Update: New Regulations on the Dec. 23 Extension and Requiring Issuers to Accept Payment until Dec. 31

The interim final rule amends the date by which a qualified individual must select a qualified health plan (QHP) through any Exchange for an effective coverage date of January 1, 2014. The rule generally allows consumers to select a QHP until December 23, 2013, which is a change from the previously stated regulatory date of December 15, 2013, but permits State Exchanges to select a different date. It also establishes a related policy regarding the date by which a consumer needs to pay any applicable initial premium to ensure timely effectuation of coverage. Generally, issuers can set the payment deadline, as long as it is no earlier than the last day before the coverage effective date. For example, for January 1 coverage, the payment could be due December 31 or after. Furthermore, issuers are encouraged to provide January 1 coverage to consumers who enroll after the December 23 date, including enrollments as late as January 31. This is optional for the issuer.

The new policy pertains to the individual market and Small Business Health Options Program in both the Federally-facilitated Exchanges and State Exchanges.  However, it does not change the plan selection or premium payment dates for coverage offered outside of the Exchanges.

The Interim Final Rule can be found here:  Maximizing January 1, 2014 Coverage

Press Release: http://www.hhs.gov/news/press/2013pres/12/20131212a.html.

CMS Fact Sheet Link: Taking Steps to Smooth Consumers’ Transition into Health Coverage Through the Marketplace

The Secretary’s blog: What We’re Doing to Help Americans Get Coverage

Community Health Worker Course

HLTH 1210 – Community Health Worker Course

3.0 College Credit hours

This course is designed for members of the general public who want to be trained as Community Health Workers (CHW).  CHWs work with people who want or need help getting medical services and healthcare for themselves or their families.

The classes are held at the College Center in South Sioux City every Thursday evening from 6:00 – 9:00pm for 10 weeks, starting January 16, 2014, followed by 45 hours of practicum April-June 2014.

To register, call 402-844-7266 or visit the Norfolk Northeast Community College Campus or the College Center in South Sioux City, NE.

This course is also being offered through the ITV distance learning system.  It will originate from South Sioux City and be sent to other locations in Nebraska.  For a location near you, call Heather Claussen at 402-844-7334.

Register here.

New Grant Opportunities for Communities to Assist with Community Behavioral Health

This is an opportunity for communities (from very rural to highly urban) to receive a grant to be involved in identifying current community behavioral health practices and to assist in developing new and improved methods. 

We are working with the “Community Assessment and Education to Promote Behavioral Health Planning and Evaluation” (CAPE) project. This is a national project dedicated to identifying and sharing best practices for benchmarking community behavioral health. Funding is through the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) and facilitated by the U.S. Department of Agriculture’s National Institute of Food and Agriculture. Project members are drawn from universities across the United States. Project website is at: http://healthbench.info/home.html

The CAPE project has issued a “Call for Proposals” to fund eight pilot communities to participate in a joint exploration of what communities are now using to gauge community behavioral health and how these methods can be improved. This includes an online survey of local health decision makers (broadly defined) aimed at developing a better understanding of where local leaders draw their information about community behavioral health trends as well as a joint shaping and testing of new tools to make the process more accurate and efficient.

PROPOSALS ARE DUE JANUARY 21, 2014. Community selections are expected to be announced at the end of January. The pilot program is expected to run from March 3, 2014 to October 31, 2014. 

Communities selected for this program will receive funds to buy out up to 8 months of up to 1.0 FTE (0.67 FTE total) per selected community for current staff members to join the CAPE project. Funding will come in the form of a contract with the land grant institution leading the community effort. Community teams of one, two, or three individuals will be considered. Pre-approved travel or other pre-approved out-of-pocket costs will be directly reimbursed.

ANY U.S. COMMUNITY IS ELIGIBLE. The eight communities are expected to be drawn from a range of community types from very rural to highly urban. Communities are expected to be defined using county lines (single-county units are preferred but multi-county proposals will be considered, especially in tribal areas) due to the availability of Federal county health statistics. The selection process may also take into account a desire to balance the eight communities across the four USDA regions to obtain input from a more diverse set of circumstances.

For more detailed information, please go to: http://healthbench.info/communities.html. Direct your questions to: Scott Loveridge, North Central Regional Center for Rural Development at loverid2@msu.edu.

 

New Grant Opportunity for Communities to Assist with Community Behavioral Health

This is an opportunity for communities (from very rural to highly urban) to receive a grant to be involved in identifying current community behavioral health practices and to assist in developing new and improved methods. 

This grant is with the “Community Assessment and Education to Promote Behavioral Health Planning and Evaluation” (CAPE) project.  This is a national project dedicated to identifying and sharing best practices for benchmarking community behavioral health.  Funding is through the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) and facilitated by the U.S. Department of Agriculture’s National Institute of Food and Agriculture.  Project members are drawn from universities across the United States.  Project website is at: http://healthbench.info/home.html

The CAPE project has issued a “Call for Proposals” to fund eight pilot communities to participate in a joint exploration of what communities are now using to gauge community behavioral health and how these methods can be improved. This includes an online survey of local health decision makers (broadly defined) aimed at developing a better understanding of where local leaders draw their information about community behavioral health trends as well as a joint shaping and testing of new tools to make the process more accurate and efficient.

PROPOSALS ARE DUE JANUARY 21, 2014. Community selections are expected to be announced at the end of January. The pilot program is expected to run from March 3, 2014 to October 31, 2014. 

Communities selected for this program will receive funds to buy out up to 8 months of up to 1.0 FTE (0.67 FTE total) per selected community for current staff members to join the CAPE project. Funding will come in the form of a contract with the land grant institution leading the community effort. Community teams of one, two, or three individuals will be considered. Pre-approved travel or other pre-approved out-of-pocket costs will be directly reimbursed.

ANY U.S. COMMUNITY IS ELIGIBLE. The eight communities are expected to be drawn from a range of community types from very rural to highly urban. Communities are expected to be defined using county lines (single-county units are preferred but multi-county proposals will be considered, especially in tribal areas) due to the availability of Federal county health statistics. The selection process may also take into account a desire to balance the eight communities across the four USDA regions to obtain input from a more diverse set of circumstances.

For more detailed information, please go to: http://healthbench.info/communities.html. Direct your questions to: Scott Loveridge, North Central Regional Center for Rural Development at loverid2@msu.edu.

 

ICD-10 Implementation Project

Recent Developments

  • Nebraska Medicaid is following the same timeline adopted by the Centers for Medicare & Medicaid (CMS) for the transition of the CMS 1500 health insurance paper claim form.  The transition timeline for moving from the current 08/05 version to the 02/12 version is as follows:
    • Effective January 6, 2014, Nebraska Medicaid will begin receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
    • Effective January 6 through March 31, 2014, Nebraska Medicaid will have a dual use and processing period during which we will continue to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
    • Effective April 1, 2014, Nebraska Medicaid will receive and process paper claims submitted only on the revised CMS 1500 claim form (version 02/12).
    • Note that on or after April 1, 2014, any claims received utilizing the older versions of the CMS 1500 claim form will be returned to the provider.  See the Provider Bulletin #13-75:  http://dhhs.ne.gov/medicaid/Documents/pb1375.pdf for additional information.

NOTE:

  • Do not use ICD-10 diagnosis codes prior to the October 1, 2014.
  • ICD-10 diagnosis codes can be used effective October 1, 2014, but only for dates of service on or after October 1, 2014.
  • If ICD-10 codes are submitted before October 1, 2014, the claims will be denied.
Information about the International Classification of Diseases, 10th Revision
ICD-10

The United States Department of Health and Human Services requires that all HIPAA covered entities use ICD-10 codes beginning October 1, 2014.  This date is an extension from the original deadline of October 1, 2013.  The ICD-10 coding system will fully replace the current ICD-9 coding system and will have a substantial impact on the entire health care industry.

The ICD-10 final rule concurrently adopts the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. These code sets will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.

As a HIPAA covered entity, Nebraska Medicaid will be transitioning to ICD-10 for both electronic transactions and paper claims.  Other affected forms and processes will be announced as decisions are made.  We are currently in the process of remediating the Medicaid Management Information System (MMIS) to accept and process with ICD-10 codes beginning October 1, 2014, for dates of service on or after October 1, 2014.

Highlights of how claims will be impacted when ICD-10 is implemented on October 1, 2014

  • Reimbursements will be impacted if ICD-10 is not implemented timely and accurately by providers.
  • Providers must use either ICD-9 or ICD-10 depending on the date(s) of service:
    • Claims for dates of service prior to October 1, 2014, must be submitted with ICD-9 codes, regardless of the date submitted
    • When the dates of service span the implementation date, for example, the discharge date and/or through date is on or after October 1, 2014, the claim should contain only ICD-10 codes.
  • Electronic and paper claims combining both ICD-9 and ICD-10 codes will be rejected, regardless of the date of service
  • Nebraska Medicaid will not accept ICD-10 codes prior to the compliance date of October 1, 2014
  • Dental Claims (paper and electronic 837D) will not require ICD-10 diagnosis codes.  Claims will not be rejected if a valid diagnosis code(s) is submitted.
  • Electronic and paper claims will be processed using the same rules for diagnosis coding.
  • On or after 10-1-2014, Providers must use either ICD-9 or ICD-10 based on the date(s) of services claimed, regardless of the billing date.
  • Providers must submit claims within180 days (6 months) after the date of service.

Test Plan

  • Nebraska Medicaid plans to begin ICD-10 electronic transaction testing with trading partners in the first calendar quarter of 2014.  More details will be published as known.

Communication

  • To assist in delivery of information, a dedicated email address has been created for questions and answers specific to the ICD-10 transition.  This email address is:  DHHS.ICD-10Implementation@Nebraska.gov.

FAQs

Resources

The Centers for Medicare & Medicaid (CMS) provides extensive information, facts sheets, tools, and resources for providers, vendors and payers for implementing ICD-10.  We are providing select links to assist you with your ICD-10 efforts.  For more information, visit the CMS website at www.cms.gov/icd10.

CMS ICD-10 Code Sets:  The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge.

45 CFR Part 162, Final Rule : Governing legislation for implementing the ICD-10 code sets.

CMS Provider Resources:  Resources to assist providers in the transition to ICD-10

CMS Vendor Resources:  Resources to assist vendors in the transition to ICD-10

CMS 2013 ICD-10-CM and GEMs and CMS 2013 ICD-10 PCS and GEMs:  GEMs are General Equivalence Mappings between ICD-10-CM and PCS and ICD-9-CM codes.  They are designed to assist converting applications and systems from ICD-9 and ICD-10 codes and are updated annually.

The CMS ICD-10 Planning Check List on the CMS website outlines the critical steps for providers to follow to accomplish implementation of ICD-10 codes.

Check out the Nebraska Health Information Management Association website at:  http://www.nhima.org for some training opportunities in Nebraska.

Nebraska ICD-Collaborative is the website of Nebraska individuals and organizations working together to facilitate communication, collaboration and information sharing.  It includes resources and events.

CMS Announcement: Taking Steps to Smooth Consumers’ Transition into Health Coverage Through the Marketplace

Giving Consumers More Flexibility on Deadlines To Sign Up and Pay For Coverage

Extending the Enrollment Deadline to December 23

  • Today, we are formally extending the deadline for signing up through the Marketplaces for coverage beginning January 1 from December 15 to December 23 (this also applies to the Federally-Facilitated SHOP).
  • We will consider moving this deadline to a later date should exceptional circumstances pose barriers to consumers enrolling on or before December 23.

Reminding Consumers of the Special Enrollment Period for Individuals Who Have Trouble Signing Up Due to an Error Made By the Marketplace

  • If an individual tries to sign up by December 23rd but experiences an issue with the Marketplace, they qualify for a special enrollment period and gain coverage as soon as possible.

Giving Those With Some of the Most Severe Health Conditions Additional Time on Their Current Health Plan

  • We are allowing enrollees to stay in the federal Pre-existing Condition Insurance Plan (PCIP) program through January to ease their transition into Marketplace plans. This step will help take pressure off of this vulnerable group’s enrollment in coverage through the Marketplace by December 23rd.

Encouraging Insurers to Give Consumers Even More Flexibility to Sign Up for Coverage Effective January 1, 2014

  • We are encouraging insurers to allow people who sign up after December 23 to get coverage on January 1.
  • This includes allowing issuers to offer retroactive coverage for people who sign up after January 1. For example, if a person signs up and pays on January 5, they can have coverage with a start date of January 1 (which qualifies them for the advance premium tax credit).

Giving Consumers More Time to Make Their First Premium Payments

  • We are requiring insurers to provide coverage beginning on January 1 if a person pays by December 31 (previously, issuers could have set an earlier deadline).
  • We are also encouraging insurers to allow individuals who signed up by December 23 but didn’t pay until sometime in January to get coverage starting on January 1. We are also encouraging insurers to allow people who pay part but not all of their premium to have their coverage start on time.

The Obama Administration is announcing the steps we are taking to immediately make it easier for individuals to purchase health plans through the Marketplace and access the doctors and prescription medications they may need during the transition to new health insurance. We will continue to look for additional steps we can take to make this process easier for consumers.

Helping Consumers Access Their Doctor and Prescription Drugs During This Transition

Strongly Urging Insurers to Cover the Additional Doctors and Prescription Drugs Consumers Need During January

  • We are strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes.
  • We are strongly encouraging issuers to treat out-of-network providers as in-network if the provider was listed in their plan’s provider directory as of the date of an enrollee’s enrollment.
  • And we are strongly encouraging insurers to refill prescriptions covered under previous plans during January.

Making Sure Consumers Have Accurate Information So They Can Pick the Health Plan That Works Best for Them

  • Provider directories and formularies (lists of prescription drugs covered by a plan) are now available in anonymous shopping and can be reviewed prior to choosing a plan.
  • We are clarifying that issuers should make sure provider directories for Marketplace plans are accurate and up to date, so that consumers have all the information they need to choose the plan that’s right for them.

Ensuring That Consumers Know Their Rights

  • We are working to make sure consumers know their existing right to appeal an insurers’ decision not to cover a particular consumer or medication, the ability to get an off-formulary drug through an exceptions process, and the right to emergency care outside of networks at in-network rates.

Nearly 365,000 Americans selected plans in the Health Insurance Marketplace in October and November

1.9 million customers made it through the process but have not yet selected a plan; an additional 803,077 assessed or determined eligible for Medicaid or CHIP

Health and Human Services (HHS) Secretary Kathleen Sebelius announced that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November.  November alone added more than a quarter million enrollees in state and federal Marketplaces.  Enrollment in the federal Marketplace in November was more than four times greater than October’s reported federal enrollment number.

Since October 1, 1.9 million have made it through another critical step, the eligibility process, by applying and receiving an eligibility determination, but have not yet selected a plan.  An additional 803,077 were determined or assessed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in October and November by the Health Insurance Marketplace.

“Evidence of the technical improvements to HealthCare.gov can be seen in the enrollment numbers.  More and more Americans are finding that quality, affordable coverage is within reach and that they’ll no longer need to worry about barriers they may have faced in the past – like being denied coverage because of a pre-existing condition,” Secretary Kathleen Sebelius said. “Now is the time to visit HealthCare.gov, to ensure you and your family have signed up in a private plan of your choice by December 23 for coverage starting January 1. It’s important to remember that this open enrollment period is six months long and continues to March 31, 2014.”

The HHS issue brief highlights the following key findings, which are among many newly available data reported today on national and state-level enrollment-related information:

  • November’s federal enrollment number outpaced the October number by more than four times.
  • Nearly 1.2 million Americans, based only on the first two months of open enrollment, have selected a plan or had a Medicaid or CHIP eligibility determination;
    • Of those, 364,682 Americans selected plans from the state and federal Marketplaces; and
    • 803,077 Americans were determined or assessed eligible for Medicaid or CHIP by the Health Insurance Marketplace.
  • 39.1 million visitors have visited the state and federal sites to date.
  • There were an estimated 5.2 million calls to the state and federal call centers.

The report groups findings by state and federal marketplaces.  In some cases only partial datasets were available for state marketplaces.  The report features cumulative data for the two month period because some people apply, shop, and select a plan across monthly reporting periods.  These counts avoid potential duplication associated with monthly reporting.  For example, if a person submitted an application in October, and then selected a Marketplace plan in November, this person would only be counted once in the cumulative data.

To read today’s report visit: http://aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/Dec2013/ib_2013dec_enrollment.pdf

To hear stories of Americans enrolling in the Marketplace visit: http://www.hhs.gov/healthcare/facts/blog/2013/12/americans-enrolling-in-the-marketplace.html.

 

Family Helpline Helps 10,000 Families

Since opening its phone lines in January 2010, the Nebraska Family Helpline has helped more than 10,000 families in the state, according to the Nebraska Department of Health and Human Services.

“The Helpline has proven to be a valuable resource for Nebraska families,” said Scot L. Adams, director of the Division of Behavioral Health, which funds the Helpline provided by Boys Town. “Perhaps most importantly, almost two-thirds of callers feel they have resolved their issue by the end of the call.”

During the past four years, 10,092 Nebraska families have called the Helpline seeking assistance for their child or youth experiencing behavioral health challenges.  The Helpline documented 14,470 inbound calls, indicating that some families have called more than once.

Caregivers call the Helpline when they are concerned with their child’s behaviors and are searching for more information or referrals for services to help. The NFH provides support for families to deal with their immediate crisis and helps them identify additional resources in their community for ongoing support. The NFH may also connect the caller with a Family Navigator, who is able to meet with the family at their location and time of choice, within 72 hours if desired.

Trained NFH counselors help to empower families with information and referrals appropriate to their situation. Of all the issues reported by callers, the top five regarding children had to do with not following family rules, being aggressive at home, arguing, conflicts with school authority figures and low grades.

The Nebraska Family Helpline is a free, 24/7 helpline provided by Boys Town and funded by DHHS. For more information, visit www.nebraskafamilyhelpline.ne.gov . The Helpline number is 1-888 866-8660.

HHS announces Affordable Care Act mental health services funding

$50 million from the health care law will expand mental health and substance use disorder services in approximately 200 Community Health Centers nationwide

The U.S. Department of Health and Human Services (HHS) today announced that it plans to issue a $50 million funding opportunity announcement to help Community Health Centers establish or expand behavioral health services for people living with mental illness, and drug and alcohol problems.  Community Health Centers will be able to use these new funds, made available through the Affordable Care Act, for efforts such as hiring new mental health and substance use disorder professionals, adding mental health and substance use disorder services, and employing team-based models of care.

It is estimated these awards will support behavioral health expansion in approximately 200 existing health centers nationwide.

Over the past year the Obama administration has taken a number of steps to reduce the barriers that too often prevent people from getting the help they need for behavioral health problems.

The Affordable Care Act expands mental health and substance use disorder benefits and parity protections for approximately 60 million Americans.

The President’s Fiscal Year 2014 Budget includes a new $130 million initiative to help teachers recognize signs of mental illness in students and refer them to services, support innovative state-based programs to improve mental health outcomes for young people ages, and train 5,000 more mental health professionals.  For more information please visit: http://www.whitehouse.gov/omb/budget/factsheet/improving-mental-health-prevention-and-treatment-services.

The Administration has also finalized rules under the Mental Health Parity and Addiction Equity Act. Because of these parity protections, many insurance plans will now include coverage for mental health and substance use conditions that is comparable to their medical and surgical coverage.

The Administration also launched www.mentalhealth.gov a new website featuring easy-to-understand information about basic signs of mental health problems, how to talk about mental health, and how to find help.