Newsletter
The North Dakota Hospital Association
Taking an active leadership role in major healthcare issues
NDHA Testifies at Interim Acute Psychiatric Treatment Committee
The North Dakota legislature’s interim Acute Psychiatric Treatment Committee met in Bismarck at the State Capitol on April 5, 2022. The committee, which is made up of eight state legislators, is studying various topics relating to behavioral health, including acute psychiatric hospitalization and related step-down residential treatment. The study, which must be completed by October 1, will review options for a long-term plan and short-term options during the next two bienniums to contract with private provider acute psychiatric care facilities to provide treatment services in four or more cities in the state; workforce needs of such specific locations; and options to replace the existing State Hospital facility with one or more treatment facilities focused on forensic psychiatric evaluation and treatment.
A consultant, Renee Schulte Consulting, LLC, was hired to determine the total number of acute care beds needed in the state and to develop recommendations for private provider contracts; treatment requirements and outcome measures; locations in the state, including private and public facilities; and the future use of facilities at the State Hospital campus. The committee heard the consultant’s summary of the draft report, which included recommendations that the state build a modern and efficient state hospital with 75 to 85 beds; develop and fund short term/emergency acute psychiatric beds in critical access hospitals; codify and update the purpose of the state hospital and human service centers; create regulations defining behavioral health levels of care; improve contracts with health care providers to include the language of “no eject/no reject”; require data reporting; and maximize the use of telehealth to bolster psychiatric services in all areas.
NDHA President, Tim Blasl, testified before the committee regarding the hospital perspective on the draft report. Mr. Blasl stressed that hospitals want to be part of efforts to improve the mental health delivery system in North Dakota. He pointed out that hospitals play a critical role in providing mental health services to their communities, but it is an unfortunate fact that hospitals and their emergency departments are often the primary source of acute care services for people with mental illness.
The committee heard that NDHA members strongly support reforms to promote mental health care access, including maximizing psychiatric services through telehealth, improving data collection and analysis, and defining levels of care for mental health so that everyone knows what constitutes the highest level of acuity and only those patients go to the State Hospital. It was pointed out that the draft report does not address several areas of concern, including the long wait times for high acuity patients to be accepted at the State Hospital and the conclusion that North Dakota has the right number of inpatient psychiatric beds.
Other concerns were addressed, including accusations that hospitals are “dumping” patients. Mr. Blasl stated that we know of no North Dakota hospitals that turn away any patient who presents to their emergency room. In response to a recommendation that hospitals only admit North Dakotans to their inpatient psychiatric beds, it was pointed out that the requirements imposed by the federal Emergency Medical Treatment & Labor Act (EMTALA) require participating hospitals that offer emergency services to take all patients who come to the hospital by providing a medical screening examination, stabilization or an appropriate transfer to another medical facility where stabilization can occur - no matter which state they come from. We can’t take North Dakota patients in our emergency rooms but turn away Minnesotans as recommended by the consultant.
It was also pointed out that, to implement other recommendations in the report, there would need to be federal and state regulatory changes. The Medicare 96-hour rule for Critical Access Hospitals which limits the length of patient stays and North Dakota Administrative Code requirements for hospital psychiatric services which require, among other standards, that the physician in charge be a psychiatrist licensed in North Dakota and the nursing personnel be a separate staff who are assigned to the hospital psychiatry services are just two examples.
Challenges with workforce were also discussed. Mr. Blasl noted that we do not have enough workforce as it is even in the larger cities - particularly psychiatric nurses. And reimbursement would have to change because specialized psychiatric beds are expensive to construct in accordance with Medicare Conditions of Participation to properly care for psychiatric patients.
NDHA also submitted written comments to the Schulte Group on the draft report. NDHA will testify again at the next Acute Psychiatric Treatment Committee meeting in Bismarck on April 28. You can find the meeting agenda here and watch the committee meeting live online. A recording of the meeting will also be available after the meeting adjourns.
HRSA: Community Health Worker Training Program
The Community Health Worker Training Program is a new multiyear program from the U.S. Health Resources & Services Administration’s (HRSA) Bureau of Health Workforce focused on education and on-the-job training to build the pipeline of public health workers. This effort will support training and apprenticeship programs to help more people enter the health workforce and serve the critical role of trusted messengers to connect people to care and support, help ensure patients follow-up on their provider’s recommendations, and focus on preventive and protective factors that can improve health and well-being.
Through this program, HRSA plans to train 13,000 community health workers, increasing access to care, improving public health emergency response, and addressing the public health needs of underserved communities. The Community Health Worker Training Program builds on several other funding opportunities related to the public health workforce.
Community health workers are critically important in rural areas where services are limited. They increase access to care by providing culturally appropriate public health and prevention education, assistance in care coordination, and advocating for individuals and communities within the health and social services system. For more information on how rural communities can develop Community Health Worker programs that meet their specific needs, please visit the Rural Health Information Hub’s Rural Community Health Worker Toolkit.
Click here to apply for the Community Health Worker Training Program via grants.gov. Applications are due June 14, 2022.
North Dakota Medicaid Update: OT/PT/ST Claims
The North Dakota Medicaid program recently provided an update regarding billing for certain therapy claims.
Therapy claims (special education unit therapy claims excluded) with dates of service July 1, 2022 and after will require the ordering provider to be submitted on each claim submission.
?837P Transactions
The referring/ordering provider should be reported at the claim level in Loop 2310A for services such as diagnostic and laboratory services. To report therapy services at the claim detail line level, report the ordering provider in Loop 2420E and/or the referring provider in Loop 2420F.
When there is only one referral use code “DN – Referring Provider." Use“P3 – Primary Care Provider” in the second iteration of the loop to indicate the initial referral from the primary care provider. Use “DK –Ordering Provider” to indicate the ordering provider.
?837I Transactions
The referring provider should be reported at the claim level in Loop2310F when the referring provider is different than the attending provider. When the referring provider on a claim detail line is different than what is reported in Loop 2310F, they are reported in Loop 2420D. An ordering provider is not reported on an 837I. Use “DN – Referring Provider” to indicate the referring provider.
?Questions? Reach out to the ND Medicaid call center at 877-328-7098 or [email protected].
CMS Web Interface and CAHPS for MIPS Survey for 2022
Registration is open for the Centers for Medicare & Medicaid Services (CMS) Web Interface and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the Merit-based Incentive Payment System (MIPS) Survey for the 2022 performance period.
NOTE: Medicare Shared Savings Program Accountable Care Organizations (Shared Savings Program ACOs) don’t need to register. Shared Savings Program ACOs are automatically registered for the CMS Web Interface and CAHPS for MIPS Survey, as they’re required to meet reporting requirements for the quality performance category under the APM Performance Pathway (APP).
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How to Register
If your group, virtual group, or APM Entity (other than a Shared Savings Program ACO) would like to submit quality measures for traditional MIPS using the CMS Web Interface and/or administer the CAHPS for MIPS Survey (for traditional MIPS or the APP) for the 2022 performance period, you must register by 8 p.m. ET on June 30, 2022. You may edit or cancel your registration at any time during the registration period.
To register, please log in to the Quality Payment Program (QPP) website. You'll need to have the Security Official role in order to register your organization. Please refer to the QPP Access User Guide (ZIP) for information about obtaining a Security Official role for your organization. You can register by:
Please note the following:
HRSA to Host First National Telehealth Conference
Over the course of two days (May 16-17), public and private sector leaders will discuss best practices and lessons learned during the COVID-19 pandemic at a telehealth conference hosted by the U.S. Health Resources & Services Administration (HRSA). Topics include the role of telehealth in underserved communities, achieving health equity through improved broadband connectivity, and telehealth as a model for integrating behavioral health care during the pandemic and beyond.
Home & Community Based Services Webinar Opportunity
The North Dakota Department of Human Services is offering the following webinar:
Chore Service, Specialized Equipment and Supplies, Environmental Modification
April 28, 2022 | Noon – 12:30 p.m., Central time
?Link to meeting or join by phone at 701-328-0950, Conference ID 676 451 010#.
Chore Service, Specialized Equipment and Supplies, and Environmental Modification will provide the supports, accessibility, and equipment needed to allow individuals to live comfortably and safely in the most integrated setting.
This Webinar will provide an overview of Chore Labor Services, Specialized Equipment and Supplies, and Environmental Modification offered through Home and Community-Based Services. Presenters will review a description of these services, how they may be funded, and general eligibility requirements. Attendees will learn how these services may be utilized to support individuals in their communities
Older adults and adults with physical disabilities, family members, caregivers, guardians, and community entities are encouraged to join to learn more.
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