Updated COVID-19 Guidance for Providers: Telehealth and Prior Authorizations - Value-Based Purchasing (VBP) and COVID-19 Related Impacts - Health Home Practice Communication Regarding Community Care Team (CCT) Services 

Updated COVID-19 Guidance for Providers: Telehealth and Prior Authorizations 

We have updated our telehealth guidance and associated billing information. The guidance now includes information regarding well-child/EPSDT visits, security considerations, prescribing, frequently asked questions, and more. 

The Prior Authorization guidance provides information on temporary changes to the medical and behavioral health authorization processes as they relate to the COVID-19 public health emergency and MaineCare’s 1135 waiver.

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Value-Based Purchasing (VBP) and COVID-19 Related Impacts

MaineCare recognizes that providers who participate in VBP initiatives have unique concerns about how changes to health care delivery will impact their performance in alternative payment models. MaineCare is committed to making appropriate adjustments to all VBP programs that may be impacted by this pandemic. This includes changing our performance assessment and benchmarking methodologies to ensure VBP providers are not inappropriately penalized for the costs or changes in quality/utilization that result from COVID-19 and allowing flexibility with reporting/program deadlines.

Please see the list below for specific changes in the immediate term. This list will be revised and updated as we learn more about the duration of the pandemic and the level of impact on our VBP programs.

Behavioral Health Homes (BHH) Pay-for-Performance

• Performance reports will be sent out at the end of April covering a performance period of January 1, 2019 – December 31, 2019. MaineCare will forgo any recoupment for this reporting period and for future performance periods, until further notice. Also, rebuttals will not be collected for this time period to ease provider administrative burden.
• Behavioral Health Homes will continue to receive data from MaineCare.

Primary Care Provider Incentive Payments (PCPIP)

• The July 2020 incentive payments cover a time period of October 1, 2018 – September 30, 2019 and will be issued as usual.
• The January 2021 and July 2021 payment reports will be adjusted to exclude data from the impacted timeframe. Any specific adjustments to the payment methodology will be determined as the data is reviewed. Payments will continue to be made on the existing schedule.
• Primary care practices will continue to receive all payment-related and non-payment-related data reports from MaineCare.

Data Focused Learning Collaborative (DFLC)/Public Reporting on Adolescent Well-Care Visits

• Data will not be publicly reported for any period that includes COVID-19 impacts.
• Practices will continue to receive data covering the agreed upon timeframes for informational purposes only.

Accountable Communities (AC)

• MaineCare will work with our analytics vendor to make appropriate adjustments to all impacted aspects of the AC program, which may include spending targets, performance scores, patient attribution, risk adjustment, etc.

Questions?

Please email HH-BHH-Services.DHHS@maine.gov for BHH and DLFCquestions, PCP-Network-Services.DHHS@maine.gov for PCPIP questions, or AccountableCommunities.DHHS@maine.gov for AC questions.  

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Health Home Practice Communication Regarding Community Care Team (CCT) Services 

This is a reminder to Health Home (HH) practices of the value of CCT services. CCTs are an extension of the HH practice for members who have significant needs or barriers that the HH is not able to meet alone. Your affiliated CCT is equipped to assist practices in meeting patients’ support or care coordination needs, including connecting eligible patients to needed community resources. Due to the current strain on practices with the COVID-19 pandemic, we want to remind you of the ways that eligible HH members can be referred to a CCT for services:

• A provider can call or fax the CCT with the member’s information for referral and the CCT can add the member to the CCT panel
• The CCT can review the health system’s Electronic Health Record (EHR) and add the member to the CCT panel
• The CCT can review a HH practice’s utilization dashboard and claims in the Value-Based Purchasing Management System (VMS) portal and add the member to the CCT panel 

Historically, members have been referred to CCT services due to high utilization of the health care system. Although utilization has recently decreased, we want to remind practices that it is also appropriate to refer members to CCT services who:

• Are using 15 or more medications for chronic conditions or are on high-risk medications
• Have high social service needs that interfere with their care 

The interruption of a member’s regular care plan due to the COVID-19 pandemic and the physical and behavioral related impacts from this interruption are also appropriate factors for practices to consider when making CCT referrals. 

To review policy regarding HH and CCT services, please refer to https://www.maine.gov/sos/cec/rules/10/ch101.htm, Chapter II, Section 91, Health Home Services. If you are not familiar with staff from your affiliated CCT, or have questions, please contact the Value-Based Purchasing Unit at HH-BHH-Services.DHHS@maine.gov.