Office about this notice and were told the following: Qualified Payment Amount (QPA) refers to the balance billing restrictions that don't generally affect psychologists because they only apply to a narrow range of services, such as emergency services and those OON at an in-network facility. CMS has not yet proposed regulations related to GFEs for patients who intend to use their insurance. The only NSA provisions for which CMS has issued regulations that apply to most psychologists are the GFE requirements for patients who don’t have or don’t intend to use their insurance.

UHC (2/7/24)

"UnitedHealthcare Community Plan members require prior authorization approval for transition of care (TOC) from another Prepaid Health Plan (PHP). The PHP or the North Carolina Department of Health and Human Services (DHHS) must provide record of approval before the member receives services.

Claims that are submitted without an approved prior authorization will be denied."

Click here to read more.

APA Practitioner Pulse Survey (2/7/24)

"APA’s 2023 Practitioner Pulse Survey...explored the nature of psychologists’ practices. This year’s survey was distributed via email to a random sample of 16,557 licensed psychologists in the United States from August 30 to September 29, 2023. A total of 561 responded to the survey."

Click here to read more.

NCPA Advocacy: Aetna and the State Health Plan (SHP) (1/31/24)

In November, Aetna leaders met with the Joint Insurance Committee (JIC), a group composed of representatives from psychology, psychiatry, social work, and mental health counseling. Aetna staff shared a prepared demonstration and responded to questions the JIC provided prior to the meeting (thank you to NCPA members who responded to the request for Aetna information last fall). Below is a summary of key points from the meeting.

Please note: The information in this Update represents hours of behind-the-scenes work by both NCPA staff and members, including members of the Advocacy and Practice Committee who serve on the JIC. This is an example of your association, your colleagues, and your membership dollars working hard for you!

Aetna’s Reach Across Segments and Members

Segment	NC Members
Medicare Advantage	150,000
Commercial Group	430,000
Individual and Family Plans (ACA)	260,000

Aetna Commercial products and networks available in NC
1. Broad network: Open Access Managed Choice (OAMC)/Choice POS II; PPO; HMO
2. Value-based products: Multi-tier Aetna Whole Health (AWH) networks
AWH Duke, WakeMed & THN/Cone Health (Triangle & Triad)
AWH Atrium Health (Charlotte & Triad)
AWH Mission Health (Western NC)
3. Connected NC network: subset of the broad network; group business includes OON benefit; Individual and Family Plans (IFP) (PCP selection and referrals not required; no OON benefits except for emergencies)

State Health Plan 2025- Benefit Plans
Base PPO 70/30
Enhanced PPO 80/20
High Deductible Plan
Benefit Differentials for Clear Pricing Project (CPP) Providers

SHP Retiree Plans
Humana will continue to administer SHP Medicare Advantage plans. As of 1/1/25, Aetna will administer the PPO plans currently administered by BCBSNC. Non-Medicare retirees have the choice of the Base PPO Plan (70/30) or the Enhanced PPO Plan (80/20). Medicare eligible retirees may choose a Medicare Advantage plan or the Base PPO Plan (70/30).

State Health Plan Timeline	Deadline:
1. Join Aetna network	3/31/2024
2. Join CPP with Aetna effective 1/1/25	5/31/2024
3. Review/Update Demographic Data	9/30/2024
4. Credential associate level providers	9/30/2024
5. SHP Member Open Enrollment and PCP Selection for 1/1/25	October 2024

Clear Pricing Project (CPP)
1. Providers must participate in the Aetna network to serve SHP members as of 1/1/25
2. Providers must elect to join CPP with Aetna (even if they are currently in CPP)
3. If providers don’t elect CPP, Aetna contract rates will apply (NC Preferred if applicable)
4. CPP schedule is determined by the SHP and will continue to function as it does today
5. Professional fees are based on 160% of current year Medicare (updated in May)
6. Providers can only join CPP during a designated open period
7. Aetna’s initial CPP open period is 11/1/23 to 5/31/24; subsequent open periods will be determined by the SHP, but will likely be one or two months in the spring
8. New providers who join the Aetna network after CPP closes may request to join CPP

Providers who are already part of the Aetna network can join CPP now. Providers only need to join CPP once for their Tax ID number (TIN). Providers can use this link to complete an amendment to their Aetna agreement online and get an email receipt:
https://www.aetna.com/health-care-professionals/nc-shp-clear-pricing-project.html

Contracting, Credentialing, and Fees
1. Credentialing takes about 90 days after the contract is signed
2. Providers must participate in all broad network products (i.e. an in network provider cannot opt out of a specific Aetna plan/product)
3. Providers who are eligible to renegotiate their contract can contact the Provider Contact Center at 1-888-MD AETNA (1-888-632-3862) (TTY: 711) and request renegotiation.
4. Some providers have already been notified of increases to their fee schedule; these are permanent changes.

Resources

Aetna
Provider Contact Center
Credentialing 1-800-353-1232 (TTY: 711)
Medicare medical and dental plans 1-800-624-0756 (TTY: 711)
Non-Medicare plans, including indiv. and family plans 1-888-MD AETNA (888-632-3862)

Provider page https://www.aetna.com/health-care-professionals.html

Provider Onboarding Center https://extaz-oci.aetna.com/pocui/

Join CPP page https://www.aetna.com/health-care-professionals/nc-shp-clear-pricing-project.html

Clinical Policy Bulletins page
https://www.aetna.com/health-care-professionals/clinical-policy-bulletins.html

Office Link Updates newsletters
https://www.aetna.com/health-care-professionals/newsletters-news/provider-newsletters-archive.html

Provider Portal https://availity.com/

State Health Plan
SHP Provider website https://www.shpnc.org/nc-state-health-plan-network

APA Medicare Quality Reporting (1/24/24)

Changes to Medicare Quality Reporting in 2024

Click here to read the full article.

BCBSNC Pricing Policy Update Effective January 1, 2024 (1/24/24)

"Blue Cross NC has modified its pricing policy language to change from using the first published file from the Centers for Medicare and Medicaid Services (CMS) for each calendar year, to the latest published file as of January 15 of each calendar year (NCPA highlight). This allows us to include CMS updates to the published file that follows the first published file."

Click here to read the full announcement and see the updated pricing policies.

NCHIEA (1/24/24)

Click here to read the December 2023 newsletter.

US Dept of Treasury (1/17/24)

New Federal Reporting Requirement for Beneficial Ownership Information (BOI)

"In 2021, Congress enacted the Corporate Transparency Act. This law creates a beneficial ownership information reporting requirement as part of the U.S. government’s efforts to make it harder for bad actors to hide or benefit from their ill-gotten gains through shell companies or other opaque ownership structures.... Beginning on January 1, 2024, many companies in the United States will have to report information about their beneficial owners, i.e., the individuals who ultimately own or control the company. They will have to report the information to the Financial Crimes Enforcement Network (FinCEN). FinCEN is a bureau of the U.S. Department of the Treasury."

Related resources:

Financial Crime Enforcement Network BOI page - Click here
FAQs - Click here
BOI Informational Brochure - Click here
Small Entity Compliance Guide - Click here

According to the FAQs:

"A reporting company created or registered to do business before January 1, 2024, will have until January 1, 2025 to file its initial beneficial ownership information report.

A reporting company created or registered on or after January 1, 2024, and before January 1, 2025, will have 90 calendar days after receiving notice of the company’s creation or registration to file its initial BOI report. This 90-calendar day deadline runs from the time the company receives actual notice that its creation or registration is effective, or after a secretary of state or similar office first provides public notice of its creation or registration, whichever is earlier."

The website also has the following fraud alert:

"Alert: FinCEN has been notified of recent fraudulent attempts to solicit information from individuals and entities who may be subject to reporting requirements under the Corporate Transparency Act. The fraudulent correspondence may be titled "Important Compliance Notice" and asks the recipient to click on a URL or to scan a QR code. Those e-mails or letters are fraudulent. FinCEN does not send unsolicited requests. Please do not respond to these fraudulent messages, or click on any links or scan any QR codes within them."

Note: NCPA is aware that members may have questions regarding this new reporting requirement and we are seeking clarification, in particular about the definition of "reporting company". In the meantime, members are advised to contact their lawyer and/or accountant directly to determine whether your practice meets the definition of a "reporting company".

Aetna SHP and CPP (1/10/24)

As reported in the December 20 APC Update, according to Aetna, providers must be a participating provider in the Choice POS II network to be in network for NC State Health Plan members starting 1/1/25.

Aetna has announced that the CPP open enrollment period is from 11/1/2023 through 5/31/2024 for 1/1/2025 participation.

Click here to read more on the Aetna SHP provider page.

See the Aetna CPP FAQs - Click here

CMS Telehealth Services (1/10/24)

Per CMS: "After December 31, 2023, use POS 02-Telehealth to indicate you provided the billed service as a professional telehealth service when the originating site is other than the patient’s home. Use POS 10-Telehealth for services when the patient is in their home." Modifier 95 is now for those working in a facility: "Use modifier 95 when the clinician is in the hospital and the patient is in the home."

Telehealth services billed with POS 10 will continue to be paid at the non-facility rate, while those billed with POS 02 will be paid at the facility rate.

Read more in the MedLearn Matters Article - Click here

CMS Provider Webinars (1/10/24)

Behavioral Health Integrated Services Webinar- January 17

"This session will include a brief overview of the CMS behavioral health initiative as it relates to general behavioral health integration services and the psychiatric collaborative Care Model (CoCM), eligible conditions, relationships and roles of care team members, and billing."
Click here to read more and register.

Psychotherapy for Crisis Webinar- January 18

"During this session we will include a brief overview of the CMS behavioral health initiative and new coverage under the CY 2024 Physician Fee Schedule (PFS) final rule. Additionally, we will explore the covered services, providers eligible to perform crisis intervention, covered locations where these services can be provided, as well as details regarding Medicare billing for these services." Click here to read more and register.

NC State Privilege Tax Repealed (1/3/24)

The North Carolina 2023-2024 fiscal year state budget was passed on October 2, 2023. The budget includes a section called “Repeal State Privilege Tax on Professionals” which repeals General Statute (G.S.) 105-41. G.S. 105-41 addresses the privilege license tax and states "Every individual in this State who practices a profession or engages in a business and is included in the list below must obtain from the Secretary a statewide license for the privilege of practicing the profession or engaging in the business. A license required by this section is not transferable to another person. The tax for each license is fifty dollars ($50.00)." Psychologists are included under the "professional art of healing" category of the statute.

Since G.S. 105-41 was repealed, effective July 1, 2024, many professionals in private practice, including psychologists, will no longer need to apply for and pay for the State Privilege License tax.

For additional information, click here to visit the NC Department of Revenue Privilege License Tax page.

And click here to read the State of North Carolina Privilege Tax Bulletin, updated November 2023.

National Academy of Sciences (1/3/24)

Strategies to Improve Access to Behavioral Health Care Services Through Medicare and Medicaid

"This National Academies committee will examine the current challenges accessing behavioral health care services due to limited behavioral health practitioner participation in Medicare, Medicaid, and Marketplace insurance programs. The committee will consider current perceptions and administrative processes that hinder practitioner participation, as well as the infrastructure requirements needed for accessible and quality behavioral health integration. The report will provide recommendations and innovative strategies to increase behavioral health workforce participation in these programs."

Click here to learn more and provide input.

CMS (12/27/23)

As previously reported in the November 29 APC Update, the 2024 CMS Physician Fee Schedule Final Rule was announced on November 2, 2023.

Click here to read the APA article from the Office of Healthcare Financing.

Some article highlights:

1. CMS is finalizing its proposal to raise the work values of codes for psychotherapy and health behavior assessment and intervention (HBAI) services by 19.1% over a 4-year period. APA Services will continue to advocate for work value increases for the psychological and neuropsychological testing codes.

2. CMS is adopting an active payment status for CPT codes 96202 and 96203 for Caregiver Behavior Management Training (CBMT).

3. CMS will implement paying claims for telehealth services, including audio-only, using POS 10 (services provided in the patient’s home) at the nonfacility rate. APA staff have confirmed that this is a permanent change. Claims for telehealth services using POS 02 (location other than the patient’s home) will be paid at the facility rate.

4. The codes for psychological and neuropsychological testing (96130–96139) will have provisional status on the 2024 Medicare Telehealth List, so will be covered through 2024.

5. Providers can continue to use their currently enrolled practice location instead of their home address when providing telehealth services from their home. Looking ahead, CMS is requesting comments on the issue of including a practitioner’s home address as a practice location.

Click here to view the CMS Announcement November 2, 2023 Fact Sheet.

Click here to see the Final Rule was published in the Federal Register on November 16, 2023.

Aetna (12/20/23)

1. Telemedicine coverage clarification

The December 2023 OfficeLink Updates newsletter contains a "telemedicine coverage clarification". Effective December 1, 2023, Aetna is not going to cover some telehealth codes/modifiers. Providers are instructed to log on to the Availity portal to see more specific information.

Click here to read the update.

2. SHP

"You must be an Aetna participating provider in the Choice POS II network to be in network for NC State Health Plan members starting 1/1/25."

CPP Open Enrollment Period

Aetna has announced that the CPP open enrollment period is from 11/1/2023 through 5/31/2024 for 1/1/2025 participation.

Click here to learn more on the Aetna SHP provider page.

Click here to read the Aetna CPP FAQs.

NC Medicaid Behavioral Health Services Rate Increases (12/20/23)

From the NC Medicaid Division of Health Benefits November 15, 2023 announcement:

"The North Carolina General Assembly appropriated $220 million in recurring funds in the Current Operations Appropriations Act of 2023 (SL 2023-134) to increase Medicaid reimbursement rates for providers of mental health, substance use disorder (SUD) and intellectual/developmental disability (I/DD)-related services. The Divisions of Health Benefits (DHB) and Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS) analyzed which services were priorities for the increases and what forms the increases might take, and calculated them at the service level to fully allocate the available funds. The rate increases will be effective Jan. 1, 2024."

Click here to read the full article.

Aetna and the SHP (12/13/23)

Effective January 1, 2025, Aetna will be the third party administrator (TPA) for the SHP. According to Aetna, you must be an Aetna participating provider in the Choice POS II network to be in network for NC SHP members starting 1/1/25.

Click here to view the NC SHP Provider page has many helpful resources related to the upcoming transition.

The following Aetna resources are included on this SHP provider page:

2025 NCSHP Network Participation Agreement

2025 NCSHP Network Rate Schedule

2025 NCSHP Network Professional Fee Schedule

2025 NCSHP Network FAQs

BCBSNC (12/6/23)

"Effective January 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is transitioning its Medicare Advantage and Medicare Supplement claims operations to the Facets system, which will enable Blue Cross NC to utilize one system for all members."

Click here to read more.

Click here to learn more about the Blue Cross NC updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2024.

NC HIEA (12/6/23)

Click here to read the November 2023 update.

APA (11/29/23)

2024 Physician Fee Schedule Final Rule Released - Click here to view

KFF (11/29/23)

Understanding the Health Insurance Marketplaces webpage

Includes a link to the article "What to Watch in the 2024 ACA Open Enrollment"

Click here to view

BCBSNC (11/22/23)

Narrow Network Changes Effective January 1, 2024. Click here.

NC HIEA (11/22/23)

Click here to read the October 23 Update.

NC Medicaid (11/22/23)

Expansion FAQs - Click here

NC Psychology Board (11/22/23)

Click here to read "The Bulletin Board" Fall newsletter.

Medicaid (11/15/23)

See the NC Medicaid Telehealth, Virtual Communications Policy dated June 1, 2023.

Click here.

Medicare (11/15/23)

Read the latest guidance on billing and coding Medicare Fee-for-Service (FFS) telehealth claims here. . .

Billing and Coding Medicare FFS Claims - Click here

Telehealth Policy Changes after the Covid-19 PHE - Click here

Medcost (11/15/23)

See the Telehealth- Providers section for updated information - Click here

Tricare (Humana Military) (11/15/23)

See the Telemedicine for Providers page, including a link to Telemedicine FAQs - Click here

UHC/Optum (11/15/23)

Optum: Behavioral Health Telehealth Billing Quick Reference Guide dated October 1, 2023:

Click here to view.

UHC Covid-19 Telehealth page, including Medicare Advantage and Medicaid, updated April 2023 - Click here

Spotlight On: Online Practice Toolkit (11/15/23)

NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas and is consistently updated by the Advocacy and Practice Committee (APC).

We have recently updated the Insurance page of the Toolkit. The page is divided into two sections. The first section includes resources related to general insurance topics such as provider contracts, billing codes, claims denials, and reimbursement. The second section lists both government and commercial payors and includes links to resources for each, such as the provider home page, clinical policies, documents and forms, and newsletter updates.

Aetna (11/8/23)

Office Link Updates newsletter (September 2023)

"When the public health emergency ended on May 11, 2023, we continued coverage for the liberalized telemedicine procedures/modifiers. Beginning December 1, 2023, we’re modifying our policy to no longer cover some of the liberalized telemedicine procedures/modifiers." Read more here.

BCBSNC (11/8/23)

The June 12, 2023 update "Telehealth Policy for 2023: Corrected Claims, Modifiers, and Reminders" contains information regarding the telehealth policy, POS codes, and modifiers. Click here to see the update.

Cigna (11/8/23)

Commercial plans: "Individual providers and outpatient clinics may permanently use telehealth for outpatient therapy, applied behavior analysis (ABA)*, medication management, and Employee Assistance Program (EAP) services. The expiration of the PHE does not apply to these telehealth services." Click here to see the full webpage, including billing information.

Medicare Advantage: Click here to see the Billing and Authorizations Guidelines document (telehealth guidance begins on page 9)

Humana (11/8/23)

Claims Payment Policy- Telehealth and Other Virtual Services - updated April 2023.
Click here.

Spotlight On: Online Practice Toolkit (11/8/23)

NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas and is consistently updated by the Advocacy and Practice Committee (APC).

BCBSNC Pricing Policy Update Effective January 1, 2024 (11/1/23)

"Blue Cross NC has modified its pricing policy language to change from using the first published file from the Centers for Medicare and Medicaid Services (CMS) for each calendar year, to the latest published file as of January 15 of each calendar year. This allows us to include CMS updates to the published file that follows the first published file."

Click here to read more including links to specific updated policies.

NC HIEA (11/1/23)

NC HealthConnex Teletown Hall November 15 12-1 PM

Click here to learn more and register.

"How to Connect" WebEx meeting November 27 12-1 PM

Click here to learn more and register.

CMS (11/1/23)

CMS is conducting a study to help us improve your experience with Medicare program and billing resources.

Click here to learn more.

APA Call for Comments (10/25/23)

The APA seeks comments from all interested individuals and groups – including psychologists, health care professionals, researchers, clients/patients and their families, APA governance members, and the general public – on the draft Clinical Practice Guideline for the Treatment of Chronic Musculoskeletal Pain in Adults.

Click here to read more.

Palmetto GBA (Medicare) (10/25/23)

Medicare Deductible, Coinsurance, & Premium Rates: CY 2024 Update
Click here to read the update.

Lunch and Learn: Improving Your Palmetto GBA Customer Experience Webinar: November 30, 2023
Read more and register here.

CMS Medicare Administrative Contractor (MAC) (10/18/23)

"A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims."

Click here to read more.

Palmetto GBA is the "MAC" for Jurisdiction M Part B providers, including North Carolina and three other states. Click here to see the home page.

The website has an Events and Education page: "The Provider Outreach and Education department (POE) educates providers and their staff regarding the fundamentals of the Medicare program, national and local policies, procedures, new Medicare initiatives, significant changes to the Medicare program, and issues identified through data analysis. Palmetto GBA offers education to providers through online, teleconference or live and in-person events."

Click here to learn more about these educational events.

APA Mental Health Parity Advocacy (10/11/23)

From the desk of Katherine B. McGuire, MS, Chief Advocacy Officer, APA Services...

Dear Colleague:

Please take 2 minutes to strengthen crucial proposed rules that would improve how insurance companies cover mental health services. Recently, the Department of Labor proposed new rules aiming to strengthen mental health parity standards and enforcement. While this proposal is a big step in the right direction with provisions we support, we have also identified provisions that need improvement. Help ensure these concerns are heard loud and clear by submitting a pre-written message today.

By participating in this campaign, you will inform key policymakers on important problems in insurance coverage of mental health services compared to medical services, including:

Desperate patients are unable to find timely and appropriate care through their insurance network.
Unfair/deceptive limits on patient’s mental health coverage.
Unreasonable limits on the length or type of mental health treatment the insurance plan will cover, even though the treatment is medically necessary for the patient’s care.
Burdensome administrative requirements such as retroactive denials after preauthorization, prepayment audits, and hours-long hold times with provider representatives.

With your help, we have a chance to make needed strides towards covering mental health services on an equal footing as physical health services. There is a limited window of opportunity to act – the new deadline is October 17. Please seize this moment and advocate for more equitable treatment in mental health care!

Center for Connected Health Policy (CCHP) (10/11/23)

"The Center for Connected Health Policy is a nonprofit, nonpartisan organization working to maximize telehealth’s ability to improve health outcomes, care delivery, and cost effectiveness. Our expertise in telehealth policy was recognized in 2012, when we became the federally designated National Telehealth Policy Resource Center."

Home page - click here

North Carolina state policies page - click here

The National Telehealth Policy Resource Center "Billing for Telehealth Encounters" July 2023
click here

Fact Sheet About Mental Health Parity (10/4/23)

Click here to view the fact sheet.

NC HIEA (10/4/23)

Click here to read the September 2023 Update.

The Trust (10/4/23)

"Traditional Continuing Education (CE) usually refers to more formal classroom experiences such as workshops, seminars, and formal classes where an expert teaches certain concepts or skills. Continuing Professional Development (CPD), in contrast, is considered a broader concept than traditional CE and encompasses a wider set of experiences that contribute to the competency of a professional." Click here to read the full article.

APA (9/28/23)

From the desk of Katherine B. McGuire, MS, Chief Advocacy Officer, APA Services...

Desperate patients are unable to find timely and appropriate care through their insurance network.
Unfair/deceptive limits on patient’s mental health coverage.
Unreasonable limits on the length or type of mental health treatment the insurance plan will cover, even though the treatment is medically necessary for the patient’s care.
Burdensome administrative requirements such as retroactive denials after preauthorization, prepayment audits, and hours-long hold times with provider representatives.

With your help, we have a chance to make needed strides towards covering mental health services on an equal footing as physical health services. There is a limited window of opportunity to act – the deadline is October 2nd at 11:50pm EDT. Please seize this moment and advocate for more equitable treatment in mental health care!

PsyPact (9/28/23)

"The PSYPACT® Commission has proposed changes to Rule 4 and Rule 5 with the addition of 4.13 and 5.13. The additions serve to clarify who "authorization" applies to as an authorization holder under PSYPACT®." There will be a public hearing on 11/16/23. Read more here:

Click here to visit the Public Comment page.

Click here to visit the Meetings page.

BCBSNC (9/27/23)

Providers asked to verify taxonomy codes - Click here to read.

Taxonomy Codes when billing for out of state members - Click here to read.

PsyPact News (9/27/23)

PsyPact Commission Releases First Annual Report. Click here to read.

Current Map of PsyPact Participating States. Click here to view.

Action Alert (9/20/23)

From the desk of Katherine B. McGuire, MS, Chief Advocacy Officer, APA Services...

Desperate patients are unable to find timely and appropriate care through their insurance network.
Unfair/deceptive limits on patient’s mental health coverage.
Unreasonable limits on the length or type of mental health treatment the insurance plan will cover, even though the treatment is medically necessary for the patient’s care.
Burdensome administrative requirements such as retroactive denials after preauthorization, prepayment audits, and hours-long hold times with provider representatives.

With your help, we have a chance to make needed strides towards covering mental health services on an equal footing as physical health services. There is a limited window of opportunity to act – the deadline is October 2nd at 11:50pm EDT. Please seize this moment and advocate for more equitable treatment in mental health care!

APA Health Information Exchanges (9/13/23)

What psychologists need to know about Health Information Exchanges.

Click here to read the article.

BCBSNC BetterDoctor (9/13/23)

"Currently, Blue Cross NC individual providers can ONLY submit directory attestations through Quest Analytics BetterDoctor. This is a correction from our previously posted communication stating providers could use the Council for Affordable Quality Healthcare (CAQH) to attest. Blue Cross NC is NOT currently partnering with CAQH for providers to attest. (Please note only credentialing is done through CAQH).

Click here to read the full announcement.

NCHIEA (9/6/23)

Click here to read the August newsletter.

APA Simple Practice Terms of Service (TOS) (9/6/23)

Simple Practice Terms of Service (TOS)

From Deborah C. Baker, JD, APA Director, Legal & Regulatory Policy:

"As you may have heard, SimplePractice updated their explanation of their Terms of Service (TOS) yesterday. Based on feedback from APA, they clarified several points to be more transparent, explained the legal language in certain sections of their Terms of Service (TSOS), and gave users who had not yet signed the TOS additional time to review. You can find their update here: SimplePractice’s Latest Update

The substance of what SP clarified boils down to the following:

New state privacy laws in many states required SP to update their TOS (happening across the industry) to make things more explicit.
They are observing all HIPAA, BAA, HITRUST regulations. We would expect them to do this.
They do not provide AI with access to practitioner or client data.
They are not selling any PHI or personal user information. We would expect them not to do this.
They do analyze de-identified data for their business purposes (marketing, new products, etc.). Business purposes can be very broadly defined.
They do not co-opt forms users put on their system and then repackage them and sell them. The legal language in their TOS implies that they could do this; however, the language in their TOS has not changed with this recent update.
They do not currently sell de-identified data and have no plans to do so; they state that they will let their users know transparently if this changes in the future.
They have clarified how to opt out of arbitration if you wish to do so.

We understand that members may ask you for advice on whether they should sign or not. Members may still have legitimate concerns about how de-identified data sets may be used, even if PHI is being protected. It is incumbent upon members to conduct their own review of any terms of service and to be comfortable with what they are signing. The decision will come down to a member’s risk tolerance, their analysis of their business needs, and their understanding of the technology industry and current business models in the industry. Having said that, based on our review, we do think that it is a legitimate and valid choice to STAY with SP and it is a legitimate and valid choice to LEAVE. We hope you find this information helpful.

Disclaimer: Please understand that APA cannot provide legal advice to its members, and members are encouraged to consult with a licensed attorney in private practice for such business and compliance decisions."

NCPA (8/30/23)

NCPA submitted a letter to provide comments on the proposed rule on the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) released by the Centers for Medicare and Medicaid Services (CMS) on July 13, 2023. Along with other recommendations, NCPA advocated that CMS:

Support telehealth access by permanently paying claims for telehealth mental health services provided in patient homes at the non-facility rate
Improve reimbursement for behavioral health services by increasing the work values for psychotherapy codes, psychological and neuropsychological testing services, and the Health Behavior Assessment & Intervention (HBAI) services
Support substance use services by increasing reimbursement for psychotherapy services in the substance use services bundle
Ensure access to evidence-based behavioral health interventions by activating reimbursement for caregiver behavior management training services
Work with APA Services and other medical societies to develop new codes for brief interventions and safety planning for patients at risk of suicide in the emergency department and other settings

Click here to read the full letter, including all recommendations.

Action Alert: CMS CY24 Physician Fee Schedule (8/30/23)

Dear Colleague:

We ask everyone representing the field of psychology – including practitioners, researchers, students and educators alike, as well as our allies in the health care field – to show a unified front in promoting greater access to and equity in the delivery of mental health care.

We need you to contribute your voice to our campaign asking the Biden Administration to invest in key psychological services. This includes reimbursement for telehealth services, interventions for clients at risk of suicide, treatment for substance abuse disorders and other services. Right now, many communities remain critically underserved, such as many rural communities, racial and ethnic minority communities and LGBTQA+ communities. Stronger funding for and flexibility around how these services are delivered will help reduce those disparities by making it more financially viable for professionals to stay in and enter mental health professions across the nation, including participating in Medicare, thus strengthening the healthcare system’s ability to meet community needs.

The Centers for Medicare and Medicaid Services (CMS) issues an annual proposed rule – the Medicare Physician Fee Schedule – that has serious implications across the health care field. It sets the benchmark for how other insurance programs cover and reimburse for specific services. It also sets the standard for what kind of services are covered, including new and emerging forms of treatment. We are weighing in because this year’s proposed rule includes promising provisions that need your support to become a reality (e.g. supporting telehealth in clients’ homes), and provisions that need improvement (e.g. the current proposal is not sufficiently inclusive of psychological testing services). You can learn more about those provisions in our action center.

This proposed rule is coming at a time when federal agencies – including CMS – are facing Congressional pressure to reduce spending. Now more than ever, it is important that psychology be represented in the public response to this proposal, to stress the need to preserve funding and strengthen access to mental and behavioral health services. Please do not sit this campaign out – take action today!

Sincerely,

Thema Bryant, PhD
APA President, 2023

BCBSNC (8/23/23)

August 18 update: "We are pleased to share that through measures taken to improve the process, we are currently enrolling new providers on a 60-day timeframe." Click here to read the full update.

Simple Practice - TOS Update (8/23/23)

APA update: On August 16, we received the following update from Deborah Baker of the Office of Legal and State Advocacy: "Marnie Shanbhag from the Office of Independent Practice and I had a collaborative and productive meeting with SimplePractice leadership and they were very amenable to hearing our concerns. They again reassured us that any user data that “lives on” beyond a customer’s account termination is completely non-identifiable and part of larger aggregate data sets, and that SimplePractice does not sell personally identifiable information (from the practitioner) nor PHI (from the client/patient) or provide AI with access to practitioner or client data. In response, they have extended their acceptance date to Sept 1st, 2023, and are going to take another look at their terms of service to see if there are areas they can make clearer. We look forward to receiving their additional clarifications."

Action Alert: CMS CY24 Physician Fee Schedule (8/23/23)

Dear Colleague:

Sincerely,

Thema Bryant, PhD
APA President, 2023

NCHIEA (8/16/23)

Click here to read the July newsletter.

Simple Practice (8/16/23)

NCPA is aware of concerns that have been raised regarding the new Terms of Service (TOS) for Simple Practice. APA is also aware of these concerns. On August 11, we received the following message from Marnie Shanbhag, PhD, Senior Director, APA Office of Independent Practice: "Deborah Baker, JD from the Practice Legal and Regulatory team and I are meeting with the leadership of Simple Practice next week to address your concerns. In the meantime, they have extended their deadline for returning the signed terms of service (TOS) to I believe 9/1/2023. They are assuring us that they do not access PHI outside of HIPAA guidelines nor do they not keep PHI after termination of customers’ accounts. Regardless, we will be discussing areas of contract language in the TOS that appear to give broader access among the other issues raised." NCPA will share additional information in future Updates.

APA (8/9/23)

"The Centers for Medicare and Medicaid Services (CMS) CY2024 Physician Fee Schedule (PFS) Proposed Rule was released on Thursday July 13, 2023. APA Services, Inc. (APASI) is very pleased to see positive results from our advocacy efforts and responsiveness from CMS."

Click here to read the article.

APA Advocacy (8/9/23)

The proposed rule still needs advocacy from all psychologists!

CMS Proposed Rule for the 2024 Physician Fee Schedule. Click here to read.

After reading, click here to share your voice.

BCBSNC (8/9/23)

Directory Attestations:

Annual NCQA Provider Directory Assessment

Click here.

Adjustment of commercial plans' length of stay guidelines

Click here.

APA (8/4/23)

CMS Proposed Rule for the 2024 Physician Fee Schedule. Click here to read.

After reading, click here to share your voice.

APA (7/25/23)

Calling on Congress to tie Medicare payment rates to inflation. Click here to read the article.

NC Psychology Board (7/25/23)

Click here to read the Summer 2023 issue of the "Bulletin Board".

988 One Year Anniversary (7/19/23)

July 16 marked the 1-year anniversary of the three-digit 988 Suicide and Crisis Lifeline.
Click here to read the APA article.

APA Call for Comments (7/19/23)

Comments Being Accepted for the 2014 Edition of the Standards for Educational and Psychological Testing, (AERA, APA, NCME):

In anticipation of the document’s upcoming revision, comments are being accepted for the 2014 edition of the Standards for Educational and Psychological Testing, American Educational Research Association (AERA), the American Psychological Association (APA), the National Council on Measurement in Education (NCME) at https://commentinggov.apa.org/. Closing deadline for comments is 5:00 p.m. EDT on August 14, 2023. Psychologists may contact Marianne Ernesto (APA Director of Testing and Assessment) at mernesto@apa.org with any questions.

PsyPact (7/19/23)

There are currently 38 PsyPact participating states. Click here to see the updated map.

NC Health Information Exchange Authority (HIEA) (7/12/23)

Click here to read the latest newsletter.

NCPA Spotlight: Online Practice Toolkit (7/12/23)

Risk Management (including Audits): In this section, members will find resources related to Risk Management topics such as record keeping (detailed versus lean records), social media, and client termination. Both in and out of network providers can find articles about responding to an audit request. Also, we've recently added resources with updated information regarding CMS topics such as Comparative Billing (CBR) reports, the Targeted Probe and Educate (TPE) program, and Additional Documentation Request (ADR) letters.

NC DHHS Delayed Launch of Tailored Plans (7/12/23)

"The Department of Health and Human Services is delaying implementation of the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. Tailored Plan launch was scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined."

Click here to read more.

APA Advocacy (7/5/23)

Advocacy Priorities Webpage - Click here

Medicare Reimbursement and Access - Click here

Washington Update newsletter page - Click here

APA (6/28/23)

Click here to view the webpage dedicated to "Information and tools to help you navigate the health care system with numerous pointers for billing and working with commercial insurers and government payers"

NC Psychology Board (6/28/23)

The Board has a dedicated "Advisory Statements" page where psychologists can find documents about topics such as "Decision Making Regarding Record Keeping Upon Death", "Medication Recommendations" and "Using Current Tests and Norms".

Click here to visit the page.

NC Medicaid (6/21/23)

Click here to view the Ombudsman home page.

What is a Local Management Entity-Managed Care Organization (LME-MCO)?

Click here for the LME-MCO Directory

Implementation of Tailored Plans targeted for October 1, 2023- click here to read the press release.

Understanding the Transition to Managed Care FAQs.

APA: The CMS Physician Fee Schedule (6/14/23)

Click here to read the June 7 update.

APA: Changes Coming To Psychology Practice After COVID-19 (6/14/23)

Click here to read the June 9 article.

Spotlight On: NCPA's Practice Toolkit (6/14/23)

NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit.

This Toolkit contains information and resources covering 24 major practice areas and is consistently updated by the Advocacy and Practice Committee (APC). For example:

1. Patient Resources: This section includes references and links to a wide variety of websites, books, TED Talks, videos, and podcasts that psychologists may wish to use in their work. Topics covered include anxiety, depression, stress, grief, relationships/marriage, parenting, ACOA, divorce, resiliency, autism, and many more.

2. North Carolina General Statutes: Here, members will find links to psychology-related statutes covering topics such as provider directories, credentialing, mental health parity, and the "record copy fee" statute, which outlines what psychologists may charge for copying records.

BCNSNC (6/7/23)

"Blue Cross NC individual providers can ONLY submit directory attestations through Quest Analytics BetterDoctor." Read more here.

NCHIEA (6/7/23)

Click here to read the May 2023 newsletter.

NCGS 58-50-61 Utilization Review (5/31/23)

"An insurer shall provide the clinical review criteria used to make the noncertification to any person who received the notification of the noncertification and who follows the procedures for a request. An insurer shall also inform the covered person in writing about the availability of assistance from Health Insurance Smart NC, including the telephone number and address of the Program."

Read the full statute here.

NC DOI (5/31/23)

Prompt Claim Payment Guidance page

"N.C.G.S. § 58-3-225 requires an insurer within thirty calendar days after receipt of a claim to either pay a claim or send a notice to the claimant. The notice must state all the specific good faith reason or reasons for the denial, including benefit limitations, coordination of benefits, lack of eligibility, or lack of coverage for the services provided." Click here to learn more.

Provider Complaints page.

Smart NC for consumers

"Smart NC can assist you with filing a complaint with your insurance company if you are covered under the North Carolina State Health Plan for Teachers and State Employees or any other self-insured company. A self-insurance company is typically a large business that pays an insurance company to administer health benefits for its employees but the company funds its own insurance program." Click here to learn more.

US DOL ERISA plans (5/31/23)

"The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans." Click here to learn more.

APA - Medicare Billing Post PHE (5/24/23)

Dr. Marnie Shanbhag, APA Practice’s Senior Director for the Office of Independent Practice, shared a document addressing Medicare billing post PHE. Contributors included Diane Pedulla, JD, and Stephen Gillaspy, PhD from the APA's Office for Healthcare Financing.

Click here to read the document.

APA Record Retention (5/24/23)

APA generally advises Medicaid and Medicare providers to maintain their records for a minimum of 10 years in order to avoid potential liability and ensure they can properly defend themselves against all False Claims Act cases. This advice is based on:

1. The federal False Claims Act (FCA) which "provides a way for the government to recover money when someone submits or causes to be submitted false or fraudulent claims for payment to the government, including the Medicare and Medicaid programs." more info here (including a brief video):

https://oig.hhs.gov/newsroom/oig-podcasts/false-claims-act/

2. A 2019 US Supreme Court decision (Cochise Consultancy, Inc. v. United States ex rel. Hunt, 139 S. Ct. 1507). The Court held that the statute of limitations for an action brought by a private party or whistleblower on behalf of the government may be up to 10 years, regardless of who initiated the action. More here:

https://www.oalaw.com/blog/health-law/how-long-should-medicaid-and-medicare-providers-retain-medical-records-six-years-or-ten-years-the-answer-may-surprise-you/

The False Claims Act applies to federal monies. Medicare managed plans are federal programs, so the 10-year retention period also applies.

For private insurance or self-pay patients, NC General Statutes 90.270-148 says the Board may take action against any psychologist who:

"Except when prevented from doing so by circumstances beyond the psychologist's control, has failed to retain securely and confidentially the complete case record for at least seven years from the date of the last provision of psychological services; or, except when prevented from doing so by circumstances beyond the psychologist's control, has failed to retain securely and confidentially the complete case record for three years from the date of the attainment of majority age by the patient or client or for at least seven years from the date of the last provision of psychological services, whichever is longer; or, except when prevented from doing so by circumstances beyond the psychologist's control, has failed to retain securely and confidentially the complete case record

indefinitely if there are pending legal or ethical matters or if there is any other compelling circumstance" https://www.ncleg.gov/Laws/GeneralStatutes

These record retention laws are minimum periods of time that providers are required to keep records- records can certainly be kept longer.

Spotlight On: NCPA’s Online Practice Toolkit (5/24/23)

NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas. For example:

- Record Keeping, Retention, and Destruction page: in addition to resources mentioned above, members will also find APA’s Record Keeping Guidelines and resources related to record creation, maintenance, and proper destruction.

- Sample Forms and Policies page: here, members will find resources such as: APA Model Forms specific to North Carolina; links to sample forms and information from sources including the APA, The Center for Ethical Practice, The Trust, and US DHHS; and original documents created by NCPA committee members addressing specific practice areas.

The Toolkit is updated consistently by the Advocacy and Practice Committee (APC).

NCPA - SHP Survey (5/17/23)

Recently, NCPA sent a survey to all members asking about the State Health Plan (SHP).
Click here to see a summary of the survey responses.

BCBSNC - Changes to Professional Fees (5/17/23)

In mid-April, NCPA received the following information from Anne Winefordner, the Director of Provider Contracting at BCBSNC:

While many of the professional fee schedules at Blue Cross NC update each year on April 1 based on a percentage of CMS rates, we routinely collaborate with providers to account for special circumstances to identify any opportunities to best support providers in our network… since 2009, our pricing policies have applied reimbursement percentages established through provider contracts with rates published by the Centers for Medicare & Medicaid Services (CMS), and therefore updated fee schedules may reflect increases or decreases in provider reimbursement rates based on CMS changes.

I am pleased to let you know that we will be updating contracts for independent behavioral health providers to increase the percentage of Medicare applicable to reimbursement rates for the important services they provide. We are targeting next week for communications to Providers on this increase.

Please know that Blue Cross NC is committed to a whole-person approach to care, and we understand that good health depends on good mental health. Thank you for your help in communicating this important upcoming change for independent behavioral health providers.

In follow-up communication with Ms. Winefordner, NCPA has been informed that:

1. The State Health Plan (SHP) was excluded. Since the SHP rates update annually based on CMS changes, providers may have seen decreases for that line of business. BCBS reports that the “increase in multiplier” was applied to all other commercial lines of business.

2. Notification will only be sent to providers who are on fee schedules that update annually with Medicare.

3. BCBSNC updated their commercial rates effective 4/1 and they are reprocessing all impacted claims. Providers do not need to contact customer service regarding these claims.

4. BCBSNC also has “more current fee schedules” that may be “a positive change for certain providers depending on their current contract rates”. BCBSNC would need to review those contracts on an individual basis; providers can call the dedicated provider line at 800-777-1643 to request a contract review. The request will be routed to the appropriate team member based on county assignment, to be worked in order of receipt.

The Covid-19 Public Health Emergency (PHE) expires at the end of the day today, May 11, 2023.

Along with the resources listed below, members can refer to
the APC Update of April 26 for information about the end of the PHE.

US DHHS Fact Sheet (5/11/23)

Click here to view the End of the Covid-19 Public Health Emergency (including information about Medicare, Medicaid, and telehealth)

CDC: End of the Federal Covid-19 PHE Declaration (5/11/23)

Click here to view the declaration.

NC DHHS (5/11/23)

Click here to view the Covid-19 web page.

Click here to view the Health Care providers page.

NCPA Advocacy- Aetna and the State Health Plan (SHP) (5/10/23)

On April 4, Martha-Turner Quest (ED) and Cristin Saffo, PsyD (DPA) met with three Aetna representatives: Jim Bostian, NC President; Linda Cecarelli, Executive Director, Network Strategy and Operations; and Michael Driscoll, head of the support team managing the SHP transition. One of the primary goals of the meeting was to begin a dialogue addressing the 2025 transition to Aetna being the third party administrator (TPA) for the State Health Plan (SHP).

Key points shared by Aetna staff:

1. Confirmation that Aetna will continue to support and administer the Clear Pricing Project (CPP). Administering the CPP was a requirement of the application to become the TPA for the SHP.

2. Aetna providers currently enrolled in the CPP will continue to receive CPP rates when Aetna becomes the TPA in January 2025. CPP providers who are already in the Aetna network will need to “re-select” the CPP on the Aetna portal (more instruction will be forthcoming). The CPP will be an amendment to the Aetna Participating Provider Agreement.

3. Providers who are neither currently credentialed with Aetna or enrolled in the CPP will need to join the Aetna network first and then apply to the CPP during its next open enrollment period; these cannot be done at the same time. It will not be an option for providers to join the CPP network but not the Aetna network.

4. Aetna plans to reach out to all out of network providers later this year, inviting them to join the Aetna network.

Key points of NCPA advocacy:

1. NCPA survey data showing that fewer members are in network with Aetna than with BCBSNC, the current TPA for the SHP (survey results will be shared in a future APC Update)

2. Reimbursement rates- discussion of Aetna, Medicare, and CPP rates

3. Issues related to network adequacy and patient access to care

Both NCPA and Aetna agreed to continued collaboration to address general issues as well as the SHP transition- we will keep members posted.

NC HIEA (5/3/23)

Click here to read the April 2023 Update.

NC Department of Insurance (5/3/23)

Click here to view the home page.

Click here to visit the provider complaints page.

Click here for Smart NC- for consumer complaints.

US DHHS Office of Civil Rights (OCR) (4/26/23)

The Covid-19 PHE is scheduled to end on May 11, 2023. During the PHE, OCR exercised HIPAA enforcement discretion and did not impose penalties on providers for noncompliance with the HIPAA Rules (in other words, for using non HIPAA-compliant technology). An HHS press release dated April 11 states:

"OCR is providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period."

Click here to read the press release.

In this press release, Melanie Fontes Rainer, OCR Director, states: “OCR is continuing to support the use of telehealth after the public health emergency by providing a transition period for health care providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA Rules.”

Click here to see the HHS website page related to HIPAA and Telehealth.

Click here to see the HHS Guidance page on HIPAA and Audio-only telehealth.

BCBSNC Documentation and Coding: Substance Use Disorders (4/19/23)

A quick reference guide to assist with accurate, complete documentation and coding that reflects the true nature of a patient’s current health status at the highest level of specificity.

Read more here.

BCBSNC Directory Facility Attestation Deadline extended to April 28 (4/19/23)

Click here to view.

Federal Trade Commission (FTC): BetterHelp broke its privacy promises (4/19/23)

Read the full article here.

APA: What psychologists need to know about online therapy services (4/19/23)

Click here to read.

APA (4/12/23)

New Psychology Licensing Exam Expands - Click here to read more

The National Psychologist (4/12/23)

Click here to read the article about subpoenas and requests for advocacy letters, written by The Trust's risk management consultants.

BCBSNC (4/5/23)

Documentation and Coding for Bipolar, Delusional, and Personality Disorders

Click here for details.

UHC (4/5/23)

Click here for April Network News.

Cigna (3/29/23)

Interim Billing Guidance for Providers

Click here to see Provider FAQs: Virtual Care Services for billing information.

UHC (3/29/23)

NC Medicaid: HealthChoice/CHIP Alert - Click here to read the details.

Humana Military/Tricare (3/29/23)

Click here to view updates to telemedicine POS and modifier.

Help Us Advocate: Complete the SHP Survey (3/29/23)

In January 2025, Aetna will begin to serve as the Third Party Administrator (TPA) for the self-funded State Health Plan (SHP). At this time, the NCPA Advocacy and Practice Committee does not know whether the SHP will use an Aetna network, or will maintain a separate network (currently the Clear Pricing Project, or CPP) to serve the clinical needs of their employees. The committee plans to use the results of this survey to 1) inform Aetna and the State Health Plan Board about how behavioral health providers are thinking about their participation in the networks and 2) advocate for providers and their patients.

Please complete the State Health Plan (SHP) survey, which should take approximately 3 minutes to complete.

The survey will close Thursday, March 30, 2023

APA - Bipartisan Legislation Introduced to Increase Medicare Patients' Access to Psychologists (3/22/23)

U.S. Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Markwayne Mullin (R-OK), and Martin Heinrich (D-NM) have introduced the Increasing Mental Health Options Act to make it easier for Medicare patients to receive treatment from a psychologist.

Click here to read the full article.

NC DHHS - "Investing in Behavioral Health and Resilience" plan (3/22/23)

On March 8, Governor Roy Cooper released a comprehensive plan to invest $1 billion in addressing North Carolina’s mental health and substance use crisis.

Click here to see the press release.

C lick here to see the plan.

NC Psychology Board Bulletin Spring 2023 (3/22/23)

Click here to read.

BCBSNC Upcoming Provider Webinars for new BCBSNC Behavioral Health Referral Services (3/22/23)

Click here to view.

CMS - Fact Sheet for Transition after PHE (3/15/23)

Waivers, Flexibilities and the Transition Forward from the Covid-19 PHE (updated February 27)

Click here to view.

APA - Online Therapy Services (3/15/23)

What Psychologists Need to Know about Online Therapy Services (March 1)

Click here to read

APA - Expanding Access to Care (3/15/23)

Expanding Access to Mental and Behavioral Health Services in Medicare (March 10)

Click here to read.

APA (3/8/23)

APA adopts policy in reaction to SCOTUS decision overturning Roe v. Wade.

Click here to read the policy.

BCBSNC (3/8/23)

Directory Attestation Deadline March 29, 2023 for Inclusion in Blue Cross NC's Online Provider Directory

Click here to read.

BCBSNC (3/8/23)

Update to New Provider Enrollment Delays.

Click here to read the details.

NC Health Information Exchange (HIE) (3/1/23)

Click here to read the February 2023 update.

CMS (3/1/23)

CMS Releases New Information to Help Health Care Providers Prepare for the End of the COVID-19 Public Health Emergency on May 11

February 23: To help health care providers prepare for the end of the COVID-19 public health emergency (PHE) on May 11, 2023, CMS published updates about how the Medicare, Medicaid, Children's Health Insurance Program (CHIP), and Marketplace programs will be affected at the conclusion of the PHE. CMS is taking these steps to keep health care providers informed as standards for compliance with CMS requirements are restored and other provider waivers will conclude as described in the updates. CMS’s approach aligns with the Biden-Harris Administration’s priority for an orderly, predictable transition leading into the close of the COVID-19 PHE.

Click here to read the update.

Public Health Emergency (PHE) (2/22/23)

On January 30, the Executive Office of the President issued a Statement of Administration Policy regarding the plan to end the Public Health Emergency (PHE) on May 11.
Click here to read the statement.

HHS (2/22/23)

On February 9, HHS released the following Covid-19 Public Health Emergency Transition Roadmap:

https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

Medicaid Reverification (2/22/23)

The Centers for Medicare and Medicaid Services (CMS) requires that all Medicaid providers are recredentialed, a process also referred to as reverification. Since March 2020, CMS has allowed for the suspension of reverification due to the Public Health Emergency (PHE) brought on by COVID-19.

According to the Statement of Administration Policy published Jan 30, 2023,the federal PHE is expected to end on May 11, 2023. With the end of the federal PHE, reverification notices will resume to providers with approaching reverification due dates, as well as those whose reverification was suspended during the PHE.

Once the federal PHE ends on May 11, 2023, reverification is not optional. Providers who receive a notice of reverification are encouraged to promptly respond. Providers who do not complete the process within the designated timeframe will receive a Notice of Suspension via postal mail and in their NCTracks Message Center Inbox.

For more information, please see the Medicaid bulletin article regarding reverification here:

https://medicaid.ncdhhs.gov/blog/2023/02/17/provider-reverification-process-be-reinstated-end-federal-health-emergency

APA - 2023 Physician Fee Schedule Final Rule (Updated 2/15/23)

"The 2023 Physician Fee Schedule final rule, released by the Centers for Medicare and Medicaid Services, includes an expansion of telehealth services, new billing codes, and changes to “incident to” billing supervision requirements." Click here to read the full article.

UHC - Audio Only Telehealth (Updated 2/15/23)

From the February 2023 Reimbursement Policy Update Bulletin:

"Effective with dates of service on or after May 2, 2023, UHC will align with the American Medical Association 2023 CPT Professional Edition's Appendix T to define services appropriate to report as real-time, interactive audio-only telehealth...when appended with modifier 93."
Click here to read more.

Click here to view the American Medical Association's Appendix T (synchronous real-time interactive audio-only services).

APA - Care Dash Closure (Updated 2/8/23)

APA Services instrumental in closure of psychology "ghost network".

Click here to view the article.

APA - Call for Comments (Updated 2/8/23)

APA boards and committees, divisions, affiliated psychological associations, and other stakeholders are invited to review and provide comments on the 2023 Revision of Guidelines for Psychological Practice with Older Adults. Click here to see the full announcement and make comments.

CMS Medicare Temporary and Permanent Changes to Telehealth Policy (Updated 2/8/23)

The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the Covid 19 Public Health Emergency through December 31, 2024. For example, 1) patients can receive telehealth services in their home, and 2) an in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter, is not required.

The Act also includes permanent Medicare changes, including the provision of behavioral health services using audio-only communication. Click here to read more.

BCBSNC (Updated 2/8/23)

BCBSNC will insource behavioral health referrals beginning April 1, 2023. Quartet has been notified of this change, and the transition process is underway. Click here to read more.

NC HIEA (Updated 2/8/23)

Click here to read the January 2023 newsletter.

APA (Updated 2/1/23)

"Beginning January 1, 2023, psychologists will be able to provide and report Caregiver Behavior Management Training (CBMT), a new group-based service administered to parent(s)/caregiver(s) of patients that have been diagnosed with a physical or mental health condition. CMBT codes allow psychologists and other providers to bill for services that involve training a patient’s parent(s) and/or caregiver(s) in interventions and strategies to help manage or treat the patient’s condition.

In the 2023 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) said that for Calendar Year 2023, they will not reimburse for CBMT services. APA strongly believes that CBMT is a distinct and reimbursable service, and we will continue to work towards making this a reimbursable service in Medicare...APA recommends that, in order to reduce the risk of your claim(s) being denied for reporting noncovered/noncontracted codes, you should check each commercial payer policy, as well as the list of codes included in your contract with each payer, to determine which codes are covered/reimbursed." Click here to read the full article.

BCBSNC MAQIP Policy Update (Updated 2/1/23)

BCBSNC has released the updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2023: Click here.

BCBS Telehealth Claims (Updated 2/1/23)

Modifiers for telehealth claims can be found on page 14 of the BCBSNC Telehealth Commercial Reimbursement Policy (last updated 9/2022): Click here to view.

APA (Updated 1/25/23)

BCBSNC (Updated 1/25/23)

BCBSNC has released the updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2023: Click here.

PHE (Updated 1/18/23)

The Covid-19 Public Health Emergency was renewed for another 90 days effective January 11.

Click here to read the renewal.

BCBSNC (Updated 1/18/23)

"In the coming weeks, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin collecting our members’ medical records for the annual Healthcare Effectiveness Data and Information Set (HEDIS®1) reporting requirements. HEDIS is required by The Centers for Medicare & Medicaid Services (CMS) for all Medicare Advantage organizations. It is used for the National Committee for Quality Assurance (NCQA) accreditation and quality initiatives."

Click here to read the full announcement.

UHC (Updated 1/18/23)

Reconsideration and appeals submission going digital - click here to read the full announcement.

APA Division 42 Community Conversation: Coding and Billing Changes for 2023 (Updated 1/18/23)

Please join Division 42, the APA Division devoted to issues that are important to Psychologists in Independent Practice, for a community conversation via zoom with Dr. Stephen Gillaspy, Senior Director of Health and Health Care Financing in the APA Practice Directorate. Dr. Gillaspy will provide a deep dive into recent coding and billing changes. Dr. Gillaspy’s team in the Practice Directorate and the Advocacy office has worked tirelessly to advocate with the Centers for Medicare and Medicaid Services (CMS) for practicing psychologists to establish new billing codes. These codes can be used by psychologists to bill for and get reimbursement for services that previously were not funded. Attend this community conversation to learn more about billing and coding changes that went into effect as of January 1, 2023.

Coding and Billing Changes for 2023
Stephen Gillaspy, PhD
Senior Director, Health & Healthcare Financing
APA Practice Directorate
Tuesday, January 24, 2023
6:00pm Eastern Time

(No Registration Required - Zoom Link Below)

Division 42 is inviting you to a scheduled Zoom meeting.
Topic: Coding and Billing Changes for 2023
Time: Jan 24, 2023 06:00 PM Eastern Time (US and Canada)

Join Zoom Meeting
https://us02web.zoom.us/j/86726138902?pwd=NkxUdXhSdXZuM3RZZS9Uc3JDUU5iUT09

Meeting ID: 867 2613 8902
Passcode: 301837

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NC Psychology Board (Updated 1/11/23)

Winter 2022 Bulletin - Click here to read the NC Psychology Board's Winter Bulletin

NC HIEA (Updated 1/11/23)

Comment Period for Proposed Ruling Changes to SUD Patient Records

The following is taken from the HIEA December 2022 Update which you can view here.

Comment Period Open for Proposed Ruling Regarding Changes to SUD Patient Records – Providers Encouraged to Respond

The U.S. Health and Human Services Department (HHS), the Office of Civil Rights (OCR), and the Substance Abuse and Mental Health Services Administration (SAMHSA) have proposed a rule change affecting the sharing of patient records for those receiving substance use treatment.

Patients receiving treatment for substance use disorder (SUD) often struggle with fears of discrimination or incarceration, preventing them from seeking treatment. Sharing of records for patients receiving substance use treatment in a federally funded program is prohibited under the Confidentiality of Substance Use Disorder Patient Records under 42 CFR part 2, known simply as “Part 2.”

While the regulations currently allow substance use disorder patients to designate an HIE as recipients of their Part 2 data, the NC HIEA's current policy is to prohibit this submission to NC HealthConnex. This is due to the inability to track and manage patient consent or to prohibit further disclosure to unauthorized recipients. Please see our Behavioral Health Sensitive Data Policy for more information.

The difficulty in sharing these records means that other health care providers may not have access to the information they need to effectively coordinate care for these patients. A primary care provider, for instance, could be completely unaware of the behavioral health care provider’s treatment plan.

The proposed ruling would allow behavioral health providers to share information more easily than they have in the past, improving whole-person care and coordination for patients undergoing treatment for SUD. The proposed rule would also increase protections regarding the unauthorized disclosure of patient records, helping patients feel secure in how their information is being used and shared.

The HHS is encouraging health care providers and other health care professionals to submit comments on the proposed changes during the 60-day comment period, which ends on January 31, 2023. Interested parties can read the Notice of Proposed Rule-Making (NPRM) document on Regulations.gov or the Federal Register website and submit comments. The HHS has also provided a fact sheet highlighting the proposed changes.

The NC HIEA will be reviewing the proposed rules to understand how the changes could impact substance use data sharing in North Carolina.

Center for Connected Health Policy (CCHP) (1/4/23)

Mid-Atlantic Telehealth Resource Center (MATRC) (1/24/23)

"The Mid-Atlantic Telehealth Resource Center (MATRC) was established as a regional Telehealth Resource Center (RTRC) in September 2011 with the mission of advancing the adoption and utilization of telehealth and telehealth best practices within the MATRC region as a way to facilitate access to quality health care in rural and underserved communities and populations; and to work collaboratively with the other federally funded TRCs to accomplish the same nationally." Learn more here: https://www.matrc.org/

Medicare Physician Fee Schedule Lookup Tool (1/24/23)

Use this site to look up fees for specific CPT codes:

https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm

APA 2023 Physician Fee Schedule Final Rule (12/28/22)

Changes to reimbursement for mental and behavioral health services are included in the final rule on the 2023 Medicare Physician Fee Schedule, released on November 1, 2022 by the Centers for Medicare and Medicaid Services (CMS). Psychologists—who submitted 12,000 comments to CMS on the proposed rule issued in July 2022—can now see how their efforts to advocate for the profession impacted the agency’s decision making. Read the full article here:

https://www.apaservices.org/practice/reimbursement/government/help-psychologists-meet-need

HIEA and NC HealthConnex (12/21/22)

(Previously published in the APC Update of July 20):

Within the North Carolina budget passed by Governor Cooper in July, there is language suggesting that no state funds will be withheld from any provider or entity who does not submit data to the Health Information Exchange (HIE) until a new law designating a lead enforcement agency is passed. Previously, providers had a deadline of January 1, 2023 to take action by signing a Participation Agreement with the NCHIE. It is not clear when such a new law will be passed, but it will likely not be any sooner than March 31, 2023 (the deadline for the HIE Advisory Board report noted below).

Please see the HIEA language excerpts below:

SECTION 9B.3.(a) By March 31, 2023, the North Carolina Health Information Exchange Advisory Board shall submit a report on the statewide health information exchange network (HIE Network) known as NC HealthConnex to the Joint Legislative Oversight Committee on Health and Human Services. The report shall include at a minimum:
(1) An update regarding the connectivity status of providers and entities required by G.S. 90-414.4 to connect to and submit data through the HIE Network. This update shall be based on an analysis conducted by the North Carolina Health Information Exchange Authority, with assistance as necessary from the Department of State Treasurer, State Health Plan Division, and the Department of Health and Human Services, Division of Health Benefits.
(2) As a supplement to the recommendations provided pursuant to Section 7(a) of S.L. 2021-26, additional recommendations regarding appropriate features or actions, including legislative or administrative proposals, to support enforcement of the Statewide Health Information Exchange Act and enhancement of the HIE Network.

SECTION 9B.3.(b) Notwithstanding any provision of Article 29B of Chapter 90 of the General Statutes or any other provision of law to the contrary, connecting to and submitting data through the HIE Network known as NC HealthConnex shall not be a condition precedent to the receipt of State funds, including Medicaid funds, by any provider or entity subject to subsection (b) of G.S. 90-414.4 until a bill designating a lead agency responsible for enforcement of the Statewide Health Information Exchange Act is enacted into law.

SECTION 9B.3.(c) This section is effective when it becomes law.

See the full budget here: The HIEA language is on page 66.

Additional information for psychologists:

HIEA October 2022 update: https://hiea.nc.gov/blog/2022/10/28/nc-hiea-october-2022-update

FAQ page: https://hiea.nc.gov/frequently-asked-questions

Connection Deadline FAQs: https://hiea.nc.gov/faqs/connection-deadline-faqs

**Action Needed to Prevent 2023 Medicare Payment Cuts** (12/21/22)

Please ask Congress today to protect Medicare from consequential cuts. Without Congressional action, reimbursement rates for all providers will decrease 4.5% in January.

Why is this important? This affects access to mental health services because cuts to Medicare rates make it hard for providers to accept Medicare beneficiaries. The payment cuts also have ripple effects for everyone else. That is because Medicare’s reimbursement rates strongly influence Medicaid and private insurance reimbursement rates. Medicare payment rate cuts for mental and behavioral health services should not be happening in the midst of a mental health crisis!

Why are these cuts happening? Current law requires that the annual updates to the Medicare fee schedule for physician and other provider services be “budget neutral,” and to meet this requirement the Centers for Medicare and Medicaid Services (CMS) annually adopts a single, across-the-board adjustment in payment rates affecting all providers. This required adjustment—in the “conversion factor” within the payment formula—often results in Medicare provider reimbursement rates failing to keep pace with inflation. However, for the last two years, CMS has scheduled noticeably larger reductions in the conversion factor to account for new, higher payments proposed for evaluation and management services provided by physicians.

How has Congress helped in the past? Thankfully, Congress has responded in each of the last two years by stepping in to zero out CMS’s across-the-board reductions in Medicare payment rates. House and Senate members from both parties are working to prevent the 4.5% cut from taking place, but we need them to hear from constituents to keep this at the top of their priority list for year-end legislation.

We need Congress step in again – please take 2 minutes to ask to prevent these cuts!
APA is part of a large coalition of health care provider organizations pushing for the inclusion of language to prevent the 4.5% reduction in the Medicare fee schedule conversion factor from taking effect in January. Our recent coalition letter—with over 100 organizations signing on—is online at: coalition letter

Please Click Here to Act Now!

PsyPact (12/14/22)

Click here to view the State Board contact page, including links to state laws, rules, and regulations.

PsyPact (12/14/22)

Click here to view the sample language for how to list the APIT and/or TAP in email signatures, vitaes, etc. (from the FAQs)

APA (12/7/22)

Securing critical wins for psychology in final Medicare Physician Fee Schedule rule - Click here

APA (12/7/22)

Advocating for comprehensive mental health reform - Click here

BCBSNC (11/30/22)

Click here to view additional information about the Telehealth Policy for 2023

Medicare (11/30/22)

Physician Fee Schedule Part B

Click here and use this tool to display or download fees effective January 2023.

ASPPB (11/23/22)

The Centre for Data and Analysis on Psychology Licensure

Annual Report on Psychology Licensure Requirements in the United States and Canada -
Read the full report here.

APA (11/16/22)

APA appoints six new members of the Advocacy Coordinating Committee - Click here to view.

The Trust (11/16/22)

The Trust Advisor Newsletter - Read the quarterly newsletter here.

NC Medicaid: Fee Schedule and Covered Code Portal (11/9/22)

As of November 3, all fee schedules currently listed on the NC Medicaid website have been moved to a new Fee Schedule and Covered Code Portal available to the public. The new website offers enhanced search options for fee schedules, covered procedure codes and covered revenue code data. These enhancements include:

Fee Schedules – (NC Medicaid Website Fee Schedules Only)
- Fee schedules are available in a formatted, standardized template
- A single link is available to download all current and archived fee schedule files
- A single link is available to access a new lookup tool that allows users to search for fee schedule data using filters
Covered Procedure Code Combinations and Covered Revenue Code Documents
- These documents are housed on a new website accessible to Health Plans and Providers
- A single link allows users to download each of the covered procedure code combinations and covered revenue code files
- A single link is available to access a new lookup tool to search for covered procedure code combinations data and covered revenue code data using filters

Please review the User Guide for additional information on navigating the new Fee Schedule and Covered Code Portal.

All fee schedule data created prior to Nov. 3, 2022, will remain on the current NC Medicaid website. Please refer any questions to the NC Medicaid Contact Center at 888-245-0179.

NCHIEA (11/9/22)

NC HealthConnex Teletown Hall: Year in Review and What's New for 2023

Click here to register for the November 16 virtual townhall.

BCBSNC (11/9/22)

New Provider Credentialing and Enrollment Process Change effective November 1, 2022.
Click here to read.

Brighton Health Plan Solutions to Administer Benefits for Select Blue Cross NC Employer Groups effective January 1, 2023. - Read more here.

Blue Cross NC and Mindoula to Expand Access to Mental Health Care - Click here to view.

NC HIEA (11/2/22)

October 2022 Update - Click here to read

World Professional Association for Transgender Health (WPATH) (11/2/22)

Standards of Care (Version 8, Updated 2022) - Click here to read

APA (10/26/22)

No Surprises Act: CMS looks for input on good faith estimate requirements - Click here to read.

NC Psychology Board (10/26/22)

Click here to read the Fall Newsletter, The Bulletin Board

PsyPact Commission (10/26/22)

Click here to read the October newsletter

PHE (10/19/22)

National PHE was renewed on October 13

Click here to read the declaration.

BCBSNC (10/19/22)

Click here for Telehealth information including a list of reimbursable telehealth services

Click here for the Corporate Reimbursement Policy for Telehealth which includes detailed list of CPT codes (beginning page 6)

Click here to read the Update: Delays for Enrolling New Providers

Association of State and Provincial Psychology Boards (ASPPB) (10/12/22)

The Centre for Data and Analysis on Psychology Licensure -
Click here for the Annual Report on Psychology Licensure Requirements in the United States and Canada

APA (10/12/22)

What Psychologists Should Know About 988 - Click here to read

BCBSNC Releases Data on Telehealth Usage During COVID-19 (10/5/22)

- New policy builds on usage data, covers 97% of pandemic telehealth claims
- Compared to the pre-pandemic policy, members will have access to 77 more telehealth services under the new policy, effective Jan. 1, 2023

Click here to read the press release.

Health Information Exchange Authority (NCHIEA) (10/5/22)

July 2022 Legal Update (initially run in the August 3 APC Update)

- State Legislature Temporarily Suspends Enforcement Provision in the Statewide Health Information Exchange Act

- January 1, 2023, Deadline to Connect to NC HealthConnex Remains Unchanged

Click here to read the full article.

APA (9/28/22)

No Surprises Act: APA awaits new rule on good faith estimates - Click here to view.

BCBSNC (9/21/22)

Notice of Pricing Development and Maintenance Policy Updates for BETOS/CCS, 2008 Pricing Policy and Non-2008 Pricing Policy - Click Here

New Provider Credentialing and Enrollment Process Change Effective November 1, 2022 -
Click Here

Care Affiliate Enhancements Effective September 2022 - Click Here

APA Services (9/21/22)

Psychology Advocacy Network Action Alert:

Why is this bill important?

This legislation repeals the discriminatory Defense of Marriage Act (DOMA), enshrines and shores up marriage equality in federal law, and provides additional legal protections for marriage equality. It does so by codifying the federal protections conferred by the Supreme Court of the United States in the Loving, Windsor, and Obergefell rulings. These landmark decisions stated that bans on marriage equality, bans on interracial marriage, and denial of federal marriage benefits are unconstitutional. The House of Representatives passed the bill with a strong bipartisan vote of 267-157. The bill could be considered by the Senate as early as next week. The voice of psychologists on this urgent piece of legislation will be critical as the bill moves to the Senate for a vote.

Research has shown that marriage provides substantial psychological and physical health benefits due to the moral, economic, and social support extended to married couples. Conversely, empirical evidence has illustrated the harmful psychological effect of policies restricting marriage rights for same-sex couples.

Following the U.S. Supreme Court’s decision in Dobbs to overturn Roe v. Wade, opponents are feeling emboldened to try and reverse other fundamental rights, including marriage equality. Please join us today to call on the Senate to defend marriage equality for same-sex and interracial couples.

DSM-5-TR (9/14/22)

American Psychiatric Association - Click here to view the DSM-5-TR Fact Sheets

Message from the NC Psychology Board (9/14/22)

The NC Psychology Board has opened license renewal.

From the desk of Daniel Collins, Executive Director of the NC Psychology Board. . .

Given the additional requirements for this year’s license renewal and the delayed opening of the online renewal system, the North Carolina Psychology Board has determined to waive the late renewal fee for this renewal only.

As a result, licensees will have until November 30, 2022 to renew their licenses without paying a late fee or having the status of their licensees affected. As a result, licenses renewed after October 1, 2022, but by November 30, 2022 will still be considered current and valid. The licenses do not “expire” if not renewed by October 1, 2022; however, licenses not renewed by November 30, 2022 will be suspended.

You must complete the State Ethics Refresher before you renew your license. If you have not taken the State Ethics Refresher, you must log into the NC Psychology Board Licensee renewal webpage to do so.

You must upload all your continuing education documentation to CE Broker by October 1. The grace period does not apply to supplying your continuing education documentation within the CE Broker system.

Should you have any questions about this matter, you may direct them to the Board office at info@ncpsychologyboard.org or (828) 262-2258.

Click here to view the official letter.

APA Services - APASI Issues "Cease and Desist" Letter to CareDash For Using Shadow Profiles (9/7/22)

After receiving reports from members, APA Services, Inc. took action to stop CareDash from creating online profiles for psychologists without their consent. Instead of allowing prospective patients to schedule appointments with the psychologists listed in the profiles, patients were redirected to make appointments on online therapy platforms or other networks of competing providers. Bloomberg interviewed psychologists about discovering shadow profiles for their practice on CareDash. APA encourages members listed on CareDash without their consent to file complaints with the Federal Trade Commission, their state’s consumer protection office, or the Better Business Bureau.

Click here to see the letter.

BCBS - Updates to Telehealth Policy Through the End of 2022 (8/31/22)

Click here to view the updates to telehealth policy through the end of 2022.

State Health Plan Budget Changes and Health Information Exchange Act Update (8/31/22)

Click here to view the state health plan budget changes and Health Information Exchange Act update.

APA Evaluate your website for ADA Compliance (8/24/22)

Evaluate your website for ADA Compliance - Click here to view

ADA Guidance on Web Accessibility and the ADA (8/24/22)

Guidance on Web Accessibility and the ADA - Click here to view

Covid-19 and Healthcare Providers (8/24/22)

On August 15, Governor Roy Cooper lifted the North Carolina Covid-19 State of Emergency.

Click here to read the press release.

The NC Department of Health and Human Services (NCDHHS) website states that "Masks are still required in places like health care and long-term care. This is because of the setting or federal regulations."
Click here to see the mask guidance page.

While this guidance may change in the future, this is the current NCDHHS information.

Advocate Today! Submit a Message to the Biden Administration Regarding the CMS Proposed Rule on the CY 2023 Physician Fee Schedule (8/24/22)

The annual Physician Fee Schedule rule has serious implications across the health care field – to researchers, clinicians, educators, and students alike. It often sets the benchmark for how other insurance programs cover and reimburse for specific services and sets the standard for how new and emerging forms of treatment are covered. Compared to previous years, this year’s Physician Fee Schedule proposed rule has a particular focus on mental and behavioral health. This means that all representing the fields of psychology and behavioral health have a unique opportunity to elevate psychologists’ voice and the key role they play in mental health treatment.

This year's proposal has consequential provisions which need improvement, including:

Needing to recognize the importance of providing training based in psychological science to behavioral caregivers, to improve outcomes for people with disabilities, behavioral disorders, and more.
Creation of new service codes that must be revised to reflect the services performed by and the contributions of psychologists and psychological science.

It also has positive provisions which might not become reality unless you speak up for them, including:

Giving psychologists flexibility to participate in treatment teams through evidence-based models of integrated care.
Expanding access to and coordination of mental health services in rural and underserved areas by enhancing the psychology workforce.
Expanding and preserving access to telehealth services beyond the COVID-19 public health emergency.

Let's beat our number of comments from last year; we need at least 310 comments! See how North Carolina currently ranks against other states below.

Click here to easily submit your message!

PSYPACT - Public Comment on Proposed Rules (8/17/22)

The PSYPACT Commission has released two proposed rules. The Commission will accept public comment until September 27, 2022 at 5:00pm EST. To submit public comment, please visit this link: https://psypact.site-ym.com/page/PublicComment

The annual Commission meeting which will contain a public hearing regarding these rules will be held on November 17th, 2022 at 11:00am EST. A registration link for this meeting can be found on the website page above.

PSYPACT News (8/17/22)

Click here to view this page. It includes links to newsletters and public statements from the PSYPACT Commission.

The Trust - Student and Early Career Resources (8/10/22)

Click here to view Student and Early Career Resources

APA - American Psychological Association of Graduate Students (APAGS) (8/10/22)

Click here to view the American Psychological Association of Graduate Students (APAGS)

APA Services - ECP Column (8/10/22)

Click here to view the ECP column.

APA Updated Guidelines (8/3/22)

The Guidelines for Assessment and Intervention with Persons with Disabilities were adopted by the APA Council of Representatives in February 2022 and replace the original Guidelines for Assessment of and Intervention with Persons with Disabilities from 2011.

Click here to view.

APA Open Comment Period for Proposed Revisions to 4 APA Practice Guidelines (7/27/22)

The 60-day public comment period for the following four (4) Professional Practice Guidelines are open.

Call for Comments: Proposed Revision for Guidelines for the Practice of Telepsychology (7/27/22)

In accordance with Association Rule 30.8, the Board of Professional Affairs (BPA) and Committee on Professional Practice and Standards (COPPS) seek member and public comments on the Proposed Revision for Guidelines for the Practice of Telepsychology.

These guidelines were developed by a cross-group collaborative and are intended to educate and guide psychologists using technology in their practices. We welcome your input, suggestions and commentary on the guidelines and key issues in this important area of professional practice. See Comment Form Instructions for more details on specific areas for input. Overarching comments are also welcome.

Link to Comment: https://apps.apa.org/CommentCentral2/Default.aspx?site=102

Deadline for Comments (60 Day Public Comment Period): August 30, 2022

Call for Comments: Proposed Revision for Guidelines for the Practice of Parenting Coordination (7/27/22)

These guidelines were developed by a cross-group collaborative and are intended to provide a specific framework and direction for psychologists for professional conduct and decision making in the practice of parenting coordination. We welcome your input, suggestions and commentary on the guidelines and key issues in this important area of professional practice. See Comment Form Instructions for more details on specific areas for input. Overarching comments are also welcome.

Link to Comment: https://apps.apa.org/CommentCentral2/Default.aspx?site=101

Deadline for Comments (60 Day Public Comment Period): August 30, 2022

Call for Comments: Proposed Revision for Practice Guidelines Regarding Psychologists' Involvement in Pharmacological Issues (7/27/22)

These guidelines were developed by a cross-group collaborative and are intended to provide a resource to psychologists interested in the issue of what represents optimal practice in relation to pharmacotherapy. We welcome your input, suggestions and commentary on the guidelines and key issues in this important area of professional practice. See Comment Form Instructions for more details on specific areas for input. Overarching comments are also welcome.

Link to Comment: https://apps.apa.org/CommentCentral2/Default.aspx?site=100

Deadline for Comments (60 Day Public Comment Period): August 30, 2022

Call for Comments: Proposed Revision of Guidelines for Psychological Evaluations in Child Protection Matters (7/27/22)

In accordance with Association Rule 30.8, the Board of Professional Affairs (BPA) and Committee on Professional Practice and Standards (COPPS) seek member and public comments on the Proposed Revision of Guidelines for Psychological Evaluations in Child Protection Matters.

These guidelines were developed by a cross-group collaborative and are intended to provide relevant, professionally sound results or opinions in matters where a child’s health and welfare may have been and/or may be harmed. We welcome your input, suggestions and commentary on the guidelines and key issues in this important area of professional practice. See Comment Form Instructions for more details on specific areas for input. Overarching comments are also welcome.

Link to Comment: https://apps.apa.org/CommentCentral2/default.aspx?site=58

Deadline for Comments (60 Day Public Comment Period): August 30, 2022

Public Health Emergency (PHE) Extended (7/20/22)

Please click here to read the renewal of determination that a public health emergency exists.

Update: NC HealthConnex (7/20/22)

Governor Cooper signed the budget into law on Monday, July 11^th. Within the budget, there is language suggesting that no state funds will be withheld from any provider or entity who does not submit data to the Health Information Exchange (HIE) until a new law designating a lead enforcement agency is passed. Previously, providers had a deadline of January 1, 2023 to take action by signing a Participation Agreement with the NCHIE. It is not clear when such a new law will be passed, but it will likely not be any sooner than March 31, 2023 (the deadline for the HIE Advisory Board report noted below). There is currently no other information available from the Health Information Exchange Authority (HIEA).

Please see the HIEA language excerpts below:

Click here to review the entire budget. The HIEA language is on page 66.

APA Audio-only Telehealth: How to maintain privacy and security (7/13/22)

A new resource from the Department of Health and Human Services helps providers comply with HIPAA while providing audio-only services. Click here for the full article.

APA CMS Physician Fee Schedule (7/13/22)

The physician fee schedule proposed rule—released annually between June and August and followed by a 60-day comment period—outlines the agency’s new proposed polices, suggested changes to services, and provider payments for the coming year. After reviewing the public comments, CMS releases a final rule in November explaining which proposed changes will become final and take effect for the next calendar year. Click here for the full article.

988 Suicide and Crisis Lifeline (7/13/22)

988 goes live on all devices on July 16, 2022:

USDHHS information: https://www.samhsa.gov/find-help/988

FCC Information: https://www.fcc.gov/suicide-prevention-hotline

PsyPact (7/6/22)

Click here to view the current map of PsyPact states.

Click here to see the PsyPact Commission newsletters.

Telehealth Certification Institute (7/6/22)

States' TeleMental Health Laws, Rules, and Regulations: View here.

The Trust: Telepsychology Competencies Credential (TCC) (7/6/22)

Introducing the Telepsychology Competencies Credential – an educational platform brought to you by The Trust and the National Register that enables providers to achieve proficiency in the most common elements of telepsychological practice.

Click here to read more.

APA Private Practice Helpline (6/29/22)

The Private Practice Helpline for APA members is an exclusive benefit to assist members seeking information regarding the business aspects of private practice. Click here to read more.

APA Division 52 International Psychology (6/22/22)

Click here to read.

Division 52 Document: Licensing Guidelines Around the World (6/22/22)

Click here to read.

BCBS Providers Invited to Join NC State Health Plan Network (6/15/22)

Click here to read the details.

North Carolina Psychologist Privilege License (6/15/22)

According to the NC Psychology Board, "a psychologist who engages in the professional art of healing (as defined) for a fee or reward is subject to...This license, issued as "psychologist" privilege license, is in addition to the regulatory license required by the North Carolina Psychology Board." Click here to read the Full Statement.

The Privilege License Tax is a $50.00 annual fee, due July 1.

Click here to view the NC Department of Revenue (NCDOR) page about the Privilege License Tax.

Click here for the NCDOR page with the tax forms and instructions.

Medicare Billing for Telehealth (6/8/22)

. NCPA has been receiving questions about billing Medicare for telehealth services. Specifically, members who switched to using a POS other than 11 (such as POS 10, patient at home) are reporting being paid at a lower rate. Here are some updated resources:

CMS update May 27

https://www.cms.gov/files/document/mm12427-newmodifications-place-service-pos-codes-telehealth.pdf

Health and Human Services (HHS) update May 17

Place of Service codes and modifiers

When billing telehealth claims for services delivered on or after January 1, 2022, and for the duration of the COVID-19 emergency declaration:

Include Place of Service (POS) equal to what it would have been had the service been furnished in person.
Medicare hasn’t identified place of service modifier 10 (PDF) for use when the patient is in their home. If they are located in any other location, utilize place of service modifier 02.
Append modifier 95 to indicate the service took place via telehealth

The CR modifier is not required when billing for telehealth services.

Full HHS article here:

https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims/#coding-claims-during-covid-19

The public health emergency (PHE) has been extended to July 15 (and is expected to be renewed again). Based on the information above, it appears that when billing Medicare, providers should continue to bill POS 11 (office) and modifier 95 (to indicate a telehealth service) during the PHE.

At this point, it is not clear what the CMS policy will be regarding reimbursement rates for telehealth services beyond the pandemic. APA has stated:

APA will advocate for all telehealth services to continue to be paid at the same rate as in-person services once the PHE ends. Before the PHE, CMS paid for telehealth services at the facility rate, which is lower than the nonfacility rate paid for outpatient office visits.

https://www.apaservices.org/practice/reimbursement/government/telehealth-after-pandemic

BCBS Providers Invited to Join NC State Health Plan Network (6/8/22)

Click here to read the details.

BCBS Annual Provider Training and Attestation Requirements (6/1/22)

BCBS Annual Provider Training and Attestation Requirements - Click here.

Action Alert - Advocate for Telehealth Services in NC (6/1/22)

NCPA is a member of the Professional Association Council (PAC).

The Professional Association Council (PAC) is providing information to our association members to contact their North Carolina Senators to help advocate for telehealth services. House Bill 149 Increase Access to Telehealth would improve telehealth coverage for all health benefit plans offered by the state. It seeks to (1) guarantee coverage to a health care service or procedure regardless of whether it is offered in-person or through telehealth. (2) Reimburse provider-to-provider consultations conducted through telehealth as long as the health benefit plan would have reimbursed the consultation had it happened in-person. (3) The health benefit plan may require a co-payment for a health care service or procedure delivered through telehealth, however, it cannot exceed the co-payment amount had the service been provided in-person. (4) No health benefit plan can require prior authorization for health care services through telehealth if prior authorization is not required had the service been in-person. (5) There cannot be any limits on the originating site or the distant site for the delivery of telehealth services. (6) Lastly, the bill clarifies that telehealth services cannot be used for anything related to abortion except in the case of an emergency therapeutic abortion (this is already state law).

This legislation passed the House in May 2021. We are asking providers to email their Senator in the North Carolina General Assembly and communicate their success stories from serving clients via telehealth during the current pandemic and to support House Bill 149. It is our desire, after hearing from many providers, the Senate will also pass House Bill 149 after realizing the importance that telehealth has played in this past year.

Providers, please remove the highlighted sections below and edit this letter to best suit your practice experience/client needs.

Find your North Carolina Senator here: https://www.ncleg.gov/FindYourLegislators
Enter your address and then select NC House and Senate (NOT US House). When it pulls up the results, you can click on the name of your North Carolina Senate member to get their email address to send the letter to.

A suggested subject line for the email: From your Constituent – Support HB 149 to Improve Access to Care Through Telehealth

Dear Senator insert last name,

My name is _____________ and I am a ___________ Licensed Psychologist I work in your county with a specialty population _____ (more about this population- aging, youth, opioid, etc).

If you have a story to share about providing telehealth services, particularly if you are in a rural area, insert that story here.

I am writing to request that you work to support HB 149 which would enact many of the same telehealth standards that many insurance companies are currently using since the pandemic.

Telehealth has particular efficacy in and application to the provision of mental health. The ability to provide telehealth services has resulted in fewer cancellations, greater therapeutic value as clients are more comfortable with the counseling process in their own homes than my office, and a greater access to care in general. Because counseling does not involve physical examinations, we have been able to provide the same quality of care as if we were doing an in person visit. Most of my clients have expressed satisfaction with telehealth services and want to continue those services.

I am applying the same skill and educational level to telehealth visits as I would an in person visit. Therefore, reimbursement for such services should be paid the same as an in person visit, and subject to the same coverage and copays, all as provided in HB 149.

Without the passage of HB 149, insurance companies will begin to rollback telehealth policies and thus limit access to behavioral health services that many of my patients have come to need and any abrupt end to telehealth policies will be disruptive to the care I provide.

Providers, feel free to share more about your experience without providing telehealth care.

I appreciate your consideration. Thank you for your service to our community and to our great State.

Sincerely,

Provider Name, Credential

The National Psychologist (5/25/22)

The National Psychologist is an online source of news and information designed for practicing psychologists who want to keep up on their profession.

Click here to visit the site.

Action Alert (5/18/22)

NCPA is a member of the Professional Association Council (PAC).

Providers, please remove the highlighted sections below and edit this letter to best suit your practice experience/client needs.

A suggested subject line for the email: From your Constituent – Support HB 149 to Improve Access to Care Through Telehealth

Dear Senator insert last name,

My name is _____________ and I am a ___________ Licensed Psychologist I work in your county with a specialty population _____ (more about this population- aging, youth, opioid, etc).

If you have a story to share about providing telehealth services, particularly if you are in a rural area, insert that story here.

I am writing to request that you work to support HB 149 which would enact many of the same telehealth standards that many insurance companies are currently using since the pandemic.

Providers, feel free to share more about your experience without providing telehealth care.

I appreciate your consideration. Thank you for your service to our community and to our great State.

Sincerely,

Provider Name, Credential

NC State Health Plan Accepting New CPP Providers (5/11/22)

The NC State Health Plan Network will be accepting new Clear Pricing Project (CPP) providers for the 2023 benefit year. Providers will be able to join beginning June 1, 2022, through June 30, 2022. Click here for more information.

APA Services Working On A New Legislative Approach (5/11/22)

Dear Colleagues:

We are sharing a request from APA Services – they need your stories! APA Services is working on a new legislative approach to establishing independent practice authority throughout Medicare. They are collecting stories from psychologists in outpatient rehabilitation facilities, skilled nursing facilities, partial hospitalization programs, home health services, and hospice programs. If you work in those settings, please take a few minutes to explain how physician referral and authorization requirements affect access to your services and patient outcomes. Share your stories today!

Your anecdotes about how the inconsistent and outdated physician authorization requirements get in the way of patient care will help connect policymakers to the issues on a human and personal level, and illustrate why they should support changing current law. If you have any questions about the legislative proposal, please contact Scott Barstow, Senior Director of Congressional and Federal Affairs. APA Services will be collecting stories until Memorial Day, May 30.

APA Services: Let's Get Technical (5/4/22)

Click here for a review of the latest apps and tools for practicing psychologists.

Online Toolkit (5/4/22)

NCPA members at the Investor level and above have access to the Online Practice Toolkit.

This Toolkit contains resources covering 24 major content areas, such as Insurance, Legal, Licensure, Record Keeping, Professional Wills, Retirement, Sample Forms and Policies, Technology and PsyPact, and much more. The Patient Resources section contains numerous suggestions for books, Ted Talks, websites, and podcasts that psychologists may wish to use in their practice.

The Toolkit is updated consistently by the Advocacy and Practice Committee (APC).

Blue Cross and Blue Shield North Carolina Survey (5/4/22)

We are gathering information about provider experiences with Blue Cross Blue Shield North Carolina (BCBSNC). Please click below to complete the survey.

BCBSNC Survey

Blue Cross and Blue Shield North Carolina Survey (4/27/22)

We are gathering information about provider experiences with Blue Cross Blue Shield North Carolina (BCBSNC). Please click below to complete the survey.

BCBSNC Survey

National Law Review Medicare telehealth waivers extended past PHE (excerpts from April 18, 2022 publication) (4/20/22)

On March 15, President Biden signed into law H.R. 2471, the “Consolidated Appropriations Act, 2022”, which extends many of the Medicare telehealth flexibilities put in place during the COVID-19 pandemic for a period following the end of the Public Health Emergency (PHE). The same day, the Office of Inspector General (OIG) issued a report highlighting the positive impact telehealth had on increasing access for beneficiaries during the first year of the pandemic. Then, during a press conference on March 18, the Department of Health & Human Services (HHS) Secretary Xavier Becerra said that HHS will seek to sustain and expand access to telehealth services after the PHE ends. While these developments signal the continued expansion of telehealth, there is still some uncertainty surrounding coverage, reimbursement and licensure flexibilities that have allowed telehealth to flourish for the past two years.

The “Consolidated Appropriations Act, 2022” included a number of provisions related to Medicare coverage of telehealth services. Specifically, the following Medicare waivers will be extended for 151 days following the end of the PHE:

Originating Site: Allows Medicare beneficiaries to receive telehealth services from any geographic location, including their home.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs): Allows FQHCs and RHCs to continue providing telehealth services.
In-person Requirement for Mental Health: Waives the requirement for mental health providers to see patients in person prior to providing behavioral health services via telehealth.
Audio-only: Allows Medicare coverage of audio-only services when appropriate.
These extensions will give Congress the opportunity to pass the Telehealth Extension and Evaluation Act, or otherwise make the flexibilities permanent, or alternatively, give providers time to prepare for a return to in-person care.

Read the full article here.

Optum Update on COVID-19 Telehealth Flexibilities (4/6/22)

Please be aware of this recent update to temporary telehealth flexibilities related to the COVID-19 pandemic. These flexibilities are applicable for UnitedHealthcare members:

• Commercial Membership - for in-network providers, expanded telehealth flexibilities have recently been extended through June 15, 2022, unless otherwise mandated by the state. These telehealth exceptions are now set to end effective June 16, 2022.

Providers are encouraged to confirm member benefits and coverage provided by their specific health plan at the time of service due to the rapidly changing situation.

For the most current information regarding COVID-19 flexibilities, please be sure to visit Provider Express. There, you'll find more detailed information, along with links to other sites, including:
• State-specific COVID-19 resources

• Other Health Plan partners' sites
We greatly appreciate your continued efforts in helping members and our communities during this health emergency.

Click here to view online.

Cigna (4/6/22)

"Billing a POS 02 for virtual services may result in reduced payment or denied claims. Billing a typical face-to-face place of service (e.g., POS 11) will ensure providers receive the same reimbursement as they typically get for a face-to-face visit."

Click here to read more.

The Trust (3/30/22)

How to Be a Good Supervisor - Click Here

How to Be a Good Supervisee - Click Here

The Trust (3/23/22)

Continuing Professional Development (CPD) Plans

Please help us Advocate Effectively: Complete BCBSNC Survey (3/16/22)

We are gathering information about provider experiences with Blue Cross Blue Shield North Carolina (BCBSNC). Click here to complete the brief survey.

Blue Cross Blue Shield of North Carolina will extend the telehealth policy until September 30, 2022. (3/10/2022)
Click here to read more.

NC Psychology Board - Continuing Education Reference Guide (3/9/2022)
Click here to view.

The Trust - Sample Informed Consent Forms Page (3/9/2022)
Includes forms for Walk and Talk therapy and Returning to In-Person Services.
Click here to view.

APA - ABCs and 123s of Encryption (3/9/2022)
Click here to view.

BCBS Extends Telehealth Policy Through March 31, 2022 (3/9/2022)
Click here to view.

Multi-Discipline Licensure Resource Project (MDLR) (3/2/22)
“The Multi-Discipline Licensure Resource Project (MDLR) is brought to you by the Association of State and Provincial Psychology Boards (ASPPB) as part of a Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) grant initiative. In May 2020, HRSA awarded ASPPB federal funding to help provide support for the 2020 Coronavirus Aid, Relief and Economic Security Act (CARES). ASPPB received grant funding to support the Licensure Portability Grantee Program in preventing, preparing for and responding to the coronavirus disease 2019 (COVID-19), including through telehealth access and infrastructure.”

Click here to view more.

APA
Understanding the No Surprises Act: How to Provide Estimates for your Services (Updated February 23, 2022)

Click here to view.

APA (2/2322)

Medicare Advantage Plans: What Psychologists Need to Know
Click here to read

What to Know About Doing Telehealth in a Different State
Click here to read

DSM-5 Revisions (2/16/22)

From the Psychiatry Online website:

“Significant changes—including the addition of prolonged grief disorder and the inclusion of symptom codes for suicidal behavior and nonsuicidal self-injury, refinement of criteria, and comprehensive literature-based updates to the text—will appear in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), to be released by American Psychiatric Association Publishing in March.”

Click here to view online.

APA (2/16/22)

Telehealth and POS codes
Recent changes in CMS guidance for telehealth regarding the in-person visit requirement and place of service codes - Click here to view

Office of Legal and State Advocacy
“The Office of Legal and State Advocacy (LSA) assists members with health insurance and managed care issues. Our staff experts work collaboratively with insurers, when possible, to smooth out troublesome billing, audit, and claims practices. LSA also collaborates with state psychological associations to pursue government agency complaints and lawsuits that challenge abusive practices by health insurance and managed care companies.”

Click here for LSA information and resources related to Insurance and Managed Care

The Trust- FAQs about the NSA- Updated January 31, 2022 (2/9/22)

Click here to read.

No Surprises Act and Good Faith Estimates- Write to your Legislative Representatives (2/9/22)

The APA, in conjunction with ten other national organizations, has sent a letter asking Health and Human Services (HHS) to exempt mental health professionals from the requirements of the No Surprises Act and its GFE mandate. Psychologists are encouraged to contact your legislative representatives personally to ask for their support in this effort.

Click here to find your legislators.

You can also do an internet search for "contact Senator XXX" or "Contact Rep. XXX" to send an email to each legislator. Many of the legislators have an online email system, into which you can type the text of an intended letter. Others can be reached at an email address.

Two sample letters are attached- one is a more general version of the letter, the other is a bit more detailed. Please feel free to use and share with colleagues:

Sample Letter - General

Sample Letter - Detailed

APA (2/9/22)

2022 Guidelines for Reporting Interactive Complexity

https://www.apaservices.org/practice/reimbursement/health-codes/2022-reporting-interactive-complexity

CMS (2/2/22)

Information for Consumers about the NSA:

Understanding Costs in Advance - Click here.

No Surprises: Understand Your Rights Against Surprise Medical Bills - Click here.

NC Health Information Exchange Authority (NCHIEA) (2/2/22)

The NCHIEA introduces a new business and provider relations manager. Also, the NC HIEA will be reaching out to unconnected providers in February. Read more here.

APA and the NSA (1/28/22)

The APA, in conjunction with ten other national organizations, has written a letter regarding the impact of the Interim Final Rules of the No Surprises Act on mental and behavioral health providers. The letter has been sent to both Xavier Becerra, Secretary of U.S. Department of Health & Human Services, and Chiquita Brooks-LaSure, Administrator, Centers for Medicare and Medicaid Services.

Click here to read the full letter here.

BCBS (1/26/2022)

State Health Plan Member ID Change for 2022
Click here to read more.

Medicare Advantage Quality Incentive Program (MAQIP)
Policy has been updated effective January 1, 2022:
Click here to read more.

HEDIS Record Reviews
BCBSNC will begin collecting our members’ medical records for the annual Healthcare Effectiveness Data and Information Set (HEDIS®1) reporting requirements. HEDIS is required by The Centers for Medicare & Medicaid Services (CMS) for all Medicare Advantage organizations. It is used for the National Committee for Quality Assurance (NCQA) accreditation and quality initiatives. BCBSNC is offering a brief overview of the annual HEDIS Medical Record Review and a review of the process for sending medical records via Blue E.

See the webinar link and read more here.

CMS (1/26/2022)

“No Surprise Billing” Overview of Rules and Fact Sheets – updated January 3, 2022

Click here to view.

CMS (1/19/2022)

New/Modifications to the Place of Service (POS) Codes for Telehealth

Effective Date: January 1, 2022

Implementation Date: April 4, 2022

POS 02: Telehealth Provided Other than in Patient’s Home

Descriptor: The location where health services and health-related services are provided
or received, through telecommunication technology. Patient is not located in their home
when receiving health services or health-related services through telecommunication
technology.

POS 10: Telehealth Provided in Patient’s Home

Descriptor: The location where health services and health-related services are provided
or received through telecommunication technology. Patient is located in their home
(which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

Click here to read the full announcement.

Place of Service Code Set- Updated September 2021

Click here to view.

The Trust- Updated FAQs: No Surprises Act (1/14/2022)

What is the No Surprises Act (NSA)?
The NSA was signed into law in December 2020 and was primarily intended to protect patients/clients from unexpected out-of-network bills for healthcare. The classic example is the person who obtains needed surgery at an in-network hospital but gets a separate and unexpected (surprise) $25,000 bill from the anesthesiologist after the procedure because the provider was not in-network.

Click here to read more.

Understanding the No Surprises Act (1/14/2022)

from the American Psychological Association

Psychologists and other health care providers are now required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer. Read APA’s updated guidance and resources on when and how to provide these estimates.

Click here to read more.

Seven Basic Steps For Starting Your Good Faith Estimate Compliance (1/14/2022)

from the American Psychological Association

Here are some basic steps you need to take to start complying with the No Surprises Act good faith estimate (GFE) requirement.

Click here to read more.

APA- FAQs On No Surprises Act and Good Faith Estimates (1/14/2022)

These FAQs are based on some of the most common questions APA has received concerning the No Surprises Act and its new requirement for providers to furnish a “good faith estimate” of expected costs to patients. This requirement takes effect January 1, 2022.

Click here to read more.

CMS (1/12/2022)
The 2022 full fee schedule has been updated on the CMS website. This includes search capability for your particular Medicare Administrative Contractor (MAC), by single or multiple HCPCS codes, and other variables.

Click here to read.

No Surprises Act (NSA) (1/7/2022)
The Trust's Preliminary Guidance on the No Surprises Act, dated 1/4/22

Click here to read.

APA's FAQs On the NSA and Good Faith Estimates (1/7/2022)

Click here to read the document.

2022 Medicare Fee Schedule: Frequently Asked Questions (1/5/2022)

from the American Psychological Association

Each year, the Centers for Medicare and Medicaid Services (CMS) drafts proposals for new regulations or modifications to existing regulations regarding, among other things: payments, services, and billing for the following year. These proposals are made public during a comment period, after which CMS reviews feedback and issues a final ruling on the proposals. This final ruling may impact providers and patients in sometimes profound ways.

These frequently asked questions cover the changes to CMS regulations for 2022 that are most likely to impact psychologists and their patients.

Click here to read more.

Telehealth After the Pandemic: CMS Outlines Proposed Changes (1/5/2022)

Psychologists who treat and assess patients via telehealth, including audio-only devices, should pay close attention to the 2022 Medicare physician fee schedule proposed rule, which outlines potential changes to health care services and reimbursement rates for all providers. If similar proposals are adopted by other third-party payers, all psychologists—not only those who work with Medicare—will be impacted.

Click here to read more.

Telehealth Services: Billing Changes Coming in 2022 (1/5/2022)

Medicare will require psychologists to use a new point of service code when filing claims for providing telehealth services to patients in their own homes.

Click here to read more.

United Healthcare and POS Code 10 (12/29/2021)

Beginning with dates of service on January 1, 2022, United Healthcare will consider POS code 10 for reimbursement.

Click here to read more.

BCBSNC Insourcing Behavioral Health Service for State Health Plan (12/29/2021)

Starting January 1, 2022, Blue Cross NC will insource Behavioral Health Services for SHP members:

Blue Cross NC’s SHP team will assume care for all Behavioral Health intensive case management (complex case management) and utilization management responsibilities from Beacon Health Options.

The provider community can speak to a Behavioral Health case manager by calling 1-833-298-1069. New options will be available to providers to submit a Prior Plan Authorization (PPA) for SHP members. You can call the telephone number on the back of your membership ID card (1-800-367-6143) to reach an intake specialist directly, complete a fax form and fax it to 1-866-987-4161 or utilize the Blue e Authorization Portal.

Providers can email the Behavioral Health mailbox at BehavioralHealth@bcbsnc.com for questions related to these changes.

Thank Congress for Halting Medicare Cuts (12/22/2021)

From the American Psychological Association

In a significant victory, last week Congress heeded calls from advocates to protect access to mental health services – please take 2 minutes to thank Senators who voted yes.

Last Wednesday evening the House of Representatives passed legislation to postpone significant Medicare reimbursement rate cuts from taking effect in January, and by the end of the day on Friday, the bill had been approved by the Senate and signed into law by President Biden. Originally, the fate of the bill was uncertain in the Senate, prompting advocates from many health care sectors to speak up. As part of this wave of support, nearly 2,000 advocates representing the field of psychology leaned in to ask the Senate to protect access to mental health services - and the Senate did!

Now, it is important to recognize the efforts of the 59 Senators who voted for this legislation. If your Senator is one of those 59 Senators, you will be able to send them a thank you message by clicking on the button below. Several Senators joined the bipartisan effort and thanking them reinforces that you -their constituent – appreciate the vote they took.

Senator Thom Tillis voted yes to protect access to mental health services.

Click here to take action now.

The legislation took important steps to protect mental health, but more action will need to be taken next year. We outline key provisions from the bill and why they matter below.

It contains a one-year, 3% increase in the Medicare conversion factor for 2022.
- This largely off-sets but does not eliminate a 3.71% cut to the conversion factor which CMS will enact as part of the final physician fee schedule for 2022.
It also provides a gradual phase-in of separate Medicare sequestration cuts of 2% that were originally taking effect on January 1st. Instead, thanks to this legislation.
- No sequestration cuts will occur in the first three months of the year.
- A 1% reduction in Medicare payments would take effect for the second quarter of 2022.
- Then, the full 2% sequestration cuts will take effect next July.
A third provision of the legislation exempts Medicare and other programs from automatic cuts in 2022 triggered by increased federal spending under the American Rescue Plan Act enacted earlier this year.

Overall, this means that while most harmful Medicare cuts have been eliminated, some cuts have only been postponed.

By protecting Medicare mental health services reimbursements, the legislation helps ensure the program and its providers can continue meeting the needs of beneficiaries as the COVID-19 pandemic continues. The pandemic has been taking a heavy toll on the nation’s mental health, with psychologists reporting large increases in demand for treatment of anxiety and depression compared with last year, and increased workloads and longer waitlists than before the pandemic.

While the fight is not over, this victory shows that when psychologists, scientists, educators, and students work together, we can make a difference. We will keep you informed on efforts to continue to protect access to mental health in 2022 and hope you will join our efforts. Thank you for your work to elevate the voice of psychology!

New Billing Disclosure Requirements Take Effect in 2022 (12/15/2021)
Psychologists will need to provide estimated costs of services before starting treatment.

The APC is monitoring this new information, including what steps psychologists might need to take in order to be in compliance with these new regulations. The APC will share any additional information in future APC Updates.

Read full article here from the American Psychological Association.

CMS Issues Final Rule for 2022 (12/15/2021)

The final rule includes information about audio-only services, psychological and neuropsychological testing, family therapy, and reimbursement rates.

Read the full article here.

Cigna Behavioral Health Changes Name to Evernorth Behavioral Health (12/15/2021)

On September 1, 2021, Cigna Behavioral Health, Inc. changed its name to Evernorth Behavioral Health, Inc. With this change, we will accelerate the delivery of innovative and flexible solutions that drive the most value for you and your patients.

Extension to NC Medicaid Managed Care Appeals Deadlines (12/8/2021)

From the NC Department of Health and Human Services

Provider appeal rights defined in the Standard Plan Contract, Section V.D.5, Provider Grievances and Appeals and the appeal processes outlined in the Prompt Payment Fact Sheet, include deadlines to submit appeals which may vary by Standard Plans, from 30 days to 365 days after the decision giving rise to the right to appeal.

The Department shared concerns from providers about these deadlines with the Standard Plans. In response, Standard Plans will temporarily extend the following minimum appeal timeframes to support the transition to NC Medicaid Managed Care:

Appeal Submission Date	Minimum Appeal Timeframe
Through Jan. 31, 2022	90 calendar days from the decision giving rise to the right to appeal
Feb. 1, 2022 through March 31, 2022	60 calendar days from the decision giving rise to the right to appeal
April 1, 2022 and later	30 calendar days from the decision giving rise to the right to appeal

For more information, see Extension to NC Medicaid Managed Care Appeals Deadlines.

Help Prevent 3.75% Reimbursement Rate Cuts (12/8/2021)

Please take 2 minutes today to prevent cuts to Medicare that would have a ripple effect across private insurance and other federal programs, including those treating vulnerable populations.

Despite a large increase in demand for mental health services as the COVID-19 pandemic continues to ravage communities and families nationwide, Medicare reimbursement rates for psychologists’ services will be cut 3.75% starting in January unless Congress takes action. Medicare payment rates are already considered low, and these pending cuts will not only impact practitioners' bottom line, they will inevitably lead to reductions in mental and behavioral health services provided to those who are most in need. And because Medicare's payment policies often serve as a benchmark for private insurance and other programs—including Tricare, the Veterans Health Administration, and state Medicaid programs—these changes ultimately will affect EVERYONE, not just providers and patients enrolled in Medicare.

Congress took action at the end of last year to prevent structural changes in Medicare billing codes from triggering a similar across-the-board reduction in Medicare payment rates. We need Congress to act before the end of this year to extend the 3.75% payment adjustment again, through at least CY 2022. Nearly 250 House members have signed a letter saying the support doing this, but we need stronger Senate support.

You can help by contacting your Senators to ask them to approve legislation this year to prevent the 3.75% reimbursement rate cuts from taking effect. Please protect Medicare providers and Medicare beneficiaries’ access to mental health services by preventing the cuts from taking place.

Click here to contact Senator Richard Burr.

Click here to contact SenatorThom Tillis.

NC HIEA (12/8/2021)

The NC Health Information Exchange Authority has revised its Privacy and Security Policy; the new policy will take effect December 16, 2021.

Click here to read more here.

BCBS Quartet Expansion (12/8/2021)

Beginning January 1, 2022, Blue Cross NC will be expanding its Quartet Health program to include State Health Plan members.

Click here to read more.

HHS Telehealth Resources (12/1/2021)
Health and Human Services has a resource-rich page related to telehealth.

Sections include preparing patients for telehealth, legal considerations, best practice guides, and more.

Click here to read more.

CMS Bulletin Regarding Place of Service Codes (12/1/2021)

The bulletin specifies a new code for telehealth in a patient's home (Place of Service code 10) that will become effective January 1, 2022. You may see some insurers starting to update their systems in anticipation of this change.

Click here to view the CMS bulletin.

Medicare Opting Out and Private Contracting (11/17/2021)
All Medicare-eligible mental health professionals must decide whether they will become credentialed as an in-network provider for the government Medicare plan or choose to “opt-out”.

From APA Services Inc:
“Healthcare professionals are required by law to submit claims to Medicare for services furnished to Medicare beneficiaries under a provision known as mandatory claims submission. Even those who never applied to become Medicare providers must abide by this requirement. Certain healthcare professionals, including psychologists, have the option of privately contracting with Medicare beneficiaries for services rather than submitting claims to Medicare. Known as the “opting out” process, this alternative allows select providers to treat Medicare beneficiaries without Medicare’s payment restrictions.” Read the full article here.

You can search for providers who have opted out, or confirm your own opt-out status, using this Medicare.gov link:

https://www.medicare.gov/forms-help-resources/find-providers-whove-opted-out-of-medicare/search-results

Additional information can be found in the Online Toolkit, including the Opt-Out Affidavit and information about creating a Private Contract.

BCBS Annual Provider Training and Attestation Requirements (11/17/2021)

This is a reminder that all participating providers in our Blue Cross and Blue Shield of North Carolina Medicare Advantage network are required to complete the Healthy Blue + Medicare (DSNP) MODEL OF CARE training.

Click here to read more.

Office of the National Coordinator for Health Information Technology (ONC) (11/10/2021)

HealthIT.gov is the official website for the Office of the National Coordinator for Health Information Technology (ONC). https://www.healthit.gov/

Psychologists can find information related to a wide variety of topics, such as privacy, security, and HIPAA. For example:

Click here for tips on how you can protect and secure health information when using your mobile device.

BCBS Update to Family Psychotherapy Coverage (11/10/2021)

Effective January 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will provide coverage for family psychotherapy without the presence of the patient.

Click here to read more.

HIPAA Security Rule and Security Risk Assessment (11/3/2021)

The Office of the National Coordinator for Health Information Technology (ONC), in collaboration with the HHS Office for Civil Rights (OCR), developed a downloadable Security Risk Assessment (SRA) Tool to help guide you through the process. The tool is designed to help healthcare providers conduct a security risk assessment as required by the HIPAA Security Rule and the Centers for Medicare and Medicaid Service (CMS) Electronic Health Record (EHR) Incentive Program.

Click here to read more and download the free SRA Tool.

Health Information Exchange (10/27/2021)

To be reimbursed for treatment and evaluation of Medicaid, State Employee Health Plan, and Children’s Health Insurance Program (CHIP) patients, the provider, whether in-network or out of network, must comply with the North Carolina HIE law.

On Monday, October 18, Martha Turner-Quest, Executive Director, participated in a North Carolina Health Information Exchange Agency (NC HIEA) focus group with other health care providers. The NC HIEA will be providing the North Carolina General Assembly with a compliance-related report concerning providers’ and organizations’ connection efforts by March 2022.

The original deadline was June 1, 2020, but due to COVID 19, the deadline is extended to January 1, 2023.

Compliance With The Law
Compliance with the law means that the provider has filled out and submitted a Participation Agreement which could be a Full Participation Agreement or a Submission Only Participation Agreement.

Full Participation Agreement allows a two-way exchange of information about patient information between the provider and the HIE.

https://hiea.nc.gov/nc-hiea-full-participation-agreement/open

Submission Only Participation allows only one-way communication from the provider to the HIE. The Submission Only Agreement does not ensure that ONLY state-funded health care patient data is submitted. The onus is on respective providers and their electronic health record (EHR) vendors to make sure that only Medicaid, State Employee Health Plan, and CHIP patient data is submitted.

NC HIEA Submission-Only Participation Agreement | NC HIEA

Acceptance of the provider’s Participation Agreement by the Health Information Exchange Authority (HIEA) puts the provider in a “queue” to be linked to the HIE. When the provider is in the Queue, by having an agreement in place, it means that they are “in compliance.” In compliance further means the provider is showing “good faith” in moving forward with the process as “development underway”. That is, they are not waiting until the last minute to hook up and have identified an HIE-approved method to submit patient information to the HIE. If you are already connected to NC HealthConnex, you are done and in full compliance with the law.

Note: The Law does not require use of an EHR. It states: “Method of Data Submissions–The data submissions required under this section shall be by connection to the HIE Network periodic asynchronous secure structured file transfer or any other secure electronic means commonly used in the industry and consistent with document exchange and data submission standards established by the Office of the National Coordinator for Information Technology within the U.S. Department of Health and Human Services.”

The Law does not define the specific behavioral data that is to be shared through your submission. It states: certain demographic and clinical information pertaining to services rendered to Medicaid and other State-funded health care program beneficiaries and paid for with Medicaid or other State-funded health care funds.

Although HIE “defaults” to talking as if an EHR is necessary, it is not a requirement by the letter of the law. It is just difficult to figure out how to hook up without an EHR.

Helpful Links

The Law:
https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_90/Article_29B.html

General FAQs About NC HealthConnex:
https://hiea.nc.gov/faqs/general-faqs-about-nc-healthconnex#what-is-the-hie-act-and-the-state%E2%80%99s-requirements-for-connectivity

HIE and COVID-19 Response
https://hiea.nc.gov/covid-19

HIE Connection Deadline FAQs
https://hiea.nc.gov/faqs/faqs-about-covid-19-legislation

NCPA Has Worked With Two Software Developers
Because many of us have been concerned about patient privacy from this law, NCPA has worked with 2 software developers to define their methods of connecting to the HIE while maintaining privacy of patient records and sending minimal data. If you have attended conferences where these developers have joined us as sponsors and presenters, you may recall:

Mark Dunnagan of Smartlink Health Solutions, (https://www.smartlinkhealth.com/), is a Cary-based software company that has invested in a connection to NC HealthConnex that can support almost any EMR or billing system. They have also constructed a Patient Registry, for paper-based practices, which is capable of securely tracking and forwarding the information required by NC HealthConnex. You may send an email to support@smartlinkhealth.com for more information.

Sean Behan of Therapy Notes (www.therapynotes.com) who, as chief technician for TN on this project, has identified minimal behavioral health information for submission only to HIE.

He states: "TherapyNotes utilizes HL7 ADT messages for the data transmission format, and the content of those messages has a very high degree of overlap with the content of a health insurance claim - things like patient demographics, insurance information, service codes, diagnosis codes, and provider information. . . We do include confidentiality indicators in the diagnosis as well, asking that diagnostics be withheld in the HIE environment unless an end-user indicates a specific need for that information.”

NCPA cannot endorse a particular software company but has had a very positive working relationship with these 2 software entities.

Other EHRs accepted by the HIE are listed on the NC HealthConnex website: https://hiea.nc.gov/providers/electronic-health-record-vendor-connectivity-report

**NCPA strongly recommends that providers work closely with their particular EHR vendor (or other non-EHR“connectors” like SmartLink) to identify the specific data points that the EHR will submit to the HIE. NCPA cannot recommend exact data sets to use with the HIEA but appreciates the care that Smartlink and Therapy Notes have taken to identify the data set in the HCFA 1500 forms. **

Meeting with Executive Director of PsyPact Commission (10/20/2021)

On Friday, October 8, Leslie Feil, PhD and Cristin Saffo, PsyD of the APC and Martha Turner-Quest, Executive Director, met with Janet Orwig, MBA, CAE, the Executive Director of the PsyPact Commission. During the meeting, Ms. Orwig shared information about PsyPact history, governance, and policies. Drs. Feil and Saffo shared information from the NCPA PsyPact survey and raised some specific questions about operating under PsyPact. The following is a summary of the main points addressed in this meeting.

Overview and General Information
The PsyPact Commission (official name Psychology Interjurisdictional Compact Commission) is the governing body of PsyPact responsible for creating and finalizing the Bylaws and Rules and Regulations. The Commission is also responsible for granting psychologists the authority to practice telepsychology and temporary in-person, face-to-face practice of psychology across state boundaries. The first PsyPact Commission meeting was held in July 2019. The Board of Psychology in each PsyPact state has its own commissioner.

ASPPB began taking applications for the E.Passport and associated credentials in July 2020. Ms. Orwig reported that delays in processing applications were due to 1) a higher than expected number of applications (possibly due to increased telehealth use with Covid) and 2) significant staffing shortages. Ms. Orwig reported that the staffing shortages have been rectified.

The PsyPact Commission has appointed several committees, including the Training and Public Relations Committee, to address issues related to operating under PsyPact. Some committee meetings are open to the public. Meeting schedules can be found on the PsyPact website, where interested parties can register to attend.

E.Passport Credentialing
An applicant’s degree program must have been accredited by the American Psychological Association/ Canadian Psychological Association or designated by the ASPPB National Register Joint Designation Project. Psychologists who earned their doctoral degree in psychology from a regionally accredited program may apply for the E.Passport if 1) they were licensed by or before January 1, 1985 and 2) have been continually been licensed since that date.

NOTE: Questions and concerns related to E.Passport credentialing should be directed to the Association of State and Provincial Psychology Boards (ASPPB), not to the PsyPact Commission.

Specific Practice Topics

Uniformity:
1. Compact states can’t impose rules or regulations that the other compact states won’t agree to. For example, no compact state can require an in-person meeting at any point during delivery of remote services.

2. PsyPact supersedes any state law pertaining to the interjurisdictional practice of telepsychology and temporary in-person, face-to-face practice.

3. Psychologists providing virtual services into other states under PsyPact can assume that the receiving state’s regulations allow for electronic provision of services; you do not need to confirm this with each state’s Psychology Board.

Home State:
1. A psychologist needs to be licensed in their designated home state in order to provide services under PsyPact from that state. If you move to another PsyPact state, you will need to apply for a license from that state. This would also apply to temporary relocation (see #3).

2. You are not operating under PsyPact if you are providing remote services from one state into another and are licensed in both states- even if both states are part of the PsyPact compact.

3. Psychologists can change their designated home state, and there is no minimum amount of time required for a home state designation. Example: Dr. X is licensed in both North Carolina and Georgia. Dr. X lives and works in the designated home state of NC. Dr. X plans to spend two months in GA and provide services while there. Dr. X can change the designated home state to GA during those two months.

Legal:
1. PsyPact does not address mental health laws and regulations. Psychologists practicing under PsyPact need to be aware of the receiving state’s laws and regulations regarding mental health. During the meeting, NCPA advocated for the need for easily accessible reference materials related to specific state law (such as duty to protect/warn and duty to report). Ms. Orwig will bring this to the Training and PR Committee.

Note: The NCPA Online Toolkit (available to members at the Investor level and above) contains a document summarizing all states’ Mental Health Professionals’ Duty to Warn. The Toolkit also contains pages related to “Technology and Electronic Records” and “Telehealth and PsyPact”.

Business and Taxes:
1. PsyPact law does not address business regulations. For example, while PsyPact law does not require a “reporting agent” to be designated in a receiving state, this may be required by the laws regulating business operations in the receiving state. Psychologists need to research the specific business laws of the receiving state.

2. PsyPact likewise does not address tax issues; Ms. Orwig advised psychologists to consult with their accountants regarding tax matters.

3. As with legal matters, NCPA advocated for the need for easily accessible, state-specific business information; Ms. Orwig will bring this to the Training and PR Committee.

Insurance:
1. PsyPact does not address insurance issues. Informational materials are available for psychologists to provide to insurance companies if they experience problems while operating under PsyPact. Contact PsyPact directly for these materials.

2. CMS considers practicing under PsyPact to be the equivalent of practicing with a license in the receiving state. (See the recent APC Updates for more on this.)

3. Ms. Orwig reported that the APA Practice Directorate is working on insurance issues related to practicing under PsyPact.

Information and Resources

PsyPact
Website: https://psypact.site-ym.com/general/custom.asp?page=telepsychology
Contact information: info@psypact.org; psypro@asppb.org; or use the “Contact us” form on the PsyPact website

Association of State and Provincial Psychology Boards (ASPPB)
Website: https://www.asppb.net/
Main email: asppb@asppg.org
Mobility program email: mobility@asppb.org

American Psychological Association (APA) Practice Directorate
Website: https://www.apa.org/practice
Contact page: https://www.apa.org/practice/contact

CMS Recognizes PsyPact Licensure Requirements for Interstate Practice (10/13/2021)
Psychologists authorized to practice in states where PSYPACT — the Psychology Interjurisdictional Compact — has been enacted will soon be eligible to bill Medicare Administrative Contractors for services provided across state lines to Medicare beneficiaries.

Click here to read more.

Medicare Clarifies Recognition of Interstate License Compact
On September 5, 2021, the Centers for Medicare and Medicaid Services (CMS) issued a revised notice regarding recognition of interstate license compact pathways.

See the notice here.

Psypact Proposed Rule for Comment
The PSYPACT Commission has released the following proposed rules. The Commission will accept public comment until November 4th, 2021 at 5:00pm EST. To submit public comment, please visit the link at the bottom of the page. The annual Commission meeting which will contain a public hearing regarding these rules will be held on November 18th, 2021 at 10:00am EST. A registration link for this meeting can be found HERE

Proposed Rules

New CE Requirements for Psychologists for 2022 Licensure Renewal (10/06/2021)

All licensees must now complete 24 total hours of Continuing Education for every two-year
license renewal cycle. A minimum of 15 of those hours must now be completed in Category
A Continuing Education. Up to a maximum of 9 hours may be completed in Category B
Continuing Education; however, all 24 Continuing Education hours may be completed in
Category A if so desired.

Beginning with the next license renewal cycle (October 1, 2022), each licensee must submit an attestation form documenting completion of the required minimum CE hours as well as copies of certificates of completion in order to renew their licenses.