PROVIDERS:

Trillium is sharing updates from the State about COVID-19 as we receive from them concerning procedural waivers, flexibilities, etc. 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 May 19, 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.

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 #62. 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 #61 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 #62 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 #62 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 #62 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 #84 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 #84 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.