Director's Decision is Pulled Back in Controversial Transition Plan

A recent ruling by an administrative law judge (ALJ) found the Arizona Health Care Cost Containment System did not follow procurement laws when they awarded new contracts to health insurers that provide services for Arizona Long Term Care System (ALTCS) patients, giving the agency until September 8 to determine how to proceed.   

The agency originally doubled down on their plan of moving to new insurers. However, on Wednesday, AHCCCS announced it will be extending a one-year contract to current carriers instead of switching members to new plans on October 1 as previously planned. 

For more information on this story, read the latest from KJZZ. 

In the wake of the Change Healthcare Cyberattack, the Arizona Medical Association has received reports of severe disruptions for physician clinics. According to reports, clinics are unable to complete routine operations required by insurers – everything from prior authorization approvals for treatments to determining insurance eligibility for patients.

As this crisis unfolds, ArMA continues to collaborate with insurer plans, regulatory agencies, and government officials to outline solutions and resources for you.

On Thursday, March 7, UnitedHealth Group released a detailed timeline for restoring its systems. Key systems are expected to be restored by March 18. In the meantime, we encourage you to utilize the resources below, which will be updated regularly.

SOLUTIONS FOR YOU 

As the largest physician-led organization in Arizona, ArMA is actively advocating for payers to create immediate solutions for our communities. Several payers have communicated their ability to offer temporary relief, including advanced payments. We strongly encourage impacted physicians to contact their payer representatives and request: 

1. An advanced payment if billing has been impacted 
2. An alternative clearinghouse for submission of claims data 
3. A relaxing of prior authorization processes until issues are mitigated 
   
   

ADDITIONAL RESOURCES 

ArMA is continuously compiling and disseminating resources from regulatory agencies and local healthcare insurance providers to keep you in-the-loop. For the most up-to-date information, be sure to check this page frequently. 

• American Medical Association | For the latest national developments and information, view the AMA's resource hub here: https://www.ama-assn.org/practice...
• Arizona Complete Health | Alternative methods for claims submission and payment processing. Website:  https://www.azcompletehealth.com/news...
• Arizona Health Care Cost Containment System | To view the latest updates from AHCCCS, visit their website: https://www.azahcccs.gov/Plans... 
• Blue Cross Blue Shield | To view BCBS' guidance for clinicians, download their fact sheet: https://www.azmed.org/resource... 
  • BCBS also encourages you to reach out to your liaison. To find your liaison, click here: https://www.azblue.com/provide... 
• Centers for Medicare & Medicaid Services | For details about what services qualify for accelerated and advanced payments, view CMS' FAQ sheet here: https://www.cms.gov/news... 
  • CMS Reopens 2023 MIPS EUC Application Following Change Healthcare Cyberattack | For details on how to submit and the full CMS Announcement here: https://www.azmed.org/news/667722/...
• Centene Corporation | Updates and support for affected members, patients, providers, and customers. Website: https://www.centene.com/chan...
  
• MercyCare | To view the latest updates from MercyCare, including an FAQ document, visit their website: https://www.mercycareaz.org/pr... 
• Noridian Healthcare Solutions | To submit requests for Advanced Accelerated payments, view Noridian’s instruction sheet and complete this form.
• United Health Group |  The latest updates and resources available for communicating with Providers, Pharmacies, Payers, Government Partners and Patients.  https://www.azmed.org/resource/re...
• U.S. Department of Health and Human Services (HHS) |  HHS has compiled information, resources, and tools from health plans and payers for providers in need of assistance. View the pdf:  https://www.ama-assn.org/...

ArMA is here to drive change and ease your burdens. If there is anything further we can do for you, please don't hesitate to reach out. 

To learn more about the cyberattack, click here.

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recently released updated Coverage to Care (C2C) resources in additional languages to help consumers understand their health coverage and utilize their health plans.

Now that Open Enrollment has ended, you can use these resources to connect the people you serve with the best coverage options for their unique health needs. Download the materials to help them receive necessary primary care and preventive services today!

The following resources are available on the C2C website:

1. Roadmap to Better Care – Explains basics of health care coverage and how to receive primary care and preventive services. (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Ukrainian | Vietnamese)

To complement the Roadmap to Better Care, four supplemental materials were developed to help explain the important components into more digestible pieces:

1. Roadmap to Better Care Poster (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Ukrainian | Vietnamese)
2. Differences Between Your Provider’s Office and the Emergency Department (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Ukrainian | Vietnamese)
3. Sample Insurance Card (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Ukrainian | Vietnamese)
4. Sample Explanation of Benefits (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Ukrainian | Vietnamese)
5. Roadmap to Behavioral Health – Offers information on services for mental health and substance use, to be used in conjunction with the Roadmap to Better Care. (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish| Ukrainian | Vietnamese)
6. Getting the Care You Need: Guide for People with Disabilities – Provides information to ensure that people with disabilities understand their rights so that they receive equal access to quality health care services. (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
7. Managing Diabetes: Coverage & Resources – Includes tips to help patients manage diabetes, as well as information on Marketplace and Medicare coverage. (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
8. Preventive Services Flyers – Outlines services available at no cost under most health coverage.
9. Adult (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
10. Women (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
11. Men (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
12. Teens (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
13. Children (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
14. Infants (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
15. Prevention: Put Your Health First Tabloid – Describes how to put your health first. (Arabic | Chinese | Haitian Creole | Korean | Russian | Spanish | Vietnamese)
16. My Health Coverage at-a-Glance – Shows how to keep track of health plan information and payment in a customizable format. (Arabic | Chinese | Haitian Creole | Korean | Russian |Spanish | Ukrainian | Vietnamese)

Health literacy is an essential part of health equity. To learn more about health equity related initiatives, visit CMS OMH at go.cms.gov/omh or the C2C initiative at go.cms.gov/c2c.

The following information regarding monkeypox was shared with the Arizona Medical Association (ArMA) by the Maricopa County Department of Public Health (MCDPH):

On June 9, the Centers for Disease Control and Prevention (CDC) confirmed the first case of West African monkeypox in Maricopa County (link). Maricopa County Department of Public Health (MCDPH) continues to investigate this case in coordination with state and federal partners. MCDPH urges providers to be alert for patients who have rash illnesses consistent with monkeypox.

A person infected with monkeypox may start showing symptoms as early as 4 days and up to 21 days from their last exposure. Prodrome typically appears 1 to 3 days before the rash, which often begins on the face and spreads to other areas of the body. Notably in this outbreak, many cases are presenting with an initial rash in their genital and/or perianal areas without a prodrome. A person is considered contagious from the prodrome until the lesion scabs have fallen off. Person-to-person transmission of monkeypox occurs primarily by direct contact with someone who has an active rash or other symptoms.

Providers who suspect monkeypox in a patient should call MCDPH at 602-506-3747 to report the suspect case and discuss testing options through public health.

Infection control guidance for healthcare practitioners include the following:

• PPE used by healthcare personnel who enter the patient's room should include:
  • Gown
  • Gloves
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
  • NIOSH-approved particulate respirator equipped with N95 filters or higher
• Place the patient in a single-person room; special air handling is not required. The door should be kept closed (if safe to do so). Transport and movement of the patient outside of the room should be limited to medically essential purposes. If the patient is transported outside of their room, they should use well-fitting source control (e.g., medical mask) and have any exposed skin lesions covered with a sheet or gown.
• Intubation, extubation, and any procedures likely to spread oral secretions should be performed in an airborne infection isolation room.
• For outpatient management, patient should wear a mask if they must be around others in their homes if close, face-to-face contact is likely.

For additional information, please see:

• Monkeypox Clinical Recognition
• Preparation and Collection of Specimens for Monkeypox
• CDC Infection Prevention and Control of Monkeypox in Healthcare Settings

As the baby formula shortage continues in the U.S., the Arizona Department of Health Services (ADHS) has compiled information and resources on a new webpage, which is available in English and Spanish. These pages contain guidelines for parents, caregivers, community organizations, child care providers, and health care providers.

As a physician, you may be fielding questions from your patients. If your patients are looking for formula, you can advise them to look at grocery stores, pharmacies, and reputable online retailers. If your practice has formula samples, consider sharing them with your patients. Patients in urgent need of EleCare products or metabolic formula can contact Abbott. Learn more »

Additionally, ADHS has compiled information on formula alternatives, which can help parents and caregivers identify different brand options for their child. View the information »

You can help patients on WIC by consulting WIC's physician's FAQ page, which includes information about formula recalls and guidelines on how WIC participants can switch formulas.

In addition to ADHS' webpage, physicians and parents can find guidance on the American Academy of Pediatrics' website. AAP has a comprehensive set of answers to questions frequently asked by parents and caregivers, including:

• What if baby formula is out of stock everywhere I look?
• I found small amounts of several different baby formulas. What is the best way to switch among the brands?
• My infant needs a specialty metabolic baby formula, but I can't find any. What should I do?
• Can I add extra water to formula and give my baby a multivitamin to make up the nutrients?

Visit AAP's website »

The deadline for providers to request to submit a late Provider Relief Fund (PRF) Reporting Period 2 (RP2) report has been extended to May 18, at 11:59PM EST.

Physicians who received more than $10,000 in provider relief funds and did not submit their Period 2 report must act immediately by submitting a late Reporting Period 2 report request by Wednesday, May 18, 2022, at 11:59PM EST. Provider Relief Fund (PRF) Period 2 spanned from July 1, 2020, thru December 31, 2020, and included physicians who see patients with Medicaid and CHIP coverage. Attached is an overview of the information needed to request to report late. If a provider did not submit a Period 2 report and does not hear from HRSA, click here to learn more about the late reporting request form or call (866) 569-3522.

When completing the late reporting request, a provider must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. HRSA has released the following as allowable extenuating circumstances:

• Severe illness or death – a severe medical condition or death of a provider or key staff member responsible for reporting hindered the organization’s ability to complete the report during the Reporting Period.
• Impacted by natural disaster – a natural disaster occurred during or in close proximity of the end of the Reporting Period damaging the organization’s records or information technology.
• Lack of receipt of reporting communications – an incorrect email or mailing address on file with HRSA prevented the organization from receiving instructions prior to the Reporting Period deadline.
• Failure to click “submit” – the organization registered and prepared a report in the PRF Reporting Portal, but failed to take the final step to click “submit” prior to deadline.
• Internal miscommunication or error – Internal miscommunication or error regarding the individual who was authorized and expected to submit the report on behalf of the organization and/or the registered point of contact in the PRF Reporting Portal.
• Incomplete Targeted Distribution payments – the organization’s parent entity completed all General Distribution payments, but a Targeted Distribution(s) was not reported on by the subsidiary.

While attesting to an extenuating circumstance is required, no supporting document or proof is required. More information and a step-by-step guide from the AMA are available here.

If HRSA approves the extenuated circumstances form, the provider will receive a notification to proceed with completing the Reporting Period 2 report shortly thereafter. The AMA will continue to advocate for greater flexibility and more information to ensure physician practices have an adequate opportunity to come into compliance.

On April 22, the Department of Health and Human Services (HHS), in partnership with the White House, issued a call to action for health care stakeholders to commit to tackling the climate crisis through a new initiative aimed at reducing emissions across the health care sector.

Climate change exacerbates health disparities, and private health care stakeholders have an opportunity to reduce their greenhouse gas emissions and mitigate future damage. Federal health systems are already taking actions to reduce emissions under the leadership of the Biden Administration. This new initiative challenges private health systems to match or exceed these goals and to build climate considerations into the future of health care.

U.S. hospitals, health systems, suppliers, pharmaceutical companies and other industry stakeholders are invited to submit pledges to reduce greenhouse gas emissions and increase their climate resilience. The White House plans to host a convening in June to highlight health care sector progress in promoting climate actions.

“We need all players on the field confronting the climate crisis; sitting on the sidelines is not an option.” said HHS Secretary Xavier Becerra. “Every stakeholder group in America must step up, and collaboration across the public and private sector is key. At HHS, we stand ready to partner with as many players as possible. Reducing emissions and fighting climate change’s catastrophic and chronic impact on vulnerable people is key to building a healthier nation.”

The voluntary pledge asks signees to, at a minimum, commit to: (1) reducing their organization’s emissions (by 50% by 2030 and to net zero by 2050) and publicly reporting on their progress; (2) completing an inventory of Scope 3 (supply chain) emissions; and (3) developing climate resilience plans for their facilities and communities. It also asks them to designate an executive lead for this work.

“We are encouraged by the bold and specific commitments to decarbonization that many organizations across the country have already made,” Admiral Rachel Levine, Assistant Secretary for Health, said. “It is time for us to both celebrate those commitments and galvanize others to take this critical step.”

“The health care sector contributes 8.5% of total U.S. emissions, so they have a big role to play,” National Climate Advisor Gina McCarthy said. “We are excited for health care leaders across the country willing to step up, reduce emissions, and help us reach the President’s bold climate goals.”

Starting with the establishment of the Office of Climate Change and Health Equity (OCCHE) in August of 2021, HHS is taking a more active role to address the challenges climate poses to health. This includes the Administration’s commitment at last November’s United Nations Climate Conference exit disclaimer icon to creating a low-carbon health system. It also includes co-chairing the National Academy of Medicine Action Collaborative on Decarbonizing the U.S. Health Sector exit disclaimer icon, a public-private partnership of leaders from across the health system committed to addressing the sector’s environmental impact while strengthening its sustainability and resilience.

The Department expects to make more climate-readiness resources and technical assistance supports available to health care providers in the coming months.

Pledge signers can download forms and find more information on the submission process here. Forms will be due by June 3, 2022.

The COVID-19 Coverage Assistance Fund which reimburses for the claims for testing, treatment and vaccine administration is running out and the deadline to submit for vaccine administration claims is quickly approaching. Claims will be accepted through April 5, 2022, at 11:59 pm via the COVID-19 CAF portal. Claims submitted to the portal after the April 5, 2022, deadline will not be adjudicated. The Health Resources and Services Administration (HRSA) notes that claims submitted by the deadline will be paid subject to their eligibility and the availability of funds. The AMA has urged Congress to appropriate more money to support the COVID-19 efforts.
 
The dedicated Coverage Assistance Fund customer support may be reached at 833-967-0770 (TTY number 888-970-2920) Monday through Friday from 8:00 am – 8:00 pm EST or at cafsupport@ssigroup.com.

As of June 1, 2022, AHCCCS providers must begin to report the individual practitioner who rendered services on professional and dental service claims. This requirement impacts all claims for AHCCCS providers registered as integrated clinics (Provider Type IC), behavioral health outpatient clinics (Provider Type 77) and clinics (Provider Type 05).  
 
Claims for dates of service on and after June 1, 2022 will be denied by AHCCCS and its Managed Care Organizations if the individual practitioner who performed the services associated with the clinic visit is not reported. See Exhibit 10-1 of the AHCCCS Fee-For-Service Provider Billing Manual for billing instructions for proper claims’ submissions. 
 
Questions? Contact David Rudnick at david.rudnick@azahcccs.gov.

Learn more » 

There have been updates on the recent changes (January, 2020) to Arizona Administrative Code (AAC) and regulations regarding the requirements for pesticide illness reporting.

Required Reporting

Pesticide poisoning is a potential public health threat due to widespread pesticide use. Reporting pesticide-related illness cases is an essential step towards prevention of future cases. Under Arizona law (AAC R9-4-202), all healthcare professionals are required to report pesticide-related illness or injuries to the Arizona Department of Health Services (ADHS).

View ADHS' pesticide-related illness infographic »

When to Report

Timely reporting on your part allows ADHS to initiate prompt investigation.

• Pesticide-related hospitalization, death, or cluster cases must be reported within 1 day.
• All other suspected or confirmed pesticide-related illnesses must be reported within 5 days.
  

How to Report

Please collect as much information as possible from the patient during the examination and use one of the following methods for reporting.

• Call the Arizona Poison Control Centers (PCCs) at 1-800-222-1222. File the case using the ADHS
• Medical Electronic Disease Surveillance Intelligence System (MEDSIS) electronically.
• Fax or Mail a report form to:

Arizona Department of Health Services
Office of Environmental Health - EHC
150 N. 18th Ave, Ste 220
Phoenix, AZ 85007 Fax: 602-364-3146

• Call Us at 602-364-3118
  

For more information, please contact us by phone (602-364-3118) or email (environmentalhealth@azdhs.gov), or visit azdhs.gov/pesticides.

View ADHS' pesticide-related illness infographic »

HRSA’s Bureau of Health Workforce is accepting applications for these grants from all 50 states, Washington D.C., and U.S. territories. HRSA estimates that it will make up to 50 awards of up to $1 million per year, over the program’s four-year project period.

“Our health care workers have worked tirelessly to save lives throughout this pandemic and now it’s our turn to invest in them,” said HHS Secretary Xavier Becerra. “This investment is critical to ensuring state public health officials can continue supporting specific needs across their communities. The Biden-Harris Administration will continue to invest in building a strong health workforce as we build our country back healthier.”

For more information, please see the materials below:

• HHS Press Release
• HRSA’s State Loan Repayment Program

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced a new application cycle for $25.5 billion in COVID-19 provider funding (Phase 4). The application for the funds is open now, and will close on October 26 at 11:59PM ET. Applicants will be able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.

PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is specifically available to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). See a detailed list of eligible provider types here.

HHS recently hosted a briefing session to provide information about these upcoming funding opportunities — view the video here. HRSA will also host webinar sessions featuring guidance on how to navigate the application portal.

Thursday, October 21, 3–4PM. ET — register to attend

Real time technical assistance is available by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8AM to 10PM CT, Monday through Friday.

Earlier this week, the Health Resources and Services Administration (HRSA), opened the online portal for health care providers to apply for funding from the Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) rural distribution. Eligible health care providers will be able to apply for $25.5 billion in relief funds, including $8.5 billion in ARP resources for providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) and $17 billion for PRF Phase 4 for a broad range of providers with changes in operating revenues and expenses.

Providers must submit their completed application by the final deadline of October 26, 2021, at 11:59 p.m. ET. In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. More information on the application portal, eligibility for the PRF, and the methodologies can be found online: https://www.hrsa.gov/provider-relief/future-payments.

HRSA will be hosting webinar sessions for Phase 4 and ARP rural applicants, featuring guidance on how to navigate the application portal:

• Thursday, September 30, 3:00 – 4:00 p.m. ET – register to attend
• Tuesday, October 5, 3:00 – 4:00 p.m. ET – register to attend
• Wednesday, October 13, 3:00 – 4:00 p.m. ET – register to attend

Additionally, HRSA is committed to transparency and proactive communications around PRF payments. To this end, HRSA published detailed information about how the PRF Phase 3 payments were calculated. Providers that believe their PRF Phase 3 payment was not calculated correctly according to this methodology can submit the completed form online by the deadline November 12, 2021, at 11:59 p.m. ET. Applicants are encouraged to apply early to facilitate review and expedite any revised payments made as a result of the reconsiderations process.

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing $25.5 billion in new funding for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.

Get Ready to Apply!

The application will open on September 29, 2021. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application and HRSA will use existing Medicaid/CHIP and Medicare claims data in calculating portions of these payments.

• Phase 4 General Distribution — $17 billion based on providers’ lost revenues and changes in operating expenses from July 1, 2020 to March 31, 2021.
  • To promote equity and to support providers with the most need, HRSA will:
    • Reimburse a higher percentage of lost revenues and expenses for smaller providers as compared to larger providers.
    • Provide "bonus" payments based on the amount of services they provide to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates.  

• American Rescue Plan (ARP) Rural — $8.5 billion based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.
  • To promote equity, HRSA will price payments at the generally higher Medicare rates for Medicaid/CHIP patients.

How Can I Prepare?

• Review eligibility information posted on the PRF Future Payments web page and additional detail will be added prior to September 29.
  
• Search the Rural Health Grants Eligibility Analyzer to see what areas qualify as "rural" for the ARP rural payments.
  
• Gather supporting documentation, such as most recent tax documents and financial statements for the second half of calendar year (CY) 2020 and the first quarter of CY 2021.

Phase 3 Reconsiderations!

As we announce the availability of Phase 4 funding, you may also have questions about how HRSA calculated your PRF Phase 3 payment. To promote transparency in the PRF program, HHS today released detailed information about the methodology utilized to calculate Phase 3 payments. Providers who believe their Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration. Further details on this Phase 3 reconsideration process are forthcoming.

Grace Period for Reporting Period 1

In light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is also announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period. Several helpful resources can be found at on the PRF Reporting web page.

We know that provider relief funding is critical for health care providers across the country. We are committed to distributing it as equitably and transparently as possible to help providers respond to and ultimately defeat this pandemic.

Thank you for all you are doing during this difficult time.

Additional resources and information can be found on the PRF Reporting Webpage or by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8 a.m. to 10 p.m. CT, Monday through Friday.

On Wednesday, Governor Ducey announced $60 million to support staffing at health care facilities. Facilities that deploy proven techniques to decrease COVID-19 related hospitalizations, including administering monoclonal antibody treatments and offering vaccination at discharge, are to be prioritized. 

Click here for more details on the Arizona Navigator Awardees.

The Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) for both the Pfizer BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine to allow for an additional dose in certain immunocompromised people.

Effective August 12, 2021, CMS will pay to administer additional doses of COVID-19 vaccines consistent with the FDA EUAs, using CPT code 0003A for the Pfizer vaccine and CPT code 0013A for the Moderna vaccine. Noridian Healthcare Solutions will pay the same amount to administer this additional dose as they did for other doses of the COVID-19 vaccine (approximately $40 each).

Noridian Healthcare Solutions will hold and then process all claims with these codes after they complete claims system updates (no later than August 27).

Learn more about Medicare COVID-19 vaccine:

• COVID-19 Vaccine Codes
• Payment

CMS will be updating the MIPS performance feedback and final scores for some clinicians for performance year 2020 and the associated MIPS payment adjustment information for payment year 2022.
We are committed to ensuring transparency in our program and alerting clinicians as soon as possible when issues are discovered. Our intention is to provide clinicians advanced notice that they may see some change to their current final scores and payment adjustment information. Additionally, because of these expected changes we will also be extending the targeted review period. More details about what will change from the initial release, who is impacted and how this will affect MIPS payment adjustments, as well as the new targeted review period deadline are coming soon. We appreciate your patience as we work to confirm the information we’re providing you is accurate.

Additional Resources:
You can view your current MIPS performance feedback, final score, and payment adjustment on the Quality Payment Program website. Please note the information you see now may be changing.

You can access your 2020 MIPS performance feedback, 2020 final score, and 2022 payment adjustment information by:

• Going to cms.gov/login
• Logging in using your HCQIS Access Roles and Profile (HARP) system credentials; these are the same credentials that allowed you to submit your 2020 MIPS data

If you don’t have a HARP account, please refer to the Register for a HARP Account and Connect to an Organization documents in the QPP Access User Guide and start the process now.

For Shared Savings Program ACOs, please note that beginning August 5, 2021, you will be able to create a HARP account and manage your account in the ACO Management System (ACO-MS). Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, please contact the ACO Information Center at SharedSavingsProgram@cms.hhs.gov or 1-888-734-6433 (Option 1).

To learn more about the information in your performance feedback, review the following 2020 MIPS Performance Feedback Resources:

• NEW! 2020 Performance Period Benchmarks (ZIP) – Identifies the performance period benchmark results (as available) for measures without a historical benchmark and provides general information about performance period benchmarks.
• 2020 MIPS Performance Feedback FAQs (PDF) – Highlights what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.
• 2022 MIPS Payment Year Payment Adjustment User Guide (PDF) – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.

MIPS Eligible Clinicians Participating in MIPS Alternative Payment Model (APM) Entities
Individual clinicians and representatives of APM Entities will also be able to access performance feedback directly on the Quality Payment Program website using their HARP account. Note: Performance feedback is not related to model-specific requirements and assessments outside of the Quality Payment Program.

Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by email at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours — before 10:00AM and after 2PM EST.

• Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

Changes that impact reportable STIs include:

1. Chlamydia: Doxycycline 100 mg orally 2 times daily for 7 days is now recommended for non-pregnant adults and adolescents; alternative regimens are azithromycin or levofloxacin. Recommendations for children have been clarified based on weight and age.
2. Gonorrhea: The full guidelines build on the December 2020 gonorrhea treatment guidance by including recommendations for treatment in neonates, children, and other specific clinical situations (e.g. proctitis, epididymitis, sexual assault, and disseminated gonococcal infections).
3. Syphilis:

• a: The guidelines caution practitioners to ensure the use of standard long acting benzathine penicillin product (Bicillin L-A), as reports have indicated the inadvertent prescribing of combination long- and short-acting benzathine-procaine penicillin (Bicillin C-R) instead, a formulation which is not adequate for treating syphilis.
• b: Due to the low prevalence of true penicillin allergy, Doxycyclineis no longer listed on the wal chart as an alternative treatment for syphilis. It however, continues to be an effective second-line treatment in situations of true penicillin allergy among nonpregnant persons, provided the patient can adhere to the 14-day treatment regimen. The guidelines provide strategies for validating a reported allergy through the use of a skin test, and suggest desensitization in those penicillin-allergic patients where follow-up or treatment adherence is a concern, and in neonates with suspected/diagnosed congenital syphilis.
• c: If the initial titer was >1:8 and there is less than a 4-fold decrease in titer after 2 years, patients should be re-evaluated for HIV and neurological symptoms.
  • i: If neurological symptoms are present, the patient should receive CSF evaluation and treatment informed by results.
  • ii: If the initial titer was >1:32 and there is less than a fourfold decrease in titer after two years, they should be re-retreated with three doses of 2.4 mu Bicillin L-A at 7-day intervals.
• d: The optimal spacing of Bicillin L-A for late latent syphilis is 7 days. Pregnant women staged as late latent who have delays in any therapy dose >9 days between doses should repeat the full course of therapy.
• e: A second dose of Bicillin L-A can be administered for women staged with early syphilis during pregnancy.
  • i: If syphilis is diagnosed during the second half of pregnancy, a sonographic fetal evaluation for congenital syphilis should be done.
  • ii: If there are signs of fetal or placental syphilis, the risk of fetal treatment failure is greater and a second dose of Bicillin L-A will likely be beneficial.
• f: All pregnant women in Arizona should receive syphilis screening during their first prenatal care visit, early in the third trimester (28-32 weeks), and at delivery (A.A.C. R-9.6.381 - A2). The new guidelines include expanded risk factors for syphilis testing among pregnant patients. This is particularly relevant given the ongoing increase in congenital syphilis and syphilitic stillbirth cases throughout Arizona.
  • i: Among populations for whom receipt of prenatal care is not optimal, syphilis screening and treatment should occur at time of pregnancy testing.
  • ii: A woman who had no prenatal care or was at increased risk for syphilis acquisition during pregnancy should have the results of syphilis serology documented before discharge of both mother and baby.
  • iii. If a person reports syphilis symptoms OR is linked to a partner who is positive providers should offer screening and same day presumptive treatment.
  • iv. If there are discordant results when testing for syphilis in a person who is low risk, practitioners can retest in 4 weeks. If both the RPR and TPPA remain negative no further treatment is necessary (the EIA/CIA/MFI may remain reactive).
  • 1. If it is unlikely that the client will return for follow-up testing, providers should offer presumptive treatment for women with discordant results.
  • v: Infants and children aged ≥1 month with diagnosed latent syphilis should be managed by a pediatric infectious disease specialist and receive a neurologic and ophthalmologic examination including CSF evaluation.
  • vi: In Arizona, a number of babies with syphilis exposure are adopted or in foster care. If the infant is > 3 months of age and syphilis exposure is unknown (i.e. birth records could not be obtained), physicians should run a syphilis cascade. Request of birth record should not delay testing in infants > 3 months of age with unknown syphilis exposure history.

• While azithromycin is still an option for treatment of several STIs, due to antibiotic resistance, it has become part of an alternative regimen for cervicitis, chlamydia, and non-gonococcal urethritis. See the CDC 2021 Wall Chart for specific antibiotic guidance.
• New information on FDA-cleared diagnostic tests for Mycoplasma genitalium as well asrectal and pharyngeal chlamydia and gonorrhea.
• Updated treatment recommendations for trichomoniasis by sex.
• Recommended parenteral, intramuscular, and oral treatment regimens for pelvic inflammatory disease (PID) should be reviewed given significant changes. The addition of Metronidazole to the antibiotic regimen for PID is recommended in order to better eradicate anaerobic organisms from the upper genital tract.
• A recommendation for two-step serologic testing for diagnosing genital herpes simplex virus (HSV) infection, along with adjustments to some recommended treatment regimens involving acyclovir.
• Human papillomavirus (HPV) vaccination recommendations have been harmonized with the Advisory Committee on Immunization Practices.
• Universal hepatitis C testing are recommended in alignment with CDC’s 2020 hepatitis C testing recommendations.

Guidelines can be accessed onli

• The 2015 STD Treatment Guidelines app was retired at the end of July 2021.
  
• A new STI Treatment Guidelines app is in development; until its release, visit the website for the most up-to-date information: https://www.cdc.gov/std/treatment-guidelines/default.htm.

Clinicians can also request a printed copy:

A limited number of printed materials are available to be ordered through ADHS. If you would like to request copies of the pocket guide or wall chart for your team, please send an email to std@azdhs.gov with the number of desired materials and a preferred shipping address.

Questions?

If you have questions about the treatment guidelines, please email the Clinical Team in CDC’s Division of STD Prevention at stitxguidelines@cdc.gov or consult the STD Clinical Consultation Network at https://www.stdccn.org/.

The Health Resources & Services Administration (HRSA) reminds entities that provide health care that American Rescue Plan Act grant funding is available through the Health and Public Safety Workforce Resiliency Training Program.

As described by HRSA, these grant funds can be used to "plan, develop, operate or participate in health professions and nursing training activities using evidence-based or evidence-informed strategies, to reduce and address burnout, suicide, mental health conditions, and substance use disorders and promote resiliency among health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals, collectively known as the “Health Workforce,” in rural and underserved communities."

Eligible applicants include entities that provide health care, including health care providers associations and Federally Qualified Health Centers.

Applications will be accepted through August 30, 2021.

Alzheimer’s dementia affects one in nine people age 65 and older, and it kills more than breast and prostate cancer combined. The Centers for Medicare and Medicaid Services (CMS) has taken steps to address this public health crisis by increasing payment for and expanding access to cognitive assessment and care plan services.

Effective January 1, 2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently covered these services via telehealth.

Four Things to Know About the Cognitive Assessment and Care Plan Services

1. If your patient shows signs of cognitive impairment at an Annual Wellness Visit (AWV) or other routine visit, you may perform a more detailed cognitive assessment and develop a care plan
2. The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam, resulting in a written care plan
3. If you report evaluation and management (E/M) services, you can offer this service, including: physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants.
4. Use CPT code 99483 to bill for this service. Part B coinsurance and deductible apply. You may bill this code separately from the AWV.

For more information, please review more detail on Medicare coverage requirements and billing standards at www.cms.gov/cognitive.

For information on assessing cognitive impairment, please refer to the Alzheimer’s and Dementia Resources for Professionals webpage at https://www.nia.nih.gov/health/alzheimers-dementia-resources-for-professionals.

Get details on Medicare coverage requirements and proper billing at cms.gov/cognitive.

The Provider Relief Fund (PRF) Reporting Portal is now open for providers who need to report on the use of funds in Reporting Period 1. HRSA is committed to supporting the providers who have received PRF payments in completing their reporting requirements successfully.

There are resources specifically for providers:

• Portal User Guides
  • Registration Process
  • Submitting Reporting Information
• Data Entry Workbook
• Frequently Asked Questions
  • Reporting Specific
  • Portal Specific
• Provider Support Line at (866) 569-3522 for TTY dial 711. Hours of operation are 8AM to 10PM CT, Monday – Friday

HRSA will host a recorded webcast on July 8, 2021 at 3PM ET to provide technical assistance on reporting requirements for PRF recipients and interested stakeholders. Interested parties can register to attend here.