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 3rd, 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)

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).

Recently updated sections include:

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)"

(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. 

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)

"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.

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)

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:

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

SegmentNC MembersMedicare Advantage          150,000Commercial Group              430,000Individual 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 TimelineDeadline:1. Join Aetna network  3/31/20242. Join CPP with Aetna effective 1/1/25   5/31/20243. Review/Update Demographic Data       9/30/20244. Credential associate level providers9/30/20245. 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.