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Trillium shares important details about ongoing COVID-19 procedures, flexibilities, and more. Please visit the link below:

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Providers Q&A COVID-19

SUBMIT NEW FAQ QUESTIONS HERE TRILLIUM COVID-19 PROVIDER FAQ
Update April 28, 2020

Click on the buttons below to find Q&A of your interest.

Revised on October 20, 2020

MCM, Hospital, FBCD

  1. Can the FAQ's include the dates they are publsihed/updated?
    On Trillium's Coronavirus Information page under the Provider button we have Provider FAQ during COVID-19 link, the "update" date is listed. Our Communication's Department will also add the published date to the FAQ document.
  2. Is there any concern about d/c planning by Vidant Health? If so, please contact me.
    Thank you, we will reach out if needed.
  3. How much of the $25mil proposed for LME-MCO's does THR expect to receive.
    Trillium has not been given that information at this time.
  4. Does Trillium have any surge projecttions for ENC regarding BH crises?
    Trillium monitors BHIDD crisis system to determine needs. We have recently expanded crisis capacity through private home respite expansion.
  5. Has anyone responded to the RFI for BHIC?
    This RFI is currently open, details can be found on Trillium's website, on our Providers page click on RFP/RFA/RFI Opportunities or read the RFI - Behavioral Health Urgent Care Document. Providers have until July 31, 2020 to submit their information.
  6. The State has said congregaet care does not need to require testing before accepting new patients, but they are. Any comments from THR on this?
    Trillium would refer residential providers with questions about the need for testing before accepting referrals to NC DHHS's March 20, 2020 Interim Coronavirus Disease 2019 (COVID-19). General Guidance for Behavioral Health and Intellectual and Developmental Disability (BHIDD) Group Homes.
  7. Is the My Strength app still open for free to Trillium consumers?
    No
  8. When do I use GT CR and/or CR for billing?
    GT CR is used when the service was provided via interactive two-way real-time audio-visual communication and CR is used when providing the service telephonically. These are both meant to allow for flexibilities during the COVID-19 emergency.
  9. I'm sorry if this has already been asked but I haven't been able to attend these meetings yet. Are the enhanced rates for the list of codes regardless of the CR modifier? Also, who do we contact if we are not seeing the enhanced rate?
    All COVID-19 related enhanced rates should have the CR modifier attached to the service code. For questions related to specific rates, please email RATESFinance@TrilliumNC.org.

Adult and Child MH/SUD Providers

  1. If we do a face to face peer support visit, do we still need to use the CR modifier or can we just bill the H0038?
    If you have not modified service delivery as a result of COVID-19, you will use the service code you would normally use to bill for the service. The modifiers are available for use in Provider contracts when service deliver has been modified.
  2. I am still providing face to face visits as requested by patients . Do you know where I can get mask? I only have one box left.
    • Trillium posted information Personal Protective Equipment (PPE) on our website on our Coronavirus Information page.
    • Additional Resources: NC DHHS posted a memo titled: dated March 30,2020 regarding PPE
    • NCDHHS COVID-10 Procurement Form: https://www.ncdhhs.gov/divisions/public-health/covid19/procurement-form
    • Please check with local emergency management and utilize the CCNC COVID-19 nurse triage line at 1-877-490-6642 for further assistance.
  3. CST Question-Affirming per NCDHHS Special Bulletin COVID-19 #46 it states "staff trainings are only waived if there are not opportunities to receive the specific trainings virtually." Based on that document, the training for the 15 hours of Permanent Supportive Housing Training is temporarily waived as it is not virtually provided....correct??
    Yes, NC DHHS Special Bulletin COVID-19 #46 Behavioral Health Service Flexibilities does waive staff training requirements within 30 and 90 days of employment, if unable to be obtained during the state of emergency and if there are not opportunities to receive the specific training virtually. According to #46, this change is retroactive to March 10, 2020. At this time, Permanent Supportive Housing Training is not available virtually, however a virtual training will be available on June 10, 11, 17 and 18, 2020. When the virtual training is available the training requirement will not be waived. More information about training registration and attendance will be forthcoming.
  4. CST Question-Per service definition, "the initial training requirements may be waived by the hiring agency if the team member can produce documentation certifying that training was completed no more than 24-months prior to hire". If a staff person already employed by the agency assumes a position on the CST Team, is the date of hire for that person the date they were hired with the agency or the date they assume the CST position?
    The day that the staff member assumes the role with the CST team.
  5. Will State funded IOP/SACOT also have same flexibility of hours as Medicaid clients?
    Yes, the flexibility listed in Special Bulletin COVID-19 Behavioral Health Service Flexibilities #046 applies to both State Funded and Medicaid members for SAIOP/SACOT Services
  6. The "no prior authorization" for new services--would this also apply to reauthorization when the time comes?
    Yes
  7. The following is Eastpointe's guidelines for obtaining plan signatures. Will this suffice for Trillium? Eastpointe will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person's (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf. The provider should document whether such consent was made via telephone, email or other means (e.g. through a window).
    According to the Records Management and Documentation Manual Guidance outlined in the APSM 45-2. Chapter 4-7 If the provider who developed the PCP is unable to obtain the signature of the legally responsible person, there shall be documentation on the signature page and/or in a service note, reflecting due diligence in the efforts to obtain the signature and documentation stating why the signature could not be obtained. When this occurs, there shall be ongoing attempts to obtain the signature as soon as possible.
    Providers will need to write on the signature line for member/LRP unable to obtain signature due to COVID-19. Also, the provider will need to document in the member’s chart/record that the member provided verbal consent.
  8. I understand that outpatient services do not require an auth, but have the edits been removed to allow for more than 24 visits to be paid?
    Yes, the edits have been removed to allow providers to bill more than 24 visits. [The outpatient codes with the CR/GT CR modifiers do not have the unmanaged visit limit edits attached to them.]
  9. If I bill a service that has a modifier, do I put that modifier in the first modifier space and the video conference code in the second space?
    The service code and modifier combination included in the your provider contract will indicate the order of the modifiers needed for appropriate billing of that service.-Christie will read answer on 4/28 call, Sheryl is unable to participate.
  10. The last call said there will be no prior autos; does this include the needed TARs for requesting more units outside of the 24 unmanaged visits? We will still need to submit one?
    There is no prior authorization required when billing using a code modified for disaster use.
  11. What is the billing code modifier for phone sessions?  This is for children/families without access to internet/smart devices.
    Yes; Please review Special Bulletin COVID-19 Behavioral Health Service Flexibilities #046. You will use the appropriate telephonic service codes (ADD CODES)
  12. How is NC DHHS handling the CMS policy change to bill the same POS for telehealth had the service taken place in person if not for PHE with a 95 modifier? As we provide services in NUR and ALF facilities, I've not found guidance on this from NCDHHS or conflicting information at best.
    Trillium has not received any guidance related to the 95 modifier. The majority of the guidance we have received around Place of Service recommends using the typical Place of Service.
  13. To clarify, if we are doing therapy over the phone (telephonic) what codes do we bill? Do we bill the standard therapy codes of 90832, 90834, 90837, 90847, and 90846 or do we do the telephonic codes based off the duration on the phone of 98966, 98967, or 98968?
    Outpatient Psychotherapy CPT codes to be used telephonically during the state of emergency are outlined in NC DHHS Special Bulletin #59 and telephonic assessment and management codes are listed in NC DHHS Special Bulletin #34.
  14. 1. Just for clarification, are phone sessions being reimbursed at same rate as video
    2. Is there any kind of time frame for telehealth as it stands. Can we expect another 2 months? Will these codes no longer be valid after stay-at-home orders are lifted? Is there any conversation regarding continued telehealth services as we are getting a lot of positive feedback about how easy and time saving it has been
    3. Are there plans to make telehealth a more long term option?

    1. Trillium has implemented a COVID-19 Crisis Event Fee Schedule that was posted on its website on Monday, April 27, 2020.  Please refer to your contract and/or Provider Communication for any special requirements to bill the temporary rates. If you have any questions regarding this communication, please email RATESFinance@TrilliumNC.org
    2. We are following information from DHHS, Trillium will publish bulletins around any kind of wind down process for transitioning back to traditional service delivery, several of the codes and/or modifiers may not be valid after a certain period of time following the State of Emergency, providers will be notified before that occurs. Many outpatient services were available via telehealth prior to the State of Emergency. 
    3. To be determined in the future.
  15. Can you provide some typical scenarios and how they would be billed and documented in the chart?
    We need more information to respond to this question
  16. Will our required connection date of 6/22 to NCHIEb be moved back because of how this virus is affecting  our businesses?
    As of April 23, 2020, Trillium has not been notified by the state that there will be a delay in North Carolina Health Information Exchange connectivity requirements. For the most update to date information from the NC Health Information Exchange Authority (NCHIEA); please go to this link:  https://hiea.nc.gov/about-us/about-nc-hiea.
  17. On special bulletin 46, it waives the 3 hour daily limit for day treatment.  Trillium had previously imposed a 2 hour minimum limit.  With Bulletin #46, does this mean there is NO minimum (for instance, we would be able to bill a 30 minutes session)
    Trillium will follow guidance in Special Bulletin #46.
  18. Trillium had previously declined extensions for 1st Aid/CPR trainings with the reasoning that Red Cross was still offering the classes.  All Red Cross classes are on-line only now.  Could Trillium reconsider either allowing us to do classes by Zoom OR  allowing an exemption if someone's certification is due to expire.
    Trillium would allow online certifications from the American Red Cross in whatever online platform/avenue the Red Cross is utilizing. Trillium has not denied this request-we are still waiting for this requirement to be waived, which must come from Secretary Cohen. We have requested consideration of this request, but in the interim, the recommendation would be to seek online certification.
  19. When will the GT modifier be working on billables.  All GT services are getting denied.  If not fixed by 4/28, we have been told to bill using regular code and re-bill when GT is corrected but this puts a large burden on the provider.
    Please reach out to your claims specialist if you have specific questions about claims/denials. We will provide general guidance on this call. Please use GTCR for two way video and CR for telephonic service delivery. You may check to see if you have the necessary codes in your contract by viewing this in Provider Direct. If you feel you are missing a code with the required modifier, please submit an email to:  NetworkServicesSupports@TrilliumNC.org.
  20. State bulletins have said we do not need authorization OR reauthorization.  If we want to err on the side of caution, can we still submit for authorizations and reauthorizations.
    TARs for services that require No Prior Auth will not be processed.
  21. Why didn't Innovations Day Support get a rate increase? We have Day Support directc care staff, CLFS staff, and Residential Supports staff because we have a day program and group homes. Some direct support staff qualify for wage increases according to the rate increases of particular services, but others do not. We need to be able to retain all our direct care staff. It's difficult to treat them differently.
    We appreciate your feedback. We will carefully consider your feedback. Any changes to rates will be communicated out to our Provider Network.
  22. Some MCOs are  making "stabilization" payments to providers to make up for funding that is being lost. Our rates have been increased for some services, but we are required to pass it on to direct care staff. If we are in this crisis for a protracted period of time, we will need additional support to keep the doors open. The direct support staff have their increased wages, but the infrastructure that supports them and the clients will be at risk. We are not currently able to get the hours we were getting because services that were provided in groups are now provided individually and because some clients' families do not want services provided in their homes.Will Trillium consider any such stabilization paymetnts in the future? 
    We appreciate your feedback. We will carefully consider your feedback. Please also be aware that small business loans are available through the CARES Act.
  23. Would Trillium consider doing anything like the "retainer" payments for MH programs that are struggling (PSR and Day Treatment) due to facility programs not being able to operate and staff trying but unable to obtain hours via telehealth or telephone?
    Not at this time, we are aware the DHHS has received this question as well and we await further guidance. Please note the retainer payments for Innovations Waiver services are specifically allowed per Appendix K that was approved by CMS
  24. Are we to only use 90832 because we can only have 30 minute sessions?
    We need additional information to provide an adequate response to this question.
  25. During this time of COVID, we had a staff member who was requested by the family to NOT WORK to lessen the amount of exposure to the person served.  A Relative as Provider is able to cover the hours that would originally be provided by the other staff. However, due to the retainer pay, we are in need of additional hours to cover the hours worked and the hours for the staff on retainer pay.
    Innovations Waiver services do not require prior authorization at this time. Therefore, your agency should be able to bill for services rendered by the Relative as Provider in addition to the retainer payments being billed. Please refer to Network Communication Bulletins on our website for more information
  26. For the new state waiver of 1 hour minimum for IIH sessions, on a progress note, staff can document the duration of their session (between 1-2 hours) and then the claim would still be processed as a full 1 unit claim, with regular reimbursement rate for sessions held for 1 hour or more?
    As per clinical guidelines, IIH has a billing unit of 1 unit = 1day; therefore, providers would still only bill 1 unit.
  27. Your bulletin #061 states that treatment planning is included in Telemedicine through video/audio and telephonic contact. Is there any directive about obtaining signatures? Is patient verbal consent, documented by the QP or Para on the PCP or Treatment Plan, sufficient?
    According to the Records Management and Documentation Manual Guidance outlined in the APSM 45-2. Chapter 4-7 If the provider who developed the PCP is unable to obtain the signature of the legally responsible person, there shall be documentation on the signature page and/or in a service note, reflecting due diligence in the efforts to obtain the signature and documentation stating why the signature could not be obtained. When this occurs, there shall be ongoing attempts to obtain the signature as soon as possible. Providers will need to write on the signature line for member/LRP unable to obtain signature due to COVID-19. Also the provider will need to document in the member’s chart/record that the member provided verbal consent
  28. Per Network Communication Bulletin 073, it states under Service Requirements c) Mental Status: Relevant mental status exam may be obtained via the telemedicine encounter. This will include a series of questions to find out if a person is oriented to time, date, and place, and and is the person's speech logical and coherent. The intent is to be sure the person is able to appropriately engage in the telemedicine appointment and they don't need a different type of intervention. Does this mean each note documented is required to reflect the mental status has been conducted and it was determined the person is able to appropriately engage in the telemedicine appointment and do not need a different type of intervention?
    Yes, it is expected that clinical staff will evaluate Mental Status to ensure that telehealth interventions continue to be appropriate.
  29. I want to clarify, we are aware that telehealth has existed. I was wondering if we will be able to keep it in our contract for outpatient therapy in the future.
    These should go through Network Development as it normally would. GT CR is to allow flexibilities (i.e. can use FaceTime) which do not follow the standard requirements around 2-way video (such as HIPAA). Once the flexibilities are ended the requirements will go back to the original telehealth requirements. When/if telehealth grows separately from COVID-19 then they would be added as appropriate and approved. GT CR would not be used after the COVID-19 Emergency is over.
  30. Is DHHS or Trillium requiring that we get a separate TeleHealth Consent on every active case or is it sufficient to have the individualized COVID-19 "disclaimer" on each service note and CCA where a Telehealth modality was used in lieu of face to face? We're concerned about the burden to clients and staff having to complete a separate consent form on all active cases to provide this service, particularly when it would have to be a documented verbal for these instances.
    DHHS has stated that this is required for every visit, consent may be verbal and noted as such on documentation.
  31. The rates that were posted yesterday did not include the outpatient codes. I know you inidicated to see the rates that were posted late yesterday, however, it appeared the only rates listed on that document were the services that were increased
    Any services that are not listed on the COVID-19 rate listing are to be billed at the Trillium standard floor rate.
  32. Please clarify as the audio went out on my computer during the answer, for outpatient services, are we required to submit authorization request after unmanaged visits are used?
    There is no prior authorization required for any services using the CR or CR/GT modifiers during the state emergency.
  33. The rates that were posted yesterday did not include the outpatient codes. I know you inidicated to see the rates that were posted late yesterday, however, it appeared the only rates listed on that document were the services that were increased
    Any services that are not listed on the COVID-19 rate listing are to be billed at the Trillium standard floor rate.
  34. I submitted the GT billing question and your answer implied that perhaps we didn't have the GT code. We do have it in our contract. The denials are coming from the Trillium side--all billing with GT is declined. Claims doesn't know when it will be fixed
    Please work with your agency's assigned Claims Specialist on any claim denials.
  35. I need to bill today but I do not know if I can bill for one hour. Please Please answer
    Assuming you are referring to psychotherapy. Please refer to Special bulletin #59, which includes various psychotherapy codes that can be delivered telephonically. For example 90837, psychotherapy with patient for 60 minutes.
  36. Reference to SAIOP:Are they are saying that we need to "offer treatment" 3x per week as we would anyway OR does this literally mean that a client must attend all 3 sessions in that week to bill any one of the sessions?
    Billing for SAIOP requried that the member attend a 3 hour session in order to bill for that session. With the Special Bulletin 046, the same would apply for each minimum 1.5hr session/3 days per week with attendance needed to bill for each individual session. Thus treatment must be offered 3days/week but the beneficiary must attend 1.5hrs of a session in order to bill for that specific session. The Beneficiary does not have to attend all 3 sessions in the week in order to bill for the sessions they successfully attended that week. If the person attended 1.5 hours of services Monday and Wednesday and missed Friday’s sessions, the provider could bill for Monday and Wednesday. But, not Friday.
  37. Reference to SAIOP: What if someone is absent one of the three days? Does that mean we cannot bill for the whole week?
    That provider would not be able to bill for the session missed that week but could bill for the two sessions that they attended.
  38. Reference to SAIOP: Does it have to be in a group call OR can it be an individual call
    The service provided would consist but not limited to the services noted in CCP 8A for SAIOP to include Individual Counseling and Group Counseling. Thus the service does not have to be only group but could include individual.
  39. Reference to SAIOP: Can it be a mixture of one day in a group call and another in an individual call?
    Yes, can be a mixture of group and individual.
  40. Reference to SAIOP: Can it be a mixture of part of the time in a group call, part of the time in individual totaling 1.5 hours of service
    Yes, services can include all of the service items noted in CCP8A for SAIOP and can be a mix of group/individual.
  41. I was on for the session for mental health OPT in addition to the session for SUD providers. The answers in these sessions regarding the future of telehealth services differed. In the first session it was stated that providers should already be aware of the telehealth OPT "options" that were available prior to COVID-19. The question was left unaddressed. However, in the session for SUD providers, there was discussion of the positive responses Trillium has had from individuals receiving services and how the options for continued telehealth services following COVID-19 were "on the table". Can you offer some clarification regarding the differences in responses? Are we to expect further discussion about the continuation of telehealth services following COVID-19, or should we refer to what as available prior to COVID-19 and expect a return to what was previously available?
    Trillium will make determinations about ongoing telehealth services during the wind down phase of this state of emergency. No long term decisions have been made about this.
  42. Bulletin #61 states a Consent to TeleHealth is needed to provide this service. Is Trillium waiving this consent requirement during the COVID State of Emergency?
    No, Trillium is not waiving this requirements, however, providers may obtain and note verbal consent.
  43. I want to be very clear. You said at last meeting that no authorization OR reauthorization was needed at this time for any Medicaid service. Is this correct? I know UM continues to process ones that we send.
    No prior authorization is required for any services that use the modifiers added for the state of emergency. If TARs for services with the modifier CR or GTCR are entered they will not be processed. If you are delivering services under the traditional method, using the traditional service code authorization and reauthorization requirements remain unchanged.
  44. Should providers continue to provide SAIOP or SACOT services after the unmanaged 60 or 30 days allotted? As they are currently being denied.
    Please reference Network Communication Bulletin 073, the regular service codes will retain normal edits. If claims are denying, please contact your Claims Specialist. To find the name of your Claims Specialist, please visit: www.TrilliumHealthResources.org -> For Providers -Provider Documents & Forms -> Claims/Finance Information & Forms -> Provider Claims Split.
  45. Will the authorization waiver afforded by NCDHHS Special Bulletin Covid-19 #46: Behavioral Health Service Flexibilities pertaining to SAIOP and SACOT services rendered after the allotted unmanaged 30 or 60 days (currently being denied), be retroactive to March 10, 2020?
    Please reference Network Communication Bulletin 073,the regular service codes will retain normal edits. If claims are denying, please contact your Claims Specialist. To find the name of your Claims Specialist, please visit: www.TrilliumHealthResources.org ->For Providers ->Provider Documents & Forms ->Claims/Finance Information & Forms ->Provider Claims Split.
  46. Why is the network closed to individual outpatient solo practitioners?
    Trillium operates a closed provider network. You can check our website for any open enrollment or RFP opportunities.
  47. Do B3 services such as Individual Support and Respite require authorization and reauthorization?
    No prior authorization is required for any services that use the modifiers added for the state of emergency. If TARs for services with the modifier CR or GTCR are entered they will not be processed. If you are delivering services under the traditional method, using the traditional service code authorization and reauthorization requirements remain unchanged.
  48. What is the minimum amount of time Day Treatment can be billed per day?
    Please refer to DHHS Special Bulletin #46 for guidance on Enhanced Services
  49. I want to clarify for telephonic therapy codes based off of Bulletin #46; are we to use regular coes such as 90834, 90837, 90846, etc.? And if so, are the rates the same?
    Yes, please use the regular codes with the appropriate modifiers. Rates are the same.
  50. RE a previous question you answered about B3 needing auth and reauth. I do not believe that B3 services have the CR code available. Can you confirm?
    That is correct, we are working on the additions. A Network Communication Bulletin will be published when these modifiers are available for billing.
  51. When the B3 services are added to the flexibilities will they be retroactive to the start of the stay at home order?
    These will be retroactive.
  52. Has B3 services been added to the flexibilities telehealth such as Individual Support Services? This was discussed in the last N.C. DHHS call
    These have not been added to the system yet, please look for a Network Communications Bulletin.
  53. How long is it taking to respond to proposals/requestes submitted by indiivudal agencies?
    This depends on the complexity of the request. We are processing requests as quickly as possible.
  54. In Network Bulletin #73 under Service Requirements it references "Mental Status". Does this mean a mental status needs to be included in each note or have documentation that the person is able to appropriately engage in the telemedicine.
    Yes, you should evaluate the appropriateness of the service intervention and the ability to engage in service delivery.
  55. Has the number of basic units allowed been lifted or are clients still limited to 24 units per fiscal year?
    When billing outpatient services with the CR and/or CRGT modifiers the edits have been removed limiting unmanaged visits.
  56. Will we be allowed to bill the Q3014 code for LCSWs? NCHC is accepting and paying for the code; however, we are getting denials when billing to Trillium.
    We are aware of this issue and working to correct it, thank you for the feedback.
  57. When do I use GT CR and/or CR for billing?
    GT CR is used when the service was provided via interactive two-way real-time audio-visual communication and CR is used when providing the service telephonically. These are both meant to allow for flexibilities during the COVID-19 emergency.
  58. Has B3 services (I.e. individual Support Services) been added to the flexibilities for telehealth yet? This was mentioned last week on the NCDHHS call.
    No, please look for a Network Communication Bulletin.
  59. Since TARs are still required for state-funded individuals, should providers be requesting authorized units/services using the modifer codes if providing services using current telehealth flexibilities? What will happen if the flexibilities end and modifiers discontinue in the middle of the authorization period?
    Yes, state funds require prior authorization. Trillium will work with provider on a wind down phase related to the flexibilities.
  60. We have heard that other MCO's are working with providers to help get clients smartphones in order to facilitate virtual meetings. Has THR considered this?
    At this time, Trillium is not funding phones. We will consider and appreciate the input. We are aware of it is a barrier to treatment members.
  61. In the previous session, you brought up the enhanced rate sheet for services. There is a code 99213 (for outpatient) -- on the old rate sheet the rate is $47.55. On the COVID rate sheet the code is $13.98 which is MUCH less. Is this 13.98 an add on?
    Service code 99213 (Office or other outpatient visit for the E&M of an established patient physician time approximately 15 minutes) is currently set at Trillium's current floor rates by specialty, per time limit. This is for both the code with and without the CR modifier.
  62. This is an addition to the question about the outpatient 99213 code. The same applies for code 99441. You don't need to address this here but in addition to looking at the rates on the COVID enhanced rate sheet.
    Service code 99441 (Physician telephone patient service, 5-10 minutes) is currently set at Trillium's current floor rates by specialty, per time limit. This code must be billed with the CR modifier.
  63. Are we supposed to utilize the new codes and rates even if we have not received our updated contract?
    Need additional information-what codes and services? Not all updated codes received an addendum.
  64. We have a day treatment in a school. We cannot use the building now or this summer. We are having a difficult time engaging with the children and families outside of the school. Can we suspend operations until the fall with no penalty?
    Yes, you may suspend operations without penalty.
  65. Any word about flexibilities in training (first aid, NCI, etc) for non IDD services?
    Trillium would allow online certifications from the American Red Cross in whatever online platform/avenue the Red Cross is utilizing. Trillium has not denied this request-we are still waiting for this requirement to be waived, which must come from Secretary Cohen. We have requested consideration of this request, but in the interim, the recommendation would be to seek online certification.
  66. Red Cross.com but for NCI or CPI, it depends on the program they use. CPI has a Zoom type option but you have to be a certified CPI instructor.
    Not a question - a recommendation for training vendors.
  67. When will my contract be updated with the GT & CR modifiers?
    Trillium is looking into the services in the provider's contract and will send an update soon.
  68. Since physical therapists, massage therapists, etc. are back at work in their offices, when can I resume my in person work. Since I’m a LPA who evaluates children, I’d like to resume providing this service. I’ll be using a plexiglass divider on my desk when I am able to start back. Several parents are waiting on me to offer them new appointments.
    Trillium does not have any prohibition on 1:1 services being delivered face to face. Providers should follow guidelines related to sanitation and social distancing during appointments.
  69. Hi, I'm trying to gain some clarity & confirmation on this new notification - not sure who can assist so I apologize if I included wrong contacts: 1. Not certain I'm completely clear on this: Are you implementing a 20% increase on ALL of our service lines? Or is it limited to Dare, Nash, Pitt recipients only? Certain Service Lines? Etc? 2. Regarding FC: Is this included and if so, would the increase actually be an additional 5% on top of the current 15% increase? 3. Do we simply start billing this enhanced rate on applicable services beginning with DOS 6/1/20
    1.
    The 20% increase was related to basic benefit outpatient services for both State and Medicaid, and was not recipient or site specific.
    2. We will need clarification on service "FC" in order to be able to answer on any additional increase to that service. Please email: RATESFinance@TrilliumNC.org for questions related to specific services and rates.
    3. Yes, for basic benefit outpatient services, you may start billing the 20% increase with DOS beginning 6/1/20.
  70. For IIH services, under the current modified waiver bulletin 46, IIH services can be implemented for 1 hour instead of the traditional 2 hours. Is the reimbursement rate the same as if it were 2 hour sessions?
    IIH service is paid via a per diem rate therefore the reimbursement rate would be the same regardless of the hours as determined are allowable during the COVID-19 state of emergency.
  71. There was a news release dated 05/20/2020 that states OPT services will experience a rate increase of 20%. Are the new telephonic codes (99441CR, 99442CR, 99443CR, 98966CR, 98967CR, 98968CR) inclusive of this?
    The telephonic codes were not increased by an additional 20%. The reason for this is that they were increased on average by 148% over the state rates when they were added to our billing system.
  72. Per correspondence dated 5/20/20, it appears outpatient rates were increased 20% effective 6/1/20-8/31/20; the COVID rate table does not show what rates those include as it appears it was last updated on 5/1/20. Can you please let me know what codes those are for and/or update the COVID rate table.
    Trillium is working to update the COVID rate table to reflect the 20% increase for outpatient services and expects to have this completed by the week of June 8th. In the meantime, for questions related to specific rates, please email RATESFinance@TrilliumNC.org.
  73. PSR. In the Friday meeting, it was discussed that you could not bill PSR (in-person) and PSR (virtual) on the same day. Follow up discussion was ambiguous. Does this mean PER CLIENT (ie: Joe can't be billed virtual in the morning and then come in person in the afternoon)? It doesn't seem logical that it would be anything but that since assisted living and group homes will not send to the PSR right now but those folks need support. Also, with a 10 person limit per space, client attendance is being staggered on a daily basis and those NOT coming, need support.
    That is correct, you may not bill PSR (in-person) on the same date of service for which you bill ILOS for PSR (DIRCS) via 1:1 service delivery, telehealth or telephonic outreach.
  74. We have submitted claims using the ILOS (H2017 CR) code, however all of our claims have denied. Does the new code need to be added to our contract? How do we get this done?
    I will have the Claims Specialist review the denials and reach out to the provider individually or other departments as needed.
  75. Code Q3014 TELEHEALTH FACILITY FEE If this is billing for the use of a facility in order for the individual provider to perform a telehealth visit, why would Trillium not want to see the Facility name in box 32 instead of the individual provider name for a facility charge? There is an additional claim billed with an E & M code for the service the provider is rendering to the patient which reimburses to the individual provider.
    I will have the Claims Specialist reach out to this provider for technical assistance.
  76. Should this form or a similar form also be used for SAIOP/SACOT?
    Please be on the look out for a Provider Meeting for providers who deliver SAIOP and SACOT will be coming soon.
  77. There is still a statewide shortage of gowns, are gowns part of this PPE requirement?
    No, we are not requiring gowns to be worn.
  78. Will the power point be sent out via email along with the informed consent form?
    Yes, this was sent to all registered participants.
  79. Specifically for Day Tx, is there a timeline for when Trillium expects the programs to be back in the facility? School-based facilities will have to rely on schools to allow entry in some cases.
    No, Trillium expects member safety to the top priority.
  80. Where can I get the consent form? Do we need to give a copy to Trillium once it is signed?
    This was emailed, along with the presentation but will also be posted to Trillium's COVID-19 provider page.
  81. Is organization required to provide member with PPE or may organization require the members to provide their own?
    Trillium is not specifying how the PPE is provided.
  82. My question is for PSR. With the limit of people in the building at a time, not all PSR clients will be able to utilize the needed amount of the service. Will the in lieu of defention continue to be available, once we have re-opened.
    Yes, the in lieu of definition is still available. PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  83. If the governor extends school closure into the 20-21 school year, will Day Treatment providers be able to continue to provide services while remote learning is in place?
    Yes, please see flexibilities under Special Bulletin #46.
  84. With us being moved into phase 2 - given that the date is effctive until June 26, will PSR's be allowed to adhere to the guidelines and able to use original group codes for groups less than 10?
    Following the approval of your reopening plan, yes, you may resume services for any members with a signed informed consent document as long as no more than 10 people are in the building.
  85. Will funding be available to help cover the cost of PPE for consumers?
    No, there is no funding available for PPE at this time.
  86. For the maximum of 10 people you discussed, does this apply for school-based locations that may have school staff located in other areas of the building?
    Please share on your reopening plan how you would mitigate risk related to shared enterances, common areas, restrooms.
  87. We operate PSRs accross the state and have not closed any of them. We have continued to operate the PSR in Columbus County following much of the guidance that was provided today, how, will that be treated in this process?
    Providers were asked to transition to the in lieu of services for PSR many weeks ago which allowed 1:1, telehealth and/or telephonic support. Please contact NetworkManagement@TrilliumNC.org for questions.
  88. If we are unable to provide lunches for our Day Treatment kids, may we be able provide services either in the morning before lunch or during the afternoon after the lunch hour? The school building we use will not be open to provide services.
    Please see the flexibilities allowed in Special Bullet #46.
  89. When is the reopening plan due to Network Management?
    Trillium has not set a deadline, but we expect group service delivery will not resume for these services until the plan has been sent and approved.
  90. Should the form be used for those members currently coming in for walk-in intakes to office that are still open? For Outpatient
    This call was specific to Day Treatment and PSR. There are various flexibilities in place for telehealth options for member who receive outpatient services. Trillium would expect outpatient practices to follow sanitation guidelines, require face coverings and allow for social distances as recommended by NC DHHS.
  91. We are currently foillowing the 10 consumer and staff total for the PSR, however, this is a multi-use facility. Are you saying we cant have other staff in a separate area of the building? This is not practical.
    Yes-that is the guidance. No more than 10 people in an in door space.
  92. Group coding is essential to remain open as payroll loans are running out in a few short weeks and new billing codes dont cover costs. Is this being considered with individualized rates?
    You may contact RATESFinance@TrilliumNC.org if you have a specific question about rates.
  93. Day Treatment: Are we able to utlize both the flexibilities in the in lieu service definition, as well as return to facility based for those students/parents that would prefer face to face? This assuming school is in allowance.
    Trillium has not implemented an In lieu of definition for Day Treatment, please follow flexibilities allowed in Special Bulletin #46.
  94. When providing Day Tx face to face with members under the in lieu of service def, do we still need to have the informed consent signed or only when facility based services are being provided again?
    Trillium has not implemented an In lieu of definition for Day Treatment, please follow flexibilities allowed in Special Bulletin #46. Informed consent is required for anyone receiving services face to face in a group setting.
  95. With PSR services and due to the limit of 10 people being in a building can a member receive face to face and telehealth for the purposes of ensuring that people may have alternative attendance to ensure that everyone is seen face to face in a week.
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  96. Our attorney has noted that employee screening are considered a part of the employee health record and are protected. Your guidance would seem to violate that protected health record of the employee.
    Trillium is requesting documentation of the process for screening staff, not actual staff records of health screening outcomes.
  97. Whats the expected turn around time for approving the reopening plans we submitt?
    Typically less than one week. Varies according to the number of plans received at one time.
  98. It is my understanding that members who live in licensed group homes are still very limited in how they can interact with others in the community (similar to Nursing Home restrictions). Will these members be able to resume attending day programs?
    This will be up to the group home service provider.
  99. Our PSR currently works out of a 10,000 square foot building. If we can create multiple entry points and ensure that groups of 10 never intermingle (never see each other, never use same restrooms, etc), would that be acceptable?
    Please submit this for review in your reopening plan, along with a lay out of your building. The point in this is to mitgate risk related to shared spaces, common areas, entrance/exists, restrooms. Network will review and provide additional guidance.
  100. If we work with residential facilities it is possible for staff to do groups of 10 or less in their homes to use group rates and still adhere to social distancing guidelines. For PSR's.
    PSR is required to be delivered in a licensed facility per DHSR. You may not deliver PSR in an unlicensed setting.
  101. For day tx - are we able to provide face to face intakes for telehealth services for new clients?
    An intake is not a billable component of Day Treatment. Intake is a part of the outpatient service area or completion of necessary paperwork prior to beginning Day Treatment. Need additional inforamtion to respond.
  102. Will you include questions with answers when you send out powerpoint. Sound quality is poor on the answers
    No, but these will be posted in our Provider Q&A section.
  103. Is the Informed Consent form required for IDD Day Support Providers prior to reopening?
    Please follow guidance received during the IDD Day Supports provider meeting. This guidance is specific to PSR and Day Treatment services.
  104. When does Trillium plan to start authorizing new clients and new enrollments again?
    Trillium has not closed admissions for services.
  105. Remind me again, can a client sign a release to opt out of using PPE in a group setting? If not, will we need to limit that Day Tx client to telehealth services?
    No
  106. If services are provided face to face are signature pages required signatures by the parent or guardian?
    If the person is willing to receive face to face services, then yes, you should obtain signatures.
  107. Is there is certain format for the reopening plan to be submitted on?
    No, please be sure to address each area where guidance was provided.
  108. If the state moves "backward" in the reopening phases due to increased COVID-19 cases, will day treatment programs be closed again?
    Yes
  109. This is in regards to PSR services. I am wondering if after we re-open for face to face meeting with clients, are we going to continue to be able to bill for over the phone wellness checks and communication?
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  110. We transport majority of our clients to the PSR program. If they have to be 6 ft apart on the van we would have to do double/triple routes. Is there anyway we can receive addition funding?
    No, there is no additional funding for transportation at this time.
  111. Can clients provide their own PPE or does the facility have to provide them?
    Trillium is not specifying how the PPE is provided.
  112. With PSR services and due to the limit of 10 people being in a building can a member receive face to face and telehealth for the purposes of ensuring that people may have alternative attendance to ensure that everyone is seen face to face in a week.
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  113. If clt/guaridan opt in for face to face but don't want to attend face to face each day, can they do the telehelath option some days and face to face others?
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  114. Because of the restriction in the number of clients, not all clients can receive the total number of hours of PSR needed. Are you saying a hybrid of traditional PSR and In Lieu of services can't be used to meet the needs of the client?
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  115. If a client only comes on campus 1 day a week for face-to-face, could you bill in-lieu of definition the other 4 days? This is necessary in order to rotate clients to ensure no more than 10 in a group per day.
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  116. Can the face to face service alternate to allow more members opportunity to have face to face?
    PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  117. PSR? or PFR? I don't know what that stands for....
    Psychosocial Rehabilitation (PSR)
  118. If school buildings are off-limits for the Day Tx summer program, what will be considered as an appropriate place of service? Especially if we may have to look at meeting in the community as a group.
    Day Treatment is required to be delivered in a site that is licensed by DHSR, unless delivering under the flexibilities allowed in Special Bulletin #46.
  119. Is there going to be guidance on how to adjust our reopening plans if they are denied?
    Trillium will provide additional guidance for remediation of the plan if it isn't accepted rather than denying the plan.
  120. I apologize, I did not hear the answer to previous question of alternating between face to face and telehealth?
    Yes, the in lieu of definition is still available. PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  121. Members are eager to return to their facilities, so alternating treatment would enhance their treatment and improve overall wellness. Just wanted to make sure we can altrenate.
    Yes, the in lieu of definition is still available. PSR and DIRCS may not be billed on the same day and the number of hours billed may not exceed the typical number of billable hours under PSR.
  122. If they choose to have face to face services but 1:1 in the community and not in a group, is the release still required? It does not read that way.
    No, the informed consent is only required when a person chooses to receive face to face services in a congregate setting.
  123. Where can I find the PSR In Lieu of Service Definition?
    All approved In Lieu Of Service defintions are published on DHHS's website.
  124. When does the school year programming end for Day Tx and summer programming begin for this year?
    The typical protocol would be followed, even if the services are delivered via telehealth.
  125. Are you prepared to accept reopening plan immediately or is there a start date to submit?
    Yes.
  126. If you have a day treatment site in the same buliding that houses other mental health personnel offices does that mean we can only have 10 people in the whole building during day treatment hours?
    10 people total
  127. It was my understanding that In Lieu of was MCO specific. I have Partners In Lieu of but some MCOs do not offer.
    Trillium's PSR definition is very similar to the definition that was approved by Partners. It is true that not every LME/MCO choose to adopt every approved in lieu of definition.
  128. What will be the hours availible to provide service for day treatment? cut off still at 6pm
    Trillium needs some clarification on this question. Please submit additional information to NetworkManagement@TrilliumNC.org.
  129. Is the rate the same for the in lieu of PSR service.
    Please see the COVID-19 rate table provided on Trillium's website.
  130. Can telehealth be provided if the therapsit is in another state and the client is in NC. The clinician has a NC license.
    We encourage the therapist to check with their licensure/certification board. NCBLCMH website has posted guidance on their website:www.ncblpc.org.
  131. I asked the question about the PSR billing and it was not answered. Specifically, is the billing PER PERSON or for the PSR in general. Can we bill PSR for those that are in person on that day and bill virtual for those NOT in attendance for phone contact?
    You may not bill PSR and DIRCS in the same day for the same member.
  132. Do to the new billing guidelines for COVID. Does all codes 99441Cr-99443 CR have to be listed on the site specific contracts?
    These codes were added based on already existing E&M codes. For example, if you had 99201 at site "X" you should see 99441 CR, 99442 CR and 99443 CR at that site.
  133. If we have a facility where staff are providing tele-medicine services from their office in the facility, not face-to-face, are they required to have a written plan and limit to 10 staff in the office?
    Trillium is only requiring Network Providers who offer services in congregate settings such as IDD Day Services, Mental Health/Substance Use Group Services, SACOT, SAIOP and other Outpatient Group Services to submit a Contingency/Re-opening Plan which would only permit 10 persons in a building. Providers should submit their plans to: NetworkManagement@TrilliumNC.org.
  134. Are there increased rates for outpatient therapies and E & M codes? If so, how do we get this information?
    Trillium has updated the COVID rate table to reflect the 20% increase for basic benefit outpatient services and this can be found on the website at: For Providers->Billing Codes and Rates->COVID 19 Rate Table FY 2019-2020.
  135. Are we getting reimbursed 20% automatically or should we start calculating 20% into our claims? I read a communication that it was effective June 1, 2020 through August 31, 2020. Is this automatic, or do we need to put the new calculated amount into the claim with the 20% increase?
    The 20% increase was related to basic benefit outpatient services for both State and Medicaid. You can start calculating the 20% into your claims for services effective 6/1/2020. Trillium has updated the COVID rate table to reflect the 20% increase for basic benefit outpatient services and this can be found on the website at: For Providers->Billing Codes and Rates->COVID 19 Rate Table FY 2019-2020.
  136. Please clarify in regards to the outpatient services codes that qualify for the rate increase of 20 percent; do they require a CR modifier to be included on each of them (i.e. 90837 CR) or if a session had to be done face to face is the increase given for a 90837? Additionally, is the increase for sessions provided on a telehealth platform using the GTCR modifier? Thank you in advance for your assistance.
    The increase was applied to the basic benefit outpatient services with the CR modifier attached. As long as we are continuing to operate under a State of Emergency that allows for flexibilities when providing services, whether it is face-to-face, telehealth, or telephonically, these are not being done under normal circumstances therefore you should continue to utilize the service codes with the CR or the GTCR modifiers.
  137. Who can we contact about increasing an “in lieu of”service definition. Granted, we are actively attempting the re-opening plan, but also need better rates for the individualized service rate. We are licensed as group treatment but due to COVID-19 we have moved into a new service definition. This definition addresses individuals with a higher rate but due to 1:1 our overall rate was decreased to 1/4th the typical money received. Our agency has had to take out a small business loan to remain afloat. Now the funding is coming to an end and we are still operating w new definition / new rate. It is our fear that we are not going to have enough money to sustain. This is scares because of our size. We typically serve 50+ a day and have continued to do that over the quarantine. Who can we y’all to to help us financially. An increased rate would literally save lives and jobs. And most were increased to benefit providers who were deemed essential during this crisis. We are essential and are barely hanging on. Your advice and assistance is greatly appreciated.
    You may not increase the billable units of an In Lieu of Services. If you are asking about increasing the rate, you may contact: RatesFinance@TrilliumNC.org.
  138. The effective date for the 20% increase for OPT is 6/1 but the table was released on 6/11 or 6/12 so do we need to refile our claims since 6/1 with the new rate?
    Replacement claims will be needed in order to receive the enhanced rate.
  139. I have a question and I am not sure who to direct it to. I work with RI International and I am looking into supporting multiple outpatient therapy sites. After COVID, would I as a fully licensed LCSW be able to use telehealth video platforms from office to office for outpatient therapy? This due to other offices not having a therapist and me not being able to commute to multiple sites each day. I have been in offices where psychiatrists are able to do this to support multiple sites, but I want to be sure that I as a therapist will be able to do this and bill.
    Trillium monitors and receives guidance from NC DHHS on tele-health flexibility. At this time, LME/MCOs have not received further guidance on tele-health post COVID-19. When NC DHHS provides further instruction or plans on changing the flexibilities, Trillium will send out a Network Communication Bulletin (NCB) to our providers notifying them of future changes.
  140. There was a notification sent about a 20 percent increase for Hazard pay for all Outpatient services effective 6/1/2020. Does this include B3 services and when will the rate take effect?
    Trillium has updated the COVID rate table to reflect the 20% increase for basic benefit outpatient services and this can be found on the website at: For Providers>Billing Codes and Rates>COVID 19 Rate Table FY 2019-2020.
  141. What resources can Trillium provide service providers who are experiencing financial shortfalls due to overall rate decreases. Some providers required a small business loan to remain functional. Now that these have run out, what can be done to sustain services.
    We understand that some of our providers may be experiencing financial shortfalls and Trillium has responded by increasing rates for many services in our benefit plan. For additional resources, please see NCB # 92 for information on the CARES Act which offers guidance on accessing the Provider Relief Fund Payment Portal for eligible Medicaid and CHIP providers.
  142. Is there any financial assistance from Trillium to providers for loss of income due to Covid-19?
    Not at this time, but you may send finance related questions to RATESFinance@TrilliumNC.org
  143. How should providers track units starting July 1st, now that the code modifiers are in place due to COVID-19, and units are not being deducted during this time?
    For Medicaid services using the CR modifier, No Prior Authorization is required.
  144. When will we be required to see clients in person?
    There is no timeline established for this. Providers will be given notice prior to the termination of any flexibilities.
  145. We would like to confirm that the proper procedure to access the OP enhanced rate is to use the CR modifier and the statement, “This service was delivered during the COVID-19 State of Emergency requiring social distancing,” even if the service is being delivered face to face with proper social distancing measures in place.
    Yes, that is correct.
  146. On PCP signature pages, we are able to receive verbal consent from the client and type that on the page where the client would sign. Are we able to also type in the clinician and provider's name on the PCP signature page?
    Yes, you can accept verbal consent and type in the clinician/provider name. Documentation should include the provider received verbal consent from member, when, and during COVID-19.
    References:
    a. Allow for verbal agreements in lieu of written signatures in every instance when acting otherwise would prohibit continuation of service. Letter allows a provider to obtain verbal agreements in lieu of the written signatures. Documentation shall include that the provider has received verbal consent/agreement from the member. (https://files.nc.gov/covid/documents/guidance/healthcare/COVID-Letter-to-LME-MCOs-03-19-2020.docx.pdf)
    b. Currently, information in the PCP manual (https://files.nc.gov/ncdhhs/documents/files/pcp-instructionmanual2-3-10.pdf) and information in APSM 45-2 only outlines signature and date requirements for the person centered planning. We unable to locate any specifics as it pertains to the person centered planning signature requirements for a clinician under the person responsible section. We followed up with medicaid.covid19@dhhs.nc.gov to post this question to ensure specifics are located.
  147. Is there a reason that enhanced rates for adult community based MH services will end prior to residential services. Direct care staff are still putting themselves at risk to provide these services face to face?
    We understand that some of our providers may be experiencing financial shortfalls and Trillium has responded by increasing rates for many services in our benefit plan. For additional resources, please see Network Communication Bulletin 092 for information on the CARES Act which offers guidance on accessing the Provider Relief Fund Payment Portal for eligible Medicaid and CHIP providers
  148. Are 2 witness signatures required when obtaining verbal consent?
    This question was covered on COVID-19 DMH and DHB Meeting with Providers (7.8.20) the response:
    "No rules to cover this. Licensure rules did not anticipate this current situation. You need a facility policy that you follow and your clients know about"
  149. Can Trillium notify schools that Day Treatments are restricted to ten people in the buildings? Providers that are located in school buildings are being requested to come back for the fall. The school personnel are not aware of the discrepancy w DHSR rules?
    The limitation of 10 people in a indoor space, is not a Trillium prohibition. It is a part of the Executive Order that addresses Phase 2 of reopening in North Carolina. We would expect providers are, given the current flexibilities, able to have these conversations with schools themselves. There has also not be a decision related to fall returns to school announced at this point. If there is a particular school site or county where there are specific challenges, please reach out to Trillium directly.
  150. The RM&D manual doesn’t seem to address this specifically- re: 2 witnesses signatures when verbal consents are obtained. Some providers are requesting 2 witness signatures on verbal consents to release records requests.
    Reference: On the COVID-19 DMH and DHB Meeting with Providers Call on 7.9.20; the response that was provided:
    "No rules to cover this. Licensure rules did not anticipate this current situation. You need a facility policy that you follow and your clients know about"
  151. Is the Zoom platform approved for telehealth and web-based therapy? It is unclear how the different platforms are HIPAA compliant. Families and children are most familiar with Zoom since it is used by the school system.
    Zoom is allowed at this time. If you would like more information on a platform's specific HIPAA compliance, Trillium recommends you reach out to the software vendor directly in order to make a decision about long term utilization of the platform related to HIPAA compliance.
  152. How do I obtain clients' signatures?
    Need more information about why the client signature is needed to provide an appropriate response.
  153. TARs for State Funded (IPRS) individuals using the modifiers are being sent back as unprocessed with a note that PA is not needed for these codes. Are TARs no longer needed for state funded individuals? I am including the modifers in the TARs as that is how we are providing services at this time. Thank you for the clarification.
    TARs are needed for state funded services, please email UM@trilliumnc.org for additional guidance
  154. When completing a PCP during COVID-19, are clinician's required to provide a wet signature under 'Person Responsible for Completing the PCP'?
    You can type in clinician/provider name. Documentation should include the provider received verbal consent from member, when, and during COVID-19.
    References:
    a. Allow for verbal agreements in lieu of written signatures in every instance when acting otherwise would prohibit continuation of service. Letter allows a provider to obtain verbal agreements in lieu of the written signatures. Documentation shall include that the provider has received verbal consent/agreement from the member. (https://files.nc.gov/covid/documents/guidance/healthcare/COVID-Letter-to-LME-MCOs-03-19-2020.docx.pdf):
    b. Currently, information in the PCP manual (https://files.nc.gov/ncdhhs/documents/files/pcp-instructionmanual2-3-10.pdf) and information in APSM 45-2 only outlines signature and date requirements for the person centered planning. We emailed medicaid.covid19@dhhs.nc.gov to post this question to ensure specifics are located.
  155. The original May 20, 2020 News Release in regards to the 20% rate increase for outpatient services. On that release, it stated the increase was for outpatient services between June 1 thru August 31; however, the Communication Bulletin #104 conflicts that stating a reminder that effective August 1, 2020 Basic Benefit Outpatient rates go back to standard floor. I could not find any other communication bulletins stating the change in the end date from the original News Release on 5/20/20 that changed the end-date for Basic Outpatient rate increase end date. Can you please clarify as originally, the basic benefit outpatient rate increase was thru August 31, 2020. Thank you in advance for this clarification.
    We are aware that there is a miscommunication on the end date related to the Basic Benefit Outpatient Services rate enhancements. The News Release on May 20 did state that the rate increase for these services was between June 1 through August 3, however, that date has now been revised to July 31 as per the Network Communication Bulletin 095 and Network Communication Bulletin 104. We apologize for the confusion on this.
  156. Due to most public schools going to virtual learning/partial virtual learning, is it possible for B3 Individual Respite monthly units to increase? In most cases, the caregivers do not have knowledge of the technical portion of virtual learning.
    Limits on the benefit plan for B3 services remain in effect. Please note that there are NOT flexibilities that allow Innovations waiver, B3, or state-funded services to be provided during the time that school is in session whether in-person or virtual learning.
  157. Network Communication Bulletin 107 references the state's announcement that NC Medicaid has determined that enhanced rates related to COVID-19 will continue through 9/30/2020. Does this mean that all previous rate enhancements that were supposed to be removed now continue to be in effect until that date? If not, which services continue to receive enhanced rates and which do not?
    SPECIAL BULLETIN COVID-19 #107: Continuation of COVID-19 Enhanced Rates is related to NC Medicaid Fee-For-Service rate enhancements. For Trillium specifically, information related to COVID-19 rate enhancements may be found within the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  158. In the latest bulletin 107, there is a reference made regarding Temporary Enhanced Rates related to COVID 19 through September 30, 2020. Does this statement override the previous bulletin 104, ending rates on July 31, 2020. Please advise so we can correct our billing claims prior to tomorrow.
    SPECIAL BULLETIN COVID-19 #107: Continuation of COVID-19 Enhanced Rates is related to NC Medicaid Fee-For-Service rate enhancements. For Trillium specifically, information related to COVID-19 rate enhancements may be found within the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  159. How long will trillium be managing the payment of claims of outpatient mental health and substance abuse services?
    We will need additional information in order to be able to respond to this question.
  160. As a provider that is new to Medicaid, who would be the person to contact to make sure documentation is correct?
    There are several ways to get in contact with Trillium Health Resources; you can visit our website: www.trilliumhealthresources.org or submit your question to: Network Services NetworkServicesSupport@TrilliumNC.org.
  161. Will B3 services qualify for any extra/emergency hours during pandemic? If yes, will any form or insurance suffice?
    The question is unclear, please provide further clarification and explanation on "If yes, will any form or insurance suffice?"; submit additional information to IWCOVIDResponse@TrilliumNC.org

ICF/IDD, Group Living, Supervised Living, CLSF Providers Residential Supports, Supported Living

  1. Will Trillium send out the exact Enhanced Rates or so we adjust them by the percentage rate that was sent out to us? The residential rate given was 30%.
    Trillium has implemented a COVID-19 Crisis Event Fee Schedule that was posted on its website on Monday, April 27, 2020. Please refer to your contract and/or Provider Communication for any special requirements to bill the temporary rates. If you have any questions regarding this communication, please email RATESFinance@TrilliumNC.org.
  2. How can I find out the exact reimbursement rate for Residential Supports services (under the Innovations Waiver) that my agency will receive once the rate enhancement is applied?
    Trillium has implemented a COVID-19 Crisis Event Fee Schedule that was posted on its website on Monday, April 27, 2020. Please refer to your contract and/or Provider Communication for any special requirements to bill the temporary rates. If you have any questions regarding this communication, please email RATESFinance@TrilliumNC.org.
  3. When are the new temporary rates going to be posted?
    Trillium has implemented a COVID-19 Crisis Event Fee Schedule that was posted on its website on Monday, April 27, 2020. Please refer to your contract and/or Provider Communication for any special requirements to bill the temporary rates. If you have any questions regarding this communication, please email RATESFinance@TrilliumNC.org.
  4. The rate enhancements for Residential Support services, will those occur automatically when the providers submit their claims?
    No, it doesn't happen automatically. The provider will need to bill the service code with the CR modifier at the enhanced rate in order for the claim to pay the correct rate.
  5. Residential Supports - should we be billing the enhanced rate of 30% for all of our Residential cases?
    The rate enhancement for Residential Supports is intended to support providers who have to pay overtime for staff when other staff cannot work due to COVID-19, or due to paying direct care staff a higher rate for hazard pay during this event, It is Trillium's expectation that this enhancement will be directly passed down to direct care staff.
  6. When can parents or guardians visit their ward in a residential facility?
    The directive to limit visitors to behavioral health group homes as made by Governor Roy Cooper in Executive Order #120, Section 3. Until changes or modifications are made to this order to lift those restrictions, those restrictions will remain in place.
  7. IDD consumer registered in our Group Home recently received a pacemaker and is now in need of one on one innovation services. Is there a way to start rendering these services immediately without authorization. Were would I begin?
    To access Innovations Waiver services, the member or legally responsible person will need to contact Trillium to request that the member be placed on the Registry of Unmet Needs. This is the list maintained for those waiting for Innovations Waiver services.
  8. Why didn't Innovations Day Support get a rate increase? We have Day Support direct care staff, CLFS staff, and Residential Supports staff because we have a day program and group homes. Some direct support staff qualifies for wage increases according to the rate increases of particular services, but others do not. We need to be able to retain all our direct care staff. It's difficult to treat them differently.
    We appreciate your feedback. We will carefully consider your feedback. Any changes to rates will be communicated out to our Provider Network.
  9. Some MCOs are making "stabilization" payments to providers to make up for funding that is being lost. Our rates have been increased for some services, but we are required to pass it on to direct care staff. If we are in this crisis for a protracted period of time, we will need additional support to keep the doors open. The direct support staff has their increased wages, but the infrastructure that supports them and the clients will be at risk. We are not currently able to get the hours we were getting because services that were provided in groups are now provided individually and because some clients' families do not want services provided in their homes. Will Trillium consider any such stabilization payments in the future?
    We appreciate your feedback. We will carefully consider your feedback. Please also be aware that small business loans are available through the CARES Act.
  10. For retainer payments, are we only eligible for them if the member is not receiving services? We have staff out sick due to COVID-19, we are still providing the Supported Living services to the member, as he is not sick, but want to know if we can receive retainer payment to pay staff who is out. If this is an option how do we submit for the retainer without looking like we are trying to double bill for the service?
    The direct care staff who is unable to work due to COVID-19 illness would be eligible for a retainer payment. In order to access retainer payments, your agency will complete a Smartsheet form every Monday for the previous week’s retainer payments. Please utilize the Smartsheet form link included in Network Communication Bulletin 62. Provider bills for service and uses CR modifier to indicated service delivered based on a flexibility. Provider also bills for same service for retainer payment and use the CR-XU modifier. This is how the system differentiates the RP billing from service delivery billing. We are working on the addition of the XU modifier and if all goes well that will should be in place sometime next week. Trillium will release a communication with the specifics on this.
  11. Does the 5% rate enhancement for CLS for all CLS cases we provide, or just for the ones we may to pay staff overtime on? It was unclear to me when reading Bulletin #66?
    The 5% rate enhancement for CLS is intended to support providers who have to pay overtime for staff when other staff cannot work due to COVID-19, or due to paying direct care staff a higher rate for hazard pay during this event It is Trillium's expectation that this enhancement will be directly passed down to direct care staff.
  12. Is there a flexibility template form that EOR's can complete to show the flexibility's that they will utilize during this period? There are a number of MCO's that have this form, which will ensure everyone is aware of the ones they are utilizing.
    Yes, provider agencies and EOR(s) shall maintain documentation (as usual) via the required service documentation grid by entering COVID-19 on the grid with the QP or EOR signature and date. Please see the Network Communication Bulletin 62 on our website for more information.
  13. We have been asked to use the CR modifier for all Innovations Waiver services provided at this time. Can we just use the CR modifier if we are using an Appendix K Flexibility, that way we can distinguish services provided without any flexibilities compared to those services provided as usual? Will retainer pay be allowed for State-Funded Day Activity services?
    Yes, CR Modifiers are intended to reflect the use of the flexibilities available in Appendix K. At this time, retainer payments do not apply to services outside of Innovations Waiver services.
  14. The 5% rate enhancement for CLS, is that for all CLS cases or only certain cases?
    The 5% rate enhancement for CLS is intended to support providers who have to pay overtime for staff when other staff cannot work due to COVID-19, or due to paying direct care staff a higher rate for hazard pay during this event, It is Trillium's expectation that this enhancement will be directly passed down to direct care staff.
  15. CST Question-Affirming per NCDHHS Special Bulletin COVID-19 #46 it states "staff trainings are only waived if there are not opportunities to receive the specific trainings virtually." Based on that document, the training for the 15 hours of Permanent Supportive Housing Training is temporarily waived as it is not virtually provided....correct??
    Yes, NC DHHS Special Bulletin COVID-19 #46 Behavioral Health Service Flexibilities does waive staff training requirements within 30 and 90 days of employment, if unable to be obtained during the state of emergency and if there are not opportunities to receive the specific training virtually. According to #46, this change is retroactive to March 10, 2020. At this time, Permanent Supportive Housing Training is not available virtually, however, a virtual training will be available on June 10, 11, 17 and 18, 2020. When the virtual training is available the training requirement will not be waived. More information about training registration and attendance will be forthcoming.
  16. CST Question-Per service definition, "the initial training requirements may be waived by the hiring agency if the team member can produce documentation certifying that training was completed no more than 24-months prior to hire". If a staff person already employed by the agency assumes a position on the CST Team, is the date of hire for that person the date they were hired with the agency or the date they assume the CST position?
    The day that the staff member assumes the role with the CST team.
  17. I was on the Q&A on 4/21/2020 and I thought I heard that we still need to bill the services to Trillium in order to receive the retention payment even if another staff is currently providing the service. If we do need to bill it through our EHR, how will you be able to know how the number of units that were actually with the consumer versus the ones that were not? Is this correct, and if so, do we still need to complete the Google sheet?
    In order to access retainer payments, your agency will complete a Smartsheet form every Monday for the previous week's retainer payments. Please utilize the Smartsheet form link included in Network Communication Bulletin 062. Your agency will continue to bill for the services (as if they were being provided) as this is how the funding will be made available to your agency for retainer payments to staff.
  18. When will the service rate be determined for this service?
    T2014CGCR (Residential Supports Level 2-AFL) has been increased by 30% and the new rate is $176.06.
  19. Would we be able to utilize the rate increase for CLS to purchase CDC recommended PPE equipment for our field staff?
    The 5% rate enhancement for CLS is intended to support providers who have to pay overtime for staff when other staff cannot work due to COVID-19, or due to paying direct care staff a higher rate for hazard pay during this event. It is Trillium’s expectation that this enhancement will be directly passed down to direct care staff.
  20. Should we still use the CR modifier even if the member is not exceeding their previously authorized frequency of services?
    Please clarify the services that are the subject of this question.
  21. If new staff is hired, is it okay to have them go through u tube training on medication administration, lst aid cp If this virus continues to be active at the end of June, is it possible for the staff who is currently an employee, training to be extended beyond June 30, 2020 date. Can you provide information to providers on the steps or process of dealing with an individual or staff who may contract the virus in order to be consistent.
    Providers will need to provide trainings as outlined in the current standards. Relatives of adult waiver members and current direct staff are able to provide services to members prior to background checks and training for 90 days. No extension beyond 90 days has been made at this time. For information on how to support members with COVID-19, please refer to the CDC and websites for more information. Trillium has a number of resources also available on our website related to COVID-19.
  22. Is the CR modifier required for all Innovations Waiver services starting 4/1/20?
    CR Modifiers are intended to reflect the use of the flexibilities available through Innovations Waiver services in Appendix K. Please utilize this modifier anytime those flexibilities available in Appendix K are being utilized.
  23. Can the Retainer payment be claimed for Residential services?
    Yes, retainer payments apply to IW Residential Supports services.
  24. Our agency hired a parent (RAP) to provide services to an adult member on 4/21/20. A care manager has informed the parent that we should bill and retro pay her for CLS services back to the date Appendix K was approved. Where can we find this information (to retro pay staff) in Appendix K? Will this be considered a conflict with current Medicaid documentation requirements?
    Services cannot be billed prior to the date that services were provided. If the Relative as Provider began providing services on 4/21/20, then billing should not begin prior to that date.
  25. Other than Assertive Engagement, can state-funded services (DT & PA) be delivered via telemedicine?
    Please refer to Network Communication Bulletin 061 for guidance on state-funded services that can be provided via telehealth.
  26. Can Innovation Waiver services be delivered both in-person and via telemedicine? (i.e. CLS is delivered via telemedicine M, W, F and is delivered in person T & Th)
    Innovations Waiver can be provided via telehealth where applicable and appropriate for the member. The member should be able to participate and have their needs met through telehealth modalities. Telehealth would not be appropriate for those members who require a significant level of support to engage (i.e. physical prompts, hand over hand assistance, complete physical assistance, or other comparable levels of support). Additional guidance from DHHS regarding the use of telehealth for Innovations Waiver Services will be forthcoming.
  27. Should we continue to submit TARs for reauthorizations for new plan year, for increase in hours of service, B3 Respite initial request for service, etc., or when are TARs needed or are they needed at all now? I was not clear on the answer given last week.
    Medicaid B and Medicaid C (Innovations Waiver services) do not require initial or concurrent authorization at this time. Enhanced State services will continue to require authorizations at this time due to the limited availability of State funds. Therefore, your agency does not have to submit a TAR for Medicaid B and C services.
  28. Trillium had previously declined extensions for 1st Aid/CPR trainings with the reasoning that Red Cross was still offering the classes. All Red Cross classes are on-line only now. Could Trillium reconsider either allowing us to do classes by Zoom OR allowing an exemption if someone's certification is due to expire.
    Trillium would allow online certifications from the American Red Cross in whatever online platform/avenue the Red Cross is utilizing. Trillium has not denied this request-we are still waiting for this requirement to be waived, which must come from Secretary Cohen. We have requested consideration of this request, but in the interim, the recommendation would be to seek online certification.
  29. Do I/DD staff need to also put COVID screenings of the client as part of their note/grids that mental health staff do?
    Documentation of screenings is not required at this time.
  30. Can they confirm that their Appendix K reporting form is ONLY for the flexibilities that were approved contingent on a case-by-case approval?
    Please see Network Communication Bulletin 062 for information on how Trillium is tracking on the Innovations waiver flexibilities available under Appendix K.
  31. Flexibility form - The Trillium appendix K reporting form reads as needing to be completed only for those flexibility that require case-by-case approval (per Appendix K), whereas other MCOs are asking for details about every flexibility that is being utilized. Confirmation blanket form per member is ok?
    Please see Network Communication Bulletin 062 for information on how Trillium is tracking on the Innovations waiver flexibilities available under Appendix K.
  32. Retainer – for documentation of daily notes – do we have to na each goal that would have been run, or ok to do a blanket notation this billing note is specific to CV IW Retainer?
    Provider agencies and EOR(s) shall maintain documentation (as usual) via the required service documentation grid by entering COVID-19 on the Grid with QP signature/EOR signature and date. It is sufficient to enter COVID-19 or a blanket statement regarding COVID-19 into the grid.
  33. Tela CLS – code/rate differentiation for telephonic vs. 2 way video (or the ILOS for that matter)?
    There is not differentiation in the rate.
  34. Tela CLS – can it be based on staff and member? Meaning, if staff a still goes in-home, and staff b can’t go in-home, but can tele on alternate days, is that allowable?
    Innovations Waiver can be provided via telehealth where applicable and appropriate for the member. The member should be able to participate and have their needs met through telehealth modalities. Telehealth would not be appropriate for those members who require a significant level of support to engage (i.e. physical prompts, hand over hand assistance, complete physical assistance, or other comparable levels of support). Additional guidance from DHHS regarding the use of telehealth for Innovations Waiver Services will be forthcoming.
  35. Modifiers – confirming, use CR for EVERY App K flex? Even if CLS is still in home or CLS tele?
    CR Modifiers are intended to reflect the use of the flexibilities available through Innovations Waiver services in Appendix K. Please utilize this modifier anytime those flexibilities available in Appendix K are being utilized.
  36. My question is in regard to billing Residential services. We have a few AFL clients who have authorizations that expire on 5/30 and we have been advised by the care coordinators not to submit a TAR. They stated that due to COVID 19 flexibilities no TAR is required to request annual services to continue to provide and bill for the most appropriate services that best meet the clients needs. My question is how do we bill after the auth expires without getting denials? Is the CR modifier added to all the services that we are currently billing for?
    All Innovations Waiver Services are no prior authorization at this time. This flexibility is afforded through Appendix K. Please utilize the CR modifier for flexibilities utilized through Appendix K when billing Innovations Wavier services.
  37. Where will face-to-face service resumption fit in with the Governor's extended Stay At Home order for resumption?
    Trillium will be holding a reopening meeting specific to IDD day services on May 15 be on the look out for registration
  38. CLS - 4.1 or 3.23? Which date for new rate? SE CR XU rate is $3.10/unit – is that right? There is no rate for CN CR. DHHS guidance was CRXU. Trillium is using XUCR - which one?
    1.
    The rate enhancement for CLS is effective 04/01/20 and the COVID rate listing has been updated to reflect this date.
    2. The rate for SE XU CR has been updated to reflect the rate of $7.75/unit on the COVID rate listing.
    3. Community Networking, H2015CR is the same rate as Trillium's standard floor rate for that service
    4. Trillium will be using the modifier order of XU-CR. Modifiers must be billed in the same order as it shows in Provider Direct. If not, claims will deny.
    Please be aware that the XU modifier is in the process of being added to all provider contracts. Additional communication will be forthcoming once the XU modifier is ready for use.
  39. I have sdarched the Trillium Network Communications but I do not see a bulletin that Residential Level III should have this statement on the residential note. Network Communication #073 has this statement for other services but not residential. "All service notes during this time must include the following statement: This service was delivered during the COVID-19 State of Emergency requiring social distancing."
    This statement should be included anytime services are provided using the CR modifier. This acknowledges to auditors in the future that there were special circumstances in place.
  40. I don't see the answers for last weeks I/DD and SU sessions on your website under Trillium Covid 19 FAQ
    We posted the answers to the questions that were submitted through the smartsheet link.
  41. In regards to the retainer services being billed- Will Trillium reimburse providers at 100% of total amount being billed? Some MCO's are stating a different percentage rate being reimbursed.
    Trillium will reimburse providers at 100% of the standard floor rate for the retainer payment services.
  42. If someone has applied for unemployment, but has not been awarded unemployment, can they cancel their unemployment claim and receive retainer payments instead?
    Please consult with unemployment with regards to how unemployment will function if cancelled. In general, retainer payments can not be given at the same time that the direct care worker receives unemployment.
  43. May an Innovations client receive in home services and telehealth? ie. CLS in home on one day and Asserive Engagement on a different day?
    No member who has Medicaid should be receiving Assertive Engagement, this is a state funded service only and by virtue of being on the waiver the member has Medicaid. If the provider is unable to deliver services under the flexibilities allowed under Appendix K the member may receive Disaster Outreach in order to ensure continuity of care. Providers should not switch between CLS and Disaster Outreach, one or the other should be delivered. The member may choose not to participate in services daily.
  44. If we are still providing face 2 face service for waiver ind do we need to bill that on flex form or continue billing as usual?
    CR Modifiers are intended to reflect the use of the flexibilities available through Innovations Waiver services in Appendix K. Please utilize this modifier when billing for services anytime the flexibilities available in Appendix K are being utilized. Please refer to Network Communication Bulletin 062 to ensure that flexibilities are utilized or requested as outlined in that bulletin.
  45. Just to clarify, first aid/cpr is the onlt training that has to be current?
    You will need to seek online recertification for services that fall outside of Innovations waiver, the flexibility allowed in Appendix K only covers Innovations Services
  46. I submitted this last week to the email, but don't think I heard it answered this morning (my apologies if you did answer this) -- for the 5% increase in CLS, it says we have to use it for OT or hazard pay, but we are having to pay an increased amount for PPE. Can we use the increased rate to purchase PPE?
    The 5% rate enhancement for CLS is intended to support providers who have to pay overtime for staff when other staff cannot work due to COVID-19, or due to paying direct care staff a higher rate for hazard pay during this event It is Trillium's expectation that this enhancement will be directly passed down to direct care staff.
  47. Due to the fact that the newest codes were released so late. If provider billed the increase without the cr modifier and were paid will provider be required to replace/rebill those claims?
    Yes, providers will need to submit replacement claims with the CR modifier to receive the enhanced rates for those services that were increased.
  48. According to the new rate sheet for Supported Employment under innovations the rate went to 3.10 per unit when it was 7.75 prior to covid 19. Is this a Typo?
    The rate for Supported Employment has been updated to reflect the rate of $7.75/unit on the COVID rate listing.
  49. What is the order of modifiers for retainer payment? We have seen CR XU, but it appears Trillium is using XU CR on the rate sheet. Network communication 80. Also, the start date on the rate sheet is 3/10. Is that correct or is it 3/13?
    Trillium is using the modifier order of XU-CR. Modifiers must be billed in the same order as it shows in Provider Direct. If the order is not correct, claims will deny. Please be aware that the XU modifier is in the process of being added to all provider contracts. Additional communication will be forthcoming once the XU modifier is ready for use. The use of the XU modifier will be effective 3/13/20.
  50. How do we bill for Residential services for our AFL clients when their current Auth expires? Care coordinators have advised us not to submit a new TAR for the upcoming plan year for two of our clients where their current auth expires 5/31.
    All Innovations Waiver Services are no prior authorization at this time. This flexibility is afforded through Appendix K. Please utilize the CR modifier for flexibilities utilized in Appendix K when billing Innovations Wavier services.
  51. Is it being discussed that services previously billed at the lower rate before new codes and rates were released? Will Trillium be able to re-adjudicate the claims for the higher rate without the claims being rebilled/replaced?
    Providers will need to submit replacement claims with the CR modifier to receive the enhanced rates for those services that were increased.
  52. If we have not requested a retainer pyament for several weeks while waiting for clarification on the issue of looking like we may have been double billing, can we submit the retianer payment smarsheet to go back further than last week?
    Yes
  53. Can you please clarify those modifiers for retainer payment billing AND regular service provision with flexibility on location?
    Please utilize the CR modifier for flexibilities utilized in Appendix K when billing Innovations Wavier services. For retainer payments specifically, Trillium is using the modifier order of XU-CR. Modifiers must be billed in the same order as it shows in Provider Direct. Please be aware that the XU modifier is in the process of being added to all provider contracts. Additional communication will be forthcoming once the XU modifier is ready for use.
  54. Do we need to bill using a specific modifier when billing for retainer payments? What if the service we are billing doesn't have an enhanced rate?
    1. Trillium is using the modifier order of XU-CR. Modifiers must be billed in the same order as it shows in Provider Direct. If the order is not correct, claims will deny. Please be aware that the XU modifier is in the process of being added to all provider contracts. Additional communication will be forthcoming once the XU modifier is ready for use.
    2. Trillium will reimburse providers at 100% of the standard floor rate for the retainer payment services.
  55. When billing retainer payments do we bill with the enhanced rate?
    Trillium will reimburse providers at 100% of the standard floor rate for the retainer payment services.
  56. Will there be any assistance from Trillium to re adjudicate claims for services retroactive 3/10/20, without the providers rebill/ replacing every individual claim. Possibly a bulk replacements/adjustments through Trillium Claims?
    If regular service codes were billed until the COVID-19 service codes with the CR modifier and/or GT CR modifiers were added to the provider’s contract, then replacement claims will have to be submitted correcting the service code. Providers will also need to submit replacement claims with the appropriate modifier to receive the enhanced rates for those services that were increased.
  57. Have anyone dicussed issues with transporting consumers to the facilities once the shelter in place ends. How would we transport safely?
    We need additional information to respond to this question. Where are you transporting individuals? Are you transporting in a group or individually?
  58. Confirming, a member can receive tele SE one day and an ILOS (DO/AE) another based on needs correct? Just not both the same day?
    No, if you are delivering the in lieu of services, disaster outreach or assertive engagement, the member may NOT receive other periodic services during that time.
  59. I have gone to the Q&A section on the website and the PDF is a 16 page document and it has been a 16 page document for several weeks and it is not getting longer. Am I at the right place?
    On Trillium's Coronavirus Information page under the Provider button we have Provider FAQ during COVID-19 link, the update date is listed. Our Communication's Department will also add the published date to the FAQ document.
  60. Can the 15% Supported Employment rate increase be used as hazard pay for staff that are continuing to provide Supported Employment in the home or is it only for staff that are continuing to provide SE in the community (store, restaurant, etc.)?
    The increase is intended to assist providers with compensating direct care staff for the risk that they are experiencing by being out in the community, so therefore providing the service in the home does not apply for the rate increase. Please reference Network Communications Bulletin #082.
  61. Can we use CLS one day and CLS telehealth the next day based upon client/staff needs?
    Innovations Waiver may only be provided using telehealth provision when it is clinically indicated for the individual, the individual needs only verbal cueing or prompting to complete tasks and there are no other health and safety issues. Please refer Special Bulletin COVID #75 on the DHHS website for specific instructions regarding the provision of Innovations waiver services through telehealth modalities.
  62. Did you say that we can bill the enhanced rate as of 3-10-2020?
    The 5% enhanced rate for the CLS service (T2013TFCR and T2013TFHQCR) may be used between dates of service of April 1, 2020 to June 30, 2020 and may be extended or lifted early by Trillium.
    *Please note this effective date was incorrect on the Trillium COVID-19 Rate Table and has now been corrected to April 1, 2020. We apologize for the mistake.*
  63. Do we have to bill with the CR modifier for services that don't have an ehanced rate?
    For services that have allowable flexibilities as a result of COVID-19, the CR modifier must be appended to all claims, whether at the standard or enhanced rate.
  64. Can a RAP choose to work all CLS hours in the ISP (80 hrs) if they are still allowing staff to work respite or do they other staff need to be providing some of the CLS?
    The flexibilities available under Appendix K allow Relatives as Provider to exceed the limits previously set on the amount of services that a Relative as Provider could provide.
  65. "the", not "they"- is the waiver flexibility for RAP providing more than 56 hours only applicable if they are not allowing additional staff to work in the home?
    No
  66. With the addition of XU modifier, can retainer notes be billed with the XU modifier from this point forward or do all retainer notes previously billed without the XU have to be replaced in provider direct?
    Trillium is not requiring providers to file replacement claims for services previously billed for retainer payments using just the CR modifier. Moving forward providers should submit the claims for retainer payments using the XU and CR Modifier. Please see Network Communication Bulletin 084 for additional information.
  67. Did you say we can bill the CLS individual enhanced rate as of 3-10-2020?
    The 5% enhanced rate for the CLS service (T2013TFCR and T2013TFHQCR) may be used between dates of service of April 1, 2020 to June 30, 2020 and may be extended or lifted early by Trillium.
    *Please note this effective date was incorrect on the Trillium COVID-19 Rate Table and has now been corrected to April 1, 2020. We apologize for the mistake.*
  68. For those staff receiving retainer funds, do they have to be the ones completing notes, or can the staff complete, while the family does not wish to receive services? or can the administration*, not staff
    Provider agencies and EOR(s) shall maintain documentation (as usual) via the required service documentation grid by entering COVID-19 on the grid with the QP signature/EOR signature and date.
  69. What was the answer for the March 10th date for billing enhanced CLS?
    The 5% enhanced rate for the CLS service (T2013TFCR and T2013TFHQCR) may be used between dates of service of April 1, 2020 to June 30, 2020 and may be extended or lifted early by Trillium.
    *Please note this effective date was incorrect on the Trillium COVID-19 Rate Table and has now been corrected to April 1, 2020. We apologize for the mistake.*
  70. If XU is in contract in PD can it be used now or is XU not active for billing at this point?
    If the XUCR modifier is available in PD, then it can be billed now. Additional XUCR codes are in the process of being added to AFL provider contracts and Trillium's expectation is to have those available for billing by 5/7/2020.
  71. I have been denied for enhanced rate for CLS during March
    The 5% enhanced rate for the CLS service (T2013TFCR and T2013TFHQCR) may be used between dates of service of April 1, 2020 to June 30, 2020 and may be extended or lifted early by Trillium.
    *Please note this effective date was incorrect on the Trillium COVID-19 Rate Table and has now been corrected to April 1, 2020. We apologize for the mistake.*
  72. Please repeat the answer about march 10 billing date.
    The 5% enhanced rate for the CLS service (T2013TFCR and T2013TFHQCR) may be used between dates of service of April 1, 2020 to June 30, 2020 and may be extended or lifted early by Trillium.
    *Please note this effective date was incorrect on the Trillium COVID-19 Rate Table and has now been corrected to April 1, 2020. We apologize for the mistake.*
  73. Are the providers required to pay retainier fee?
    If a provider submit billing for retainer payments, it is expected that the provider will make retainer payment to the direct care workers. Trillium encourages providers to utilize retainer payments to help retain direct care workers and maintain the workforce for provider agencies.
  74. Just to quadruple check - we use the CR code for Retainer payments until the XU code becomes available, correct?
    If the XUCR modifier is available in PD, then it can be billed now. Additional XUCR codes are in the process of being added to AFL provider contracts and Trillium's expectation is to have those available for billing by 5/7/2020.
  75. If the XU modifier code isn't available, how will we put the retainer payments claims through since it requires the XU CR modifiers?
    If the XUCR modifier is available in PD, then it can be billed now. Additional XUCR codes are in the process of being added to AFL provider contracts and Trillium's expectation is to have those available for billing by 5/7/2020.
  76. When do I use GT CR and/or CR for billing?
    GT CR is used when the service was provided via interactive two-way real-time audio-visual communication and CR is used when providing the service telephonically. These are both meant to allow for flexibilities during the COVID-19 emergency.
  77. If parent requests no staff due to Covoid and they work all the hours in the ISP can the staff still be paid retainer payments?
    Yes, the direct care worker who is no longer able to provide services can receive retainer payments.
  78. Can Trillium create a grid/excel document with all the Covid changes & flexibilities which have been implemented during the last two months by service?
    Trillium created Modifications to Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policies grid. Please refer to Network Communication Bulleting #079.
  79. Can CLFS 1 be provided in the home? If not, what is the preferred alternate service?
    In this instance, Disaster Outreach and Engagement should be provided.
  80. Will there be an increase for Community Networking services during the Covid 19 period? CN is predomitley provided to Res. Support clients some whom are level 4 with extreme behaviors, therefore having staff to provide more innovated ways to assist with coping during this shelter in place.
    Trillium is continuing to consider other services for rate enhancements due to COVID-19 and will communicate as soon as any additional ones are approved.
  81. Do Provider Agencies still need to submit Enhanced Rate Requests for Nursing Level of Care? We have a consumer with an ISP date of 7/1/2020 and typically submit for the enhanced rate the month prior.
    If it is a request that has already been approved, then additional paperwork is not required. If this is a new request, then the form would need to be submitted with a budget attached.
  82. 1. Communication bulletins have addressed extensions for CPR and NCI training. Does this apply to FIrst Aid training also?
    2: Is there an extension for PCP meetings? Some of our parents do not have the ability to do virtual meetings and phone meetings do not seem adequate.
    3: Should I assume when Governor Cooper talks about congregate settings and LTC, he is also including 6 bed group homes? Asking because of visitors and home visits Question 4: If we continue to have shortages in TP, PT and possibly meat is there any help from Trillium or the state to get needed supplies?
    1.
    Yes, the flexibility for training extends to First Aid as well
    2. There are not currently any flexibilities available to extend the person-centered plan outside of the Innovations Waiver.
    3. Executive Order #120 issues by Governor Roy Cooper applies to BH group homes.
    4. Trillium only manages behavioral health funding for our members. We are unable to control or effect changes to the supply chain for toilet, paper towels, and meat.
  83. If TARs are not required at this time how should providers ensure that the units are increased in the authorization to bill for flexibilities in Appendix K?
    Innovations Waiver services do not require authorization at this time. Therefore, your agency should be able to bill for the increased hours that the member needs during this time, as long as the appropriate modifiers are used when billing.
  84. As of May 7, 2020 retainer form is no longer required and retainer pay should be billed using XU modifier, should retainer pay for dates prior to May 7, 2020 still be billed with XU modifier if not already billed?
    Yes, for any retainer payment billing that has not yet been completed, please utilize the XU and CR modifiers. Please see Network Communication Bulletin 084 for additional information regarding retainer payment billing.
  85. Confirming CLS rate date - effective 4.1 or 3.13? We've heard both and only see 4.1 written, which is fine. Just trying to get our billing straight.
    The effective date for CLS to be billed at the standard rate with flexibilities related to COVID-19 is 3/13/20. The 5% enhanced rate is effective 4/1/20.
  86. So let me make sure I understand the use of modifiers, Supported Living has an additional CR, Community Living and Supports has an additional CR, Staff Retention Services have an additional XUCR, but other services, (Community Networking and Supported Employment) have no modifiers unless they are billed as staff retention services.
    CR (catastrophe/disaster related) modifier is to be used at any time for COVID flexibilities defined in code definitions including with telephonic codes. GT CR modifier is to be used when the service was provided via interactive two-way real-time audio-visual communication and COVID flexibilities. XU CR modifier is to be used when billing retainer payments.
  87. Is it possible to use this format to walk through the new Q/A format that has just been rolled out on the website?
    Yes
  88. The written communication says that the rate increase for CLS (T2013 TF) starts 4/1, however we have heard verbally that the rate increase starts 3/10. Can you verify the start date of the CLS enhanced rate?
    The flexibilities related to COVID-19 for the CLS service are retroactive to 3/13/20. Trillium implemented a temporary 5% rate enhancement that is effective between the dates of service 4/1/20 - 6/30/20.
  89. Is the XU CR modifier ready to be billed in PD as of today?
    Yes, the XU CR modifiers are available for use.
  90. I keep reading different effective dates for the rate enhancements for IAFT services and Residential Treatment II. My agency has an amendment that states effective 3/23.
    Trillium implemented 10-30% rate enhancements on specific residential services including IAFT effective 3/23/20 through 6/30/20, and may be extended or lifted early by Trillium if necessary.
  91. Can you speak more to the extension of plans etc. You stated that only innovations were extended?
    The flexibilities available in Appendix K allow for service plans that are expiring and currently meeting an affected waiver participant’s needs, but a new person-centered plan is unable to be developed due to ongoing COVID-19 recovery efforts, the time limit to approve the plan by the last day of the birth month may be extended by 3 months after the birth month, when monthly telephonic monitoring is provided to ensure the plan continues to meet the participant’s needs. For services such as CLFS and Day Activity, there is no flexibility to extend the PCP. However, there is flexibility that allows PCPs to be implemented without signatures due to the COVID-19 crisis. If a signature is not able to be obtained, COVID-19 should be entered on the PCP.
  92. Can providers now submit claims with XU CR modifiers?
    Yes, the XU CR modifiers are available for use.
  93. Do we have to do replacement claims using the XU modifier for all retainer payments that have already been billed?
    Replacements claims are not needed for retainer payments that have already been billed.
  94. If a parent does not want services and wants to be paid during the time they have the client home with them, are we still to pay the actual staff while they cannot work.
    In the situation described, a Relative as Provider can provide services while the Direct Care Staff (who was previously providing services) can also receive retainer payments. Trillium highly encourages Provider to take advantage of the retainer payments available to Direct Care Staff to help retain their employee and prevent destabilization of the workforce that supports our members.
  95. If an individual hasn't been able to receive their Day Supports services and the family is ready to allow services in the staff home, can units that were not billed previously be utilized now which would be an increase over the weekly units in the ISP?
    Services should be provided as outlined in the member's Individual Support Plan. Any increase or change of services will need to be made by and/or approved by the member or their legally responsible person.
  96. Should the CR modifier be used with the IAFT and Residential Treatment II. This is not identified in my agency's amendment.
    Yes
  97. On the fee schedule I have it says 5.84 for CLS COVID-19 effective 3/10/2020.
    The flexibilities related to COVID-19 for the CLS service are retroactive to 3/13/20. Trillium implemented a temporary 5% rate enhancement that is effective between the dates of service 4/1/20 - 6/30/20.
  98. Code is T2013 TF CR?
    Code T2013 TF CR is for Community Living Supports (CLS)
  99. When we submit TAR for IDD services such as B3 Respite, will we use the CR modifier on the TAR?
    GT and CR modifiers do not apply to B3 Respite Services.
  100. If the staff is receiving unemployment, then are they entitled to staff retention payments?
    No, employees cannot receive retainer payments and unemployment for the same hours. Provider Agencies must implement a retainer agreement with employees who receive retainer payments. That agreement must include the following statement: “The employee who receives retainer payments will not be eligible for unemployment for the specific hours in the agreement.”
  101. Early in the meeting you stated no flexibility for PCP meetings and later said there is a 3 month extension for ISP. Please explain the difference.
    Currently, the flexibilities available in Appendix K allow for service plans that are expiring and currently meeting an affected waiver participant’s needs, but a new person-centered plan is unable to be developed due to ongoing COVID-19 recovery efforts, the time limit to approve the plan by the last day of the birth month may be extended by 3 months after the birth month, when monthly telephonic monitoring is provided to ensure the plan continues to meet the participant’s needs. For services such as CLFS and Day Activity, there is no flexibility to extend the PCP. However, there is flexibility that allows PCPs to be implemented without signatures due to the COVID-19 crisis. If a signature is not able to be obtained, COVID-19 should be entered on the PCP.
  102. We have been advised that currently no TAR's/Authorizations are needed for Innovations ISP plan renewals, revisions and provider transfers. Will TAR's/Authorizations need to be completed at a later date within those existing plan years?
    Trillium will be sure to provide technical guidance and support to Provider Agencies in collaboration with our partners at DHHS, DHB, etc. as the COVID-19 crisis comes to an end. As the COVID-19 crisis remains ongoing at this time and for the foreseeable future, there is no guidance to provide at this time.
  103. Are there any guidelines for staff hazard pay?
    It is Trillium's intention that Provider Agencies utilize to pay overtime for staff when other staff cannot work due to COVID-19, OR due to paying direct care staff a higher rate for hazard pay during the COVID-19 crisis. Please refer to your contracts for additional information and guidance on the use of rate enhancements provided during the COVID-19 crisis.
  104. Can we bill retainer payments, but not pay staff if the staff is collecting unemployment?
    No, you cannot bill for retainer payments and not pay staff retainer payments. This is fraudulent. Also, it is important to note that employees cannot receive retainer payments and unemployment for the same hours. Provider Agencies must implement a retainer agreement with employees who receive retainer payments. That agreement must include the following statement: “The employee who receives retainer payments will not be eligible for unemployment for the specific hours in the agreement.”
  105. Can providers continue to submit TARs for reauthorization for Innovations Waiver service even though they are not required right now, and if so should the modifier be included?
    Innovations Waiver services are no prior authorization at this time. TARs submitted during this time frame will not be processed at this time.
  106. Are we still submitting special rate requests every 3 months during this time?
    If a client specific rate has already been approved, then you do not need to resubmit every 3 months during the COVID-19 crisis event. Once the flexibilities have been lifted by Trillium, the normal procedure for submission and audits of the client specific rates will resume.
  107. Can you define the modifiers please? i.e. what does the CR, XU, XUCR, mean. I feel like it will stick in my head better if I understand what each means.
    CR (catastrophe/disaster related) modifier is to be used at any time for COVID flexibilities defined in code definitions including with telephonic codes. GT CR modifier is to be used when the service was provided via interactive two-way real-time audio-visual communication and COVID flexibilities. XU CR modifier is to be used when billing retainer payments.
  108. For individuals who already have enhanced rates prior to COVID, do they receive an increase in residential rates as well?
    If a client specific rate was already approved prior to the COVID-19 crisis event, the Trillium approved rate enhancement as a result of COVID-19 will be added to that rate. For details related to those updated rates, please email RATESFinance@TrilliumNC.org.
  109. Is a PCP revision, additional goals, or any other documentation required (service order, cca, TAR) in order to provide Disaster Outreach & Engagement for I/DD, in lieu of CLFS 1?
    Please document on the member’s PCP that Disaster Outreach was delivered during the COVID-19 event. We are not requiring a new Service Order or new signature on the PCP. Documentations should be consistent with the regular document you would use under normal operations.
  110. When we use the retainer payment flexibility for staff, will the amount of flexibility payment billed go against the person served's annual budget amount or is that a completely separate funding? If it is attached to the annual budget of the person served it could indicate another flexibility being used of going over the annual budget limit.
    Retainer payments will not count towards a member's individual budget.
  111. The rate enhancement was only for the primary service which we are not allowed to provide. How is this beneficial to providers?
    Please review Urgent Notification dated 03/23/20 for fully contracted services and Network Communication Bulleting #078 for SCAs if you received an addendum based on these 2 communications you will use the CR to receive the enhanced rate.
  112. Is staff eligible for retainer payment if work is missed due to lack of child care/public schools closed?
    Yes, staff are eligible for retainer payments when they are unable to work due to the shelter in place that was put in place due to the COVID-19 emergency and the reason for the staff not working is directly related to COVID-19.
  113. I know Kenneth was "taking it back", but trying to confirm retainer clarifications if you all have heard. Issue one - if staff was placed with other client, are they eligible for balance hours (e.g. they picked up T/R, but not M/W/F, retainer ok for MWF?
    Retainer payments are available for those staff who are unable to work due to the shelter in place that was implemented in response to the COVID-19 crisis as long as the reason for the staff not working is directly related to COVID-19.
  114. Issue 2 - retainer - what about additional hours in balance of above schedule (in other words, the TR hours are longer than typical bc of "summer/cv hours"
    Yes, retainer payments can cover an increase in hours during the summer break.
  115. I understand that primary staff can get retainer payments if the services are provided by a relative as provider, but what if another non-relative staff is taking over those hours? Is the original primary staff eligible for retainer payments?
    Retainer payments are available for those staff who are unable to work due to the shelter in place that was implemented in response to the COVID-19 crisis as long as the reason for the staff not working is directly related to COVID-19.
  116. Can retainer payments be made to staff if another staff, not a family member, is providing the service?
    Retainer payments are available for those staff who are unable to work due to the shelter in place that was implemented in response to the COVID-19 crisis as long as the reason for the staff not working is directly related to COVID-19.
  117. When is regular training expected to resume (med adm, EBPI?NCI, lst aid cpr, etc.)
    Flexibilities available in Appendix K allow for provider agencies to receive an extension of 90 days for existing staff and new relative as providers on background checks and CPR/First Aid and NCI Training. DHHS is requesting additional time be allowed for extensions within the second amendment of Appendix K. It is important to note that the second amendment to Appendix K is NOT approved. Trillium will communicate as soon as possible if/when this flexibility is approved. Providers should note that there are multiple options for being able to take these trainings online. Trillium encourages providers to research and access these options during the COVID-19 crisis.
  118. Do we still need to submit authorizations for personal assistance and B3 services?
    Yes, B3 and state funded services are capitated and, therefore, continue to require prior authorization.
  119. Do we submit TARs for authorizations as usual or are authorizations automatically extended? (adding for CLFS)
    TARs will still need to be submitted for CLFS.
  120. What should we do when we are receiving denials?
    If you have questions on your claim denials, please reach out to your assigned Claims Specialist. The list of Specialist are located on Trillium’s website at www.trilliumhealthresources.org under For Providers tab, goes to Documents & Forms Under the Section –> Claims/Finance Info & Forms -> Provider Claims Split
  121. After the 90 days, are provider agencies expected to resume regular in-person training. The 90 days will be up sometime in June.
    Flexibilities available in Appendix K allow for provider agencies to receive an extension of 90 days for existing staff and new relative as providers on background checks and CPR/First Aid and NCI Training. DHHS is requesting additional time be allowed for extensions within the second amendment of Appendix K. It is important to note that the second amendment to Appendix K is NOT approved. Trillium will communicate as soon as possible if/when this flexibility is approved. Providers should note that there are multiple options for being able to take these trainings online. Trillium encourages providers to research and access these options during the COVID-19 crisis.
  122. If we are receiving a brand new referral for Innovation services to our agency during this time shouldn't we complete a TAR since we have never had an authorization for the individual before?
    Initial requests for Innovations Waiver services do not require a TAR as these services are no prior authorization for concurrent and initial authorizations. Provider agencies should be sure to coordinate with the member's treatment team to ensure that appropriate services and supports are implemented during the COVID-19 crisis.
  123. What if it is not safe to complete the traiings and the 90 day is up?
    Flexibilities available in Appendix K allow for provider agencies to receive an extension of 90 days for existing staff and new relative as providers on background checks and CPR/First Aid and NCI Training. DHHS is requesting additional time be allowed for extensions within the second amendment of Appendix K. It is important to note that the second amendment to Appendix K is NOT approved. Trillium will communicate as soon as possible if/when this flexibility is approved. Providers should note that there are multiple options for being able to take these trainings online. Trillium encourages providers to research and access these options during the COVID-19 crisis.
  124. Will we be required to enter authorizations at a later time for Innovations consumers who we currently are not required to do so? Due to no prior authorization
    No
  125. Will Trillium consider reducing the requirement for educational documentation needed to support day treatment services? Documentation from the school IEP/504, behavior reports, teacher notes, progress reports, etc. from the school.
    No, Trillium will not waive the educational documents required per Clinical Coverage Policy. The school system is still delivering educations services to children. DHHS has not allowed this flexibility.
  126. For ISP extensions (when ISP is extended for new plan year) do we bill regular services, or need to add CR modifier to all our billing?
    The CR modifier should be billed. The CR Modifier should be utilized anytime the flexibilities in Appendix K are utilized.
  127. Can you show how to get to the rate sheet again?
    The Trillium COVID rate sheet can be found on our website under For Providers tab ->Billing Codes and Rates-> COVID-19 Rate Table FY2019-2020.
  128. If a member has a special rate for Supportive Living, do they get the 30% increase in their service rate?
    If a client specific rate was already approved prior to the COVID-19 crisis event, the Trillium approved rate enhancement as a result of COVID-19 will be added to that rate. For details related to those updated rates, please email RATESFinance@TrilliumNC.org.
  129. Where can we find those options for NCI and Red Cross?
    On NC DHHS website they have a specific page devoted to NC Interventions (NCI) Training Program and provided an email address to ask questions related to NCI. Also Red Cross Trainings are available on the Red Cross website: https://www.redcross.org/take-a-class.
  130. If we already submitted TARs and got approved for service without CR modifier (over a month ago), and we've billed it already that way, will we have to submit replacement claims for ALL that billing? If revisions were for COVID reasons?
    For any COVID flexibilities or rate enhancements, replacement claims will be needed using the appropriate modifier.
  131. For ISP extensions (when a new plan is extended without new ISP), do we bill regular services, or do we need to add CR modifier to all our billing?
    Yes. For Innovations waiver services, the CR Modifier should be utilized anytime a flexibility is available through Appendix K (such as the extension of an annual ISP) is being utilized.
  132. In the presentation regarding re-opening of Day Programs, there is language that providers make available PPE for staff and members. Does this mean we must supply masks/ face coverings for each participating member, or can we require the member to provide their own?
    Trillium is not dictating who is responsible for obtaining the face masks/coverings, only that one is required to attend the Day Support program.
  133. Is 03/23/2020 the start date of the increased/hazard rate for CLFS 5?
    Yes, Trillium enhanced rates for levels 1 - 5 of CLFS by 30% effective 3/23/2020.
  134. What criteria/guidelines will be applied to consider modification to current re-opening requirements (10 in a building regardless of sq footage) for CLFS/ADVP programs moving forward?
    The requirements for re-opening were developed using the current guidance and recommendations put in place by Governor Roy Cooper, the Department of Health and Human Services, and the CDC. Until those recommendations or guidance changes, Trillium will continue to use those as the requirements for Day Support Programs to be able to re-open.
  135. The only question we had was if a parent wanted to take an innovation consumer home from his residential group home placement during COVID-19, can we use the retainer pay for residential?
    Yes, retainer payments are available for Residential Support services.
  136. Are day support programs allowed to open? We have one member through Trillium and she has not been able to attend our day program. When will she be able to come to the program?
    Trillium is implementing specific guidance and requirements for Day Support programs to be able to open. Please contact NetworkMonitoring@TrilliumNC.org.
  137. Does the salary information in the Loan Forgiveness Application apply to 2019 or 01/01/2020 to 02/29/2020? Also on the Loan Forgiveness Application, on the Schedule A Worksheet, what is entered under the category entiled "Salary/Hourly Wage Reduction"?
    Trillium Health Resources does not manage the Loan Forgiveness Program available through the CARES Act and is unable to provide guidance on how to complete this form.
  138. It was just stated that CLS rate was increased by 30% isn't that 15%?
    The 30% increased referenced in the Provider Q&A was for CLFS (Community Living Facilities and Supports) NOT CLS (Community Living and Supports).
  139. Which services are getting the 20% rate increase?
    Trillium has updated the COVID rate table to reflect the 20% increase for basic benefit outpatient services and this can be found on the website at: For Providers->Billing Codes and Rates->COVID 19 Rate Table FY 2019-2020.
  140. Question re PPE and Day program - It is a requirement in order to reopen the Day Program to wear a mask- Since we do work with individuals with sensitivities what is Trillium's standard if we have a client who wants to attend but cant keep a mask on?
    If a member is not able to keep a mask on, then it is not appropriate and safe for the member to attend the Day Support program.
  141. For an indivual receiving PA: Is it possible for the PCP and consents to be extended because we cannot get signatures. We have not seen anything for IPRS or B3 funded services for what to do in these situations, only Innovations.
    For state-funded and B3 services, providers are able to enter COVID-19 on the signature page when they are unable to obtain signatures for annual PCPs.
  142. Where do we stand with State approval of the new alternative services for CLFS and ADVP?
    Update as of 6/10/20: The In Lieu of Service definition has been approved. Trillium is working to add this service to contracts now. This service is for CLFS and is Medicaid only.
  143. We billed retainer pay with CR modifier but form that was linked to Bulletin #62 was removed before we could enter the services as retainer. Can form be reactivated or do we need to enter replacement claims in PD with XU CR modifier?
    Providers no longer have to utilize the Smartsheet to document retainer payments. Providers are able to bill for retainer payments using the XU and CR modifiers as outlined in their contract. Trillium is not asking providers who have billed the CR modifier (prior to the addition of the XU modifier) for retainer payments to file replacement claims. For additional information regarding retainer payments, please see Network Communication Bulletin 084.
  144. Can you repeat the answer to the previous question related to members wearing masks in day programs for individuals with intellectual disabiliites?
    If a member is not able to keep a mask on, then it is not appropriate and safe for the member to attend the Day Support program.
  145. We are using the already approved alternative services for CLFS and ADVP, but our members are being called and told about services that can be done in the home and are asking when that may start.
    Trillium has assigned Care Managers to each member receiving Day Services regardless of funding source. This is to provide members and families with education regarding their options for alternate services during the COVID-19 crisis.
  146. On 5/26 an email came out saying the reimbursement rates would be increased by 20%. When I look on the website, the COVID-19 rate schedule has increases of 15%. Can I get clarification on what the rates really are?
    Trillium has updated the COVID rate table to reflect the 20% increase for basic benefit outpatient services and this can be found on the website at: For Providers->Billing Codes and Rates->COVID 19 Rate Table FY 2019-2020.
  147. Will the increase we received for Innovations Waiver services due to COVID-19 continue after June 30, 2020.
    We are hopeful that we can extend the rate increases beyond, but are waiting to hear back from the State on that.
  148. Will all members signing up for the 2 meals a day be selected to receive those meals, and where will the meals be delivered? Do the meals have to be delivered to their home, or can they be delivered at another regular location during the delivery of service?
    Trillium is currently identifying the interest in meal delivery for our members through a Smartsheet link in Network Communication Bulletin 089. It is important to note that completing this form does NOT mean that the member will qualify for this service. Trillium is continuing to work with our partners at Department of Health and Human Services to clearly understand the rules that will apply to this service. We continue to work to ensure that this service is made available as soon as possible to our members.
  149. Has there been any determination made as to whether the enhanced rates for Innovations services (CLS, Supported Living, Residential Supports) to assist with overtime/hazard pay, will end or be continue beyond June 30, 2020?
    We are hopeful that we can extend the rate increases beyond, but are waiting to hear back from the State on that.
  150. I just want to verify that we do not need to rebill retainer payments with the XU/CR modifiers if we had already billed. If we do a replacement claim using the modifiers, will that cause an issue?
    Retainer payments submitted prior to the implementation of the XU CR modifier do not need to have replacement claims submitted to add the XU CR modifier.
  151. For Group Homes, visitors are not allowed in GH at this time to minimize interactions with others and decrease chances of exposure to the virus. Does this mean that residents should continue to stay at home and avoid community outings? Should Day Supports and Community Networking continue to be done in the GH and not the community? For Group Homes, is the Day Support or Community Networking direct care provider still not allowed to provide the Residential Services in the Same Day (this has changed for AFLs)?
    1. The stay at home order issued by Governor Roy Cooper remains in effect. Trips into the community should not be made unnecessarily. Providers should ensure staff and members practice the 3 W's (Wear, Wash, & Wait) that are recommended by NC DHHS. This includes wearing a mask, washing or sanitizing hands frequently, and waiting six feet apart. If members are unable to follow the 3 W's, then it would likely not be appropriate and safe for them to make trips into the community.
    2. Trillium encourages providers to utilize the flexibilities available to them and our members to help ensure the safety of our members and staff at provider agencies. This includes allowing HCBS services such as Community Networking and Day Supports to be provided in alternate locations. Day Supports services should only be provided at the Day Support facility after providers have worked with our Trillium Network department to submit their re-opening plan and have gotten approval to move forward with re-opening.
    3. Day Supports/Community Networking and Residential Supports can NOT be provided at the same time of day. However, those services are able to be provided on the same day. That has not changed with the implementation of flexibilities.
    It is important to note that cases of COVID-19 continue to rise and in some instances the metrics are greater (for example the number of hospitalizations) than when the COVID-19 crisis first began to climax in North Carolina. We are asking our providers to exercise all due caution when it comes to the provision of services to our members.
  152. Parents have been asking if there is any information on a possible date when visitors will be allowed at Group Homes again?
    Not at this time. DHHS is in the process of developing guidance that will apply to Innovations Waiver group homes. In the meantime, we encourage our providers to implement creative ways to help families connect with their loved ones.
  153. If AFL's are now able to provide periodic services, who actually bills for the periodic service if the client gets their periodic services from a different agency than who their AFL is through?
    It is important to note that although this flexibility has come available, this is NOT a flexibility that AFL providers can unilaterally implement. In order to implement this flexibility, the treatment team (at minimum the member and/or legally responsible person) would need to meet to discuss the needs of the member and whether or not the member would benefit from this flexibility. It is the decision of the member and/or the legally responsible person to make this change to the services and supports that the member is receiving. Once that decision is made, it should be communicated to all treatment team members to prevent any confusion and/or duplication of services between providers. Use of this flexibility should be documented using the Smartsheet link in Network Communication Bulletin 089. Providers should also be sure to check their contract to ensure that they are contracted for the services that they will be providing. If/when contracted for those services, the AFL Provider is able to begin providing and billing for services as all Innovations waiver services are no prior authorization at this time.
  154. Would like to know why AFL providers did not get 30% hazardous pay due to covid-19.
    Finance will reach out to this provider directly.
  155. If a consumer has CLS hours in the am and CN in the afternoon; but mother requests only those 3 CLS hours be done and not the CN due to Covid-19 and she feels that is too long for someone to be in her home is the staff still able to receive the retainer payment?
    Yes, direct care staff are able to receive retainer payments for the hours that they are unable to work.
  156. Have the COVID-19 rates been extended beyond June 30, 2020?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. Please reference Urgent Notification "Rate Enhancement on Services" and Network Communication Bulletin 078 for details.
  157. If a consumer has CLS hours in the am and CN in the afternoon; but mother requests only those 3 CLS hours be done and not the CN due to Covid-19 and she feels that is too long for someone to be in her home is the staff still able to receive the retainer payment?
    Yes, direct care staff are able to receive retainer payments for the hours that they are unable to work.
  158. Have the COVID-19 rates been extended beyond June 30, 2020?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. Please reference Urgent Notification "Rate Enhancement on Services" and Network Communication Bulletin 078 for details.
  159. Bulletin 95 talks about enhanced rate for Day Supports, is it for Individual and Group? I looked on the covid rate sheet but don't see an increase.
    Innovations Waiver Day Supports, service code T2021 will be enhanced for both individual and group. Trillium is still working on updating contracts and the COVID rate table at this time.
  160. Why are Group homes with 10 or less people at all times being held to the same standards/restrictions as nursing homes where more people with more risk factors live?
    This is not a Trillium decision, these decisions are made at the state and/or federal level (ICFs). The state has a bi-weekly provider call where you can submit your questions about group home visitation.
  161. Will retainer pay continue for those staff members affected by changes due to COVID-19?
    At this time, retainer payments will remain in place until further notice from DHHS or DHB.
  162. Residential Level II - Will no prior auth and re-authorizations continue past 6/30/2020 or are TARs required 7/1?
    At this time, the Appendix K flexibilities (including no prior authorization) are continuing until further notice from DHHS or DHB.
  163. We are thankful to Trillium for these enhancements. Will this occur automatically or do we need to readjudicate and re-bill at the higher rates? Do we need to indicate which services? For instance our SCS staff are salaried. For staff we have not paid higher rates to we would retro a lump sum to them in this scenario. Is that within the vision or do we just skip? Also to clarify, enhanced rates for CLS (IW) end today? Only enhanced July rates for IDD providers are residential and CLS at this time outside of this bulletin.
    Thank you for that feedback. Trillium is still in the process of updating rates and codes in the contracts and will send out a NCB once all codes and rates are updated in contracts so that replacement claims may be submitted. Yes, for those employees providing services that will be retroactive for dates of service from March 1, 2020 to June 30, 2020 a lump sum to reimburse them is acceptable.
    The CLS service will follow the same timeline as the residential services rate enhancements due to COVID-19 and all terms and conditions remain in place until further notice
  164. Can Retainer Payments be paused, to allow staff to return to work, but if the situation calls for the staff to stop working, could retainer payments resume?
    Yes, as long as the retainer payments continue to meet the criteria set forth.
  165. I have not seen anything that addresses the 5% increase we received for CLS due to COVID-19. Will that increase remain in place until July 31, 2020?
    The CLS service will follow the same timeline as the residential services rate enhancements due to COVID-19 and all terms and conditions remain in place until further notice.
  166. Checking to verify that for all services provided in person (IDD, B3, outpatient, etc) there should be documentation to reflect that the beneficiary was screened to determine if the beneficiary has symptoms of COVID-19 or had close contact with a person diagnosed with COVID-19 in the past 14 days.
    Yes
  167. Network Communication Bulletin #95 states that there is a 12% rate increase for Innovation Service, including Home and Community Supports. Home and Community Supports is not an Innovation Waiver service.
    The specific service is H2015 (Community Networking Individual and Group) that will be enhanced by 12% which falls under the service definition of Innovations Waiver - Home and Community Supports.
  168. How long do we have as an agency to recert current staff's CPR and CPI if they expire during this time being that we are now set back to phase 2?
    Existing staff are able to continue to provide services for 90 days when CPR and/or NCI re-certifications have lapsed. To document the use of this flexibility, please see the link to the Smartsheet link form in Network Communication Bulletin 089. DHHS is working with CMS for additional flexibility in this area, but it has not been provided at this time.
  169. Have the enhanced rates been approved past 6/30/20?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. Please reference Urgent Notification "Rate Enhancement on Services" and NCB #78 for details.
  170. Has the service "Disaster Outreach and Engagement" been extended past 6/30/20?
    Yes, this service is valid for the duration of the state of emergency.
  171. A parent of an Innovations Waiver Participant wants to become a Relative As Provider but does not have a High School Diploma or GED. Can they be a RAP or are they not eligible because they do not meet minimum educational requirement to be a provider?
    The parent has to meet the minimum educational requirements. Those are not waived as a part of the Appendix K flexibilities at this time.
  172. The mass gathering limit of 10 people in a single indoor space does not apply to child care facilities, day camp, and overnight camps per the Executive Order FAQs from the Governor; would this not also encompass and include programs such as Day Support programs, Day Activity Programs, and Social Rec?
    It does not. It is important to note that intellectual/developmental disability populations are not served typically at child care facilities. Intellectual/developmental disability populations are populations that often have unique conditions and needs that place them at greater risk which constitutes the need to put protections in place to support these populations. Please do not forget that these measures are in place to protect and SAVE the lives of our members, direct care staff, and ALL of the people that they come into contact with. We encourage our providers to use the flexibilities in place to help support our members, direct care staff, and all others to remain safe during the COVID-19 crisis.
  173. I understand that at this point that only Residential rates increase have been extended but we are trying to avoid stopping the rate increases if Trillium may continue the hazard rate increase for CLS in near future. Any updates on this?
    The CLS service will follow the same timeline as the residential services rate enhancements due to COVID-19 and all terms and conditions remain in place until further notice.
  174. Are there any changes in day program restrictions, specifically the limit of 10 people in a building?
    There are no changes to this requirement at this time. Trillium will continue to monitor NC DHHS, Executive Orders and CDC guidelines to ensure members remain safe and healthy.
  175. Is there a rate increase for Community Guide/Community Navigator?
    For specific information related to COVID-19 rate enhancements, please reference the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  176. How long will retainer pay be extended for, sorry if already answered, my audio was not working?
    Retainer payments are a part of Appendix K flexibilities. Appendix K has been approved until 3/12/21 and will remain in effect until that time or such a time as DHHS or DHB determines that the flexibilities will end. Trillium will be sure to communicate any changes made to the timeline of flexibilities as soon as possible.
  177. Hi! The DHHS bulletin (JCB 368) regarding CPR / First Aid and NCI came out yesterday. Is the smart form still required since the DHHS has been published?
    Yes. DHHS requires Trillium to track on the Appendix K Flexibilities including staff who are utilizing an extension on their CPR and NCI training certifications.
  178. RAP can also be extended to AFL provider if that person is not a realtive or guardian but is the provider of choice correct? I believe that was the definition from DHHS but wanted to be sure.
    Relatives as Provider are defined as individuals related by blood or marriage to the waiver beneficiary. The Relative as Provider must meet the definition of relative.
  179. When will the rate increase go into effect for Community Guide/Community Navigator?
    Trillium released Network Communication Bulletin 103 on July 17th which addresses this question, which is that all additional services that received rate increases have been updated in contracts.
  180. Did you say that there is a rate increase for Community Networking (Innovations Waiver)?
    For specific information related to COVID-19 rate enhancements, please reference the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  181. For annual consents for services, can we also type unable to get signatures due to COVID-19 or do we have to have all consents signed?
    Yes you can accept verbal consent and type in the clinician/provider name. Documentation should include the provider received verbal consent from member, when, and during COVID-19.
    References:
    a. Allow for verbal agreements in lieu of written signatures in every instance when acting otherwise would prohibit continuation of service. Letter allows a provider to obtain verbal agreements in lieu of the written signatures. Documentation shall include that the provider has received verbal consent/agreement from the member. (https://files.nc.gov/covid/documents/guidance/healthcare/COVID-Letter-to-LME-MCOs-03-19-2020.docx.pdf):
    b. Currently, information in the PCP manual (https://files.nc.gov/ncdhhs/documents/files/pcp-instructionmanual2-3-10.pdf) and information in APSM 45-2 only outlines signature and date requirements for the person centered planning. I have been unable to locate any specifics as it pertains to the person centered planning signature requirements for a clinician under the person responsible section. I have emailed medicaid.covid19@dhhs.nc.gov to post this question to ensure specifics are located.
    c. Trillium Website: https://www.trilliumhealthresources.org/news-events-training/coronaviru…
    The following is Eastpointe's guidelines for obtaining plan signatures. Will this suffice for Trillium? Eastpointe will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person's (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf. The provider should document whether such consent was made via telephone, email or other means (e.g. through a window).
    According to the Records Management and Documentation Manual Guidance outlined in the APSM 45-2. Chapter 4-7 If the provider who developed the PCP is unable to obtain the signature of the legally responsible person, there shall be documentation on the signature page and/or in a service note, reflecting due diligence in the efforts to obtain the signature and documentation stating why the signature could not be obtained. When this occurs, there shall be ongoing attempts to obtain the signature as soon as possible.
    Providers will need to write on the signature line for member/LRP unable to obtain signature due to COVID-19. Also, the provider will need to document in the member’s chart/record that the member provided verbal consent.
  182. If a Trillium person is being served out of area, should the provider follow the guidance of the host MCO on day program guidelines or Trillium?
    Host MCO.
  183. Will Innovations Day Supports Individual/Group get a rate increase/hazard pay?
    For specific information related to COVID-19 rate enhancements, please reference the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  184. Not a question was just a follow up to the 90 day extension asked earlier. According to the joint Bulletin, existing certifications that are held by staff are extended and valid through Sept 30. Does this apply only to prevention or to both parts?
    Per JCB368, the guidance in the bulletin applies to "staff who are currently certified or seeking initial certification in the prevention components of restrictive intervention curricula." Please refer to JCB368 for full details on the guidance provided therein.
  185. So, CLFS and YP770 continue with the 30% increase?
    Yes, that is correct, until further notice.
  186. In a situation where an AFL or RAP could provide an additional service per flexibility such as Day supports, can this service be provided if not currently in the provider's contract?
    No, the service must be included in the provider's contract.
  187. How much is the rate increase for DSI and DSG? When will we be able to bill the increased rate?
    For specific information related to COVID-19 rate enhancements, please reference the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  188. Sorry, we’re having trouble locating the smart sheet to document flexibilities regarding CPR expiration extensions. Can you please point us towards that bulletin or the location on the website?
    To document the use of the Appendix K flexibility that allows direct care staff to receive a 90 day extension for CPR and NCI certifications that are expiring, please refer to Network Communication Bulletin 089. Within the bulletin, please utilize the "Appendix K Flexibility Requests/Tracking" link provided. The link is also provided here for your convenience: Appendix K Flexibility Requests/Tracking
  189. How much is increase for dsi and dsg?
    For specific information related to COVID-19 rate enhancements, please reference the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  190. When can we start billing new rate for dsi and dsg?
    For specific information related to COVID-19 rate enhancements, please reference the COVID-19 Rate Table on Trillium's website: For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021
  191. Is AFL increase staying since we are still in phase 2?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. Please reference Urgent Notification "Rate Enhancement on Services" and Network Communication Bulletin 078 for details.
  192. If a provider failed to submit a smart sheet for retainer pay, but billed with CR modifier and was paid, is it necessary to complete now? If so, where can it be found?
    Providers do not have to complete a Smartsheet to document retainer payments. However, it is important to note that to bill retainer payments providers should be using the XU CR modifiers in addition to the service code. If billing for retainer payments was completed using just the CR modifier prior to 5/6/2020, replacement claims will not be needed. If billed after 5/6/2020 without the XU CR modifier, replacement claims will be needed.
  193. When or under what circumstances will building occupancy rates compared to square footage instead of a group of 10 maximum staff/consumers be applied to service providers who can reopen safely with social distancing?
    This is largely dependent upon the Phase of re-opening per Governor's order. Please submit a re-opening plan for consideration.
  194. Was the enhanced rate extended beyond June 30th?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. Please reference Urgent Notification "Rate Enhancement on Services" and Network Communication Bulletin 078 for details.
  195. Currently Innovations Waiver Services, do not allow billable services to cover transportation to/from school. Due to COVID, would flexibilities be granted to allow staff to bill transportation time for client to/from school? Would flexibilities also be allowed for State Funded/B3 Services (i.e B3 Respite and Developmental Therapy)?
    No, flexibilities are not available for Innovations waiver, B3, or state-funded services to provide transportation to and from the school. Transportation is the responsibility of the school system.
  196. I just wanted to clarify that the rate enhancement for AFL providers still remains in effect until further notice per Network Communication Bulletin 103.
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. Please reference Urgent Notification "Rate Enhancement on Services and Network Communication Bulletin 078 for details.
  197. Not as much a question but a suggestion based on my experience as a consultant with several provider agencies and the parent/guardian of a member who receives home and community-based supports. DSPs who support individuals with IDD are not receiving the support and oversight they need to follow safety recommendations to reduce risk of spreading COVID-19 to members and their families. For example, one member I serve has a DSP who is symptomatic but has not been tested because last time she was exposed to someone who tested positive, she had to pay for the test herself (even though the exposure was through a co-worker at the same agency). The DSP was aware of free test-sites but stated that she has two other jobs and can't wait in line all day at a CVS. I know Trillium is trying to track cases and exposures; I propose that Trillium create a COVID-19 Testing Navigator position. The C-19 TN can arrange testing (provide a mobile testing service?), then follow-up with results and perhaps even recommendations for quarantine or at least when it is safe to return to work. So much variability across provider agencies regarding how to manage and prevent the spread of COVID-19. Some have strict policies in place and monitor closely. Others leave it up to parents/guardians to make day-to-day decisions and are not monitoring symptoms or requiring any communication about potential exposures. Help! We can do better together!
    Thank you for your observations and feedback! We will consider this as we continue to work with our providers to help ensure the safety of our providers and members throughout the COVID-19 pandemic.
  198. With the COVID-19 pandemic, can there be an increase of hours for b3 respite or is it still limited to the annual amount?
    Limits on the benefit plan for B3 services remain in effect.
  199. Will there be a COVID related flexibility implemented allowing Habilitative services such as DT, PA and CLS to be provided during school hours for families that are choosing not to send their kids to school for upcoming school year due to COVID?
    No. There are NOT flexibilities that allow Innovations Waiver, B3, or state-funded services to be provided during the time that school is in session whether in-person or virtual learning.
  200. Will there be a flexibility implemented for providers to be able to apply for State funded services such as DT, PA and respite for a client without a current Psychological Evaluation? We have a waiting list of families in need or services but we cannot submit a request because they cannot obtain a current Evaluation. Would Trillium consider waiving this requirement for at least the next year?
    Documentation for initial requests is required to confirm the presence of a diagnosis of Intellectual and/or Developmental Disability and other requirements of the service. To assist with finding a psychologist to complete psychological evaluation, please contact our Call Center by dialing 1-877-685-2415.
  201. Will CL&S service be available to school age children during regular school hours if the child is not returning to the regular classroom, but will be learning from home? If so can the parent provide the service?
    No. There are NOT flexibilities that allow Innovations waiver, B3, or state-funded services to be provided during the time that school is in session whether in-person or virtual learning.
  202. We want to be sure that the increased rates should be provided to direct care staff even when they are not using virtual means or similar flexibilities and the service is being provided following other safety guidelines, such as practicing social distancing, wearing mask, gloves, etc. when providing the services which are approved for the temporary increase.
    For the rate enhancements that are still in place for Residential Services, the expectation is that the additional rate be used for providers who need to pay overtime for staff when other staff cannot work due to COVID-19, OR due to paying direct care staff a higher rate for hazard pay during this event. It is not necessarily intended for only virtual means of providing the service.
    Please reference Urgent Notification "Rate Enhancement on Services" dated March 23, and Network Communication Bulletin 078 for details.
  203. Do RAP's still have 90 days to complete their initial training or is there an extension to the 90 day training?
    New Relative as Providers only have one extension of 90 days to obtain their initial trainings.
  204. Will habilitative services be able to be provided during the original traditional school hours 8a-3p; although many members are recieving virtual services for a few hours?
    There are NOT flexibilities that allow Innovations waiver, B3, or state-funded services to be provided during the time that school is in session whether in-person or virtual learning.
  205. Can residents of a 6 bed group home go to barbershops or salons to get their hair cut? Can the group home invite a hairstylist to come to the home and cut resident's hair on an exterior patio while wearing masks?
    Trillium cannot make these decisions for providers. Providers should adhere to their current policies and procedures which should have been developed using the guidance issued by the CDC and DHHS in addition to considerations that should be taken based upon the specific member needs in the residential settings.
  206. Is Trillium still restricting programs to no more than 10 people per building?
    At this time, the requirement of 10 people indoors remains in place. Executive Order #155 clarified this mandate remains in place and that mass gatherings are limited to 10 people indoors and 25 people outdoors.
  207. Are the enhanced rates and retainer payments going to continue? Any idea how long?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice.Please reference Urgent Notification "Rate Enhancement on Services" dated March 23, and Network Communication Bulletin 078 for details. There is also no end date at this time for Retainer Payments.
  208. Will Trillium re-instate the enhanced service rates for our day services (Innovations, CLFS) so that we can continue to pay hazard pay to our direct support staff?
    For residential services that were enhanced due to COVID-19, all terms and conditions remain in place until further notice. .Please reference Urgent Notification "Rate Enhancement on Services" dated March 23, and Network Communication Bulletin 078 for details.
    If you are not being paid for the residential services at the enhanced rate, please email RATESFinance@TrilliumNC.org with examples so that we can look into this for you.
  209. Hi, We were informed that the 5% rate enhancement for Innovations Waiver service codes T2013 TF and T2013 HQ were extended beyond June 30th, 2020. Could you confirm this and/or direct us toward the communication bulletin that contains this information?
    The CLS service will follow the same timeline as the residential services rate enhancements due to COVID-19 and all terms and conditions remain in place until further notice.
  210. Day Program can only have 10 people but can operate at 50%. Can you please clarify?
    At this time, the requirement of 10 people in the indoors remains in place. Executive Order #155 clarified this mandate remains in place and that mass gatherings are limited to 10 people indoors and 25 people outdoors.
  211. What is Trillium's understanding of how school hours are defined for the purpose of ensuring there is not overlap with Innovations services and school hours? Will they be defined as hours of scheduled direct or virtual instruction and activities as assigned for each student or as the traditional school hours for each school?
    Please see Joint Communication Bulletin #372 for clarification on the provision of Medicaid and state-funded services during the school year.
  212. Can you please clarify if the previous guidance of no more than 10 people (staff and members total) can be inside a building at one time even if the individuals are more than 6 feet apart and the square footage allows for this that a program cannot reopen. Can you please specify which statute is being referred to for this guidance/restriction in the Governor's Executive Order?
    The initial Executive Order that provided this mandate was Executive Order #120. Executive Order #155 clarified this mandate remains in place and that mass gatherings are limited to 10 people indoors and 25 people outdoors.
  213. A while back in one of the meetings information was shared that a new service was going to be made available (we think CLS) and that the definition would be coming out on DHHS web site. We believe that it may have been an alternative service for non-innovations medicaid. Are there any updates on this service?
    All approved Trillium definitions are posted on DHHS's website. Link HERE for ease of access.
  214. Will the 2 daily meals be available for the members currently on the registry of unmet needs receiving B3 Respite service awaiting Innovations Waiver services for several years now?
    Home Delivered Meals is currently a service that is only available to Innovations Waiver Members and B3 Innovations Waiver Services.
  215. Could we be provided with information regarding how to bill for the Appendix K flexibility? Are there modifers that should be utilized when billing for the flexibility?
    In general, any flexibilities utilized through Appendix K should be billed with the regular service code and a CR modifier. If a service is provided via telehealth (please see Special Bulletin #75 & #76 for a list of services that can be provided through telehealth), the service should be billed with a CR and GT modifier. To bill for retainer payments, providers should bill the regular service code with a XU and CR modifier.
  216. I was told the 30% increase in rate was being decreased to 15% effective July 1, yet you are saying there is no change. Please clarify.
    ICF rates that were increased by 30% due to COVID-19 will be reduced by 15% effective with DOS 7/1/2020 and until further notice.
  217. Will there be a flexibility implemented to waive the Psychological requirement for reauthorizing services for State funded clients whose current evaluation is expired? it has been extremely challenging trying to find a provider with availability to complete them without long wait periods and families are beginning to lose services when they can't obtain a current psychological in time for their reauthorization. Some UM Reviewers have approved authorizations for a few months but unfortunately it hasn't been enough time and the families are still struggling to obtain an updated evaluation for their child due to waiting list.
    Documentation for ongoing service requests is required to ensure that the member continues to meet the requirement for a particular service. Please be sure to document efforts made to obtain a psychological evaluation when requesting services. To assist with finding a psychologist to complete psychological evaluation, please contact our Call Center by dialing 1-877-685-2415.
  218. A student/member that is considered complete virtual learning (Plan C) and their active virtual learning times are specific times, for example: 9a-10:30a and 1p-2p, services are not to be billed during this active instruction? Part 2 of this question: If this is correct, schedule from the teacher/school is appropriate documentation to support?
    For the first question, that is correct. Innovations, (b)(3), and state-funded services cannot be provided at the same time as educational services/supports (i.e. virtual meetings, pre-recorded meetings/instructions, homework/assignments, etc.). For the second question, documentation from the school administrator or teacher can be used to support the member's school schedule and why services were provided at certain times of the day.
  219. When will the Q&A page be updated? Last updated June 22, 2020.
    The Provider Questions and Answers were Revised on August 20, 2020; we will be adding more questions and answers to the Providers Q&A COVID-19 page by August 31, 2020.
  220. Is there an age requirement for state funded Assertive Engagement in lieu of services?
    Assertive Engagement is covered under child target pop and normal age restrictions apply.
  221. I see that T2025 U1CR has an enhanced rate of $196 from 3/1-6/30/20. Does that only apply to the clients who do not have authorizations? Or does that apply to all clients from March to June?
    The enhanced rate of $196 would apply for the service provided with COVID flexibilities for dates of service 3/1/2020-6/30/2020 no matter if an authorization was obtained or not as T2025 U1 CR is currently NPA.
  222. We have a parent to request that the staff TRY and return to provide services for 30 hours per week, member is authorized for 84 per week; Will the staff per able to receive retainer payment for the 54 hours not worked?
    Yes, retainer payments can be provided for the difference in hours between services that are currently being provided and what was authorized in the ISP.
  223. How long has hazard pay been extended, for all services?
    For a listing of current COVID-19 enhanced rates, please visit our website, under For Providers>Billing Codes & Rates>COVID-19 Rate Table FY 2019-2021.
  224. What was the source of the 30% increase given to ICF Providers effective 3/23/2020 and does this disqualify us for applying for the additional relief funding due by the end of August?
    The source was additional Medicaid funding specifically for ICF/IID facilities. The rate increases do not disqualify providers from applying for other COVID-19 related relief funds.
  225. We have an employee that has been exposed to a positive COVID-19 person. He is being quarantined for the prescribed period. Under these circumstances he is eligible for retainer payments. Can we then bill those same services for him as the XUCR and then also bill the same services for the staff that actually provided them as substitute staff?
    Provider needs to check their contract to ensure that they are using the correct modifiers for retainer payments.
  226. Where can we find the service definitions for in lieu of services, assertive engagement and disaster outreach for IDD clients?
    NC DHHS: COVID-19 and Behavioral Health
  227. An agency has stopped paying their staff and placed them on a leave of absence because the parent/guardian does not want their child in the day program. The parent/guardian is getting paid for the day program services. Would the employee qualify for the retainer pay?
    Yes, when direct support staff are unable to work as a result of COVID-19, they are eligible to receive retainer payments.
  228. If retainer payments have been extended, why have some agencies stopped paying their employees, placed them on a personal leave of absence and suggested that they apply for unemployment if they are prepared to work but the parents have refused services because they are getting paid to provide the service?
    At this time, Trillium has not received direction from the Department of Health and Human Services to change retainer payments. We will be sure to communicate any changes made to retainer payments as soon as any direction is received from the Department of Health and Human Services. We cannot speculate on the actions taken by other providers.