July 2015

Read our July 2015 issue of Provider News.

From the Chief Medical Officer, Karen Boudreau, MD

During the summer it seems as if many businesses and indeed entire industries enter a more relaxed period, with the pace of work slower than during the rest of the year. That’s certainly not the case for anyone working in health care.

As you’ll see in this installment of Provider News, BMC HealthNet Plan continues to work with the state to ensure that MassHealth recipients who are required to do so, submit new applications for health benefits this year in order for the state to determine if they still qualify for coverage. Those who do not reapply will lose their coverage.

As a provider, this can affect your practice since loss of MassHealth eligibility means loss of BMC HealthNet Plan coverage. This is why I encourage you to speak with your MassHealth patients and urge them to reapply if they haven’t yet done so. Please see the article for details on how they can complete the process.

This e-newsletter also covers the topic of the opioid abuse crisis with an article containing relevant information about how you can work with your patients for whom you’ve prescribed opioid painkillers and those who may have addictions to them. Given how devastating and far reaching this crisis has become, the more you can educate yourself, the more successful you’re likely to be.

If you’re a PCP, you also know what a challenge it can be to treat patients who have behavioral health issues. Fortunately you’ll find information in this e-newsletter about a specially designed toolkit you can access to assist you with your efforts, as well as an Antidepressant Medication Management Outreach Program.

Again, I urge you to contact your MassHealth patients to ensure that, if they have been contacted by MassHealth, they reapply for coverage. They’ll be grateful that you reached out and helped ensure that they’d continue having health care coverage.

Karen Boudreau, MD
Chief Medical Officer

Many MassHealth Recipients Must Reapply This Year or Lose Their Coverage

States must review Medicaid eligibility every 12 months as required by the Affordable Care Act. This spring MassHealth reviewed the eligibility of 500,000 members, and many thousands more will be required to apply this summer. Those who are required to apply but fail to do so will lose their MassHealth coverage.

This past spring we performed extensive member outreach to support this effort. Yet in times like these our members often look to their providers for guidance. That’s why it’s so important to speak with your MassHealth patients and urge them to complete the application process if they’ve been contacted by MassHealth to do so. For those patients and for you, it is important that they do not lose their health coverage.

We will make available to you lists of your BMC HealthNet Plan patients who are eligible for renewal. You’ll be able to access the lists through the provider portal; we’ll email you when those lists have been uploaded. We’ll also email you a toolkit containing materials that you can share with your BMC HealthNet Plan patients encouraging them to renew their MassHealth enrollment.

The fastest way to reapply for coverage is online through MAhealthconnector.org, but members may also apply using paper applications, in person at an Enrollment Assister, or through the MassHealth Customer Service Center at 800-841-2900 (800-497-4648 for the hearing impaired).

The renewal process for the remaining 500,000 MassHealth members will be similar and will take place during this summer.

How to Become a Partner in the Fight Against Opioid Addiction

On June 22, Governor Baker announced a $27-million investment in fighting the state’s opioid epidemic, which claimed more than 1,000 Massachusetts lives in 2014. In a May 19 Boston Globe article, the governor asked that physicians be “full-fledged partners” with the state in this fight. His comment was in response to a poll that asked Massachusetts residents whether their physicians had warned them about the addictive potential of prescription painkillers. Only 36% of survey respondents replied they had received this warning from their physicians, compared to 61% nationally.

As health care organizations devise their plans, our behavioral health partner, Beacon Health Strategies, has written a white paper about opioid dependence as a chronic disease and a suggested model of care to address it.

Physicians, particularly PCPs, first must recognize that opioid addiction is a chronic disease and should be treated as such, much like asthma or diabetes. To that end, there are important first steps around informed consent that practitioners can take:

  • Inform about pain management. Always discuss the risks and benefits involved in opioid use for pain management.
  • Discuss treatment options. Inform your patients of treatment options and alternatives, as well as risks and benefits, including medication-assisted therapies (e.g., methadone, buprenorphine, naltrexone).
  • Broaden the support system. Include your patient’s personal support system whenever possible and acceptable to the patient when creating a treatment plan.

Physicians can also take steps to educate themselves about the chronic nature of addiction and the services to address it.

  • Learn about the mental health services available in your community. A detox program alone is not enough; addicts must be linked to community-based services once released from these programs, and physicians need to be proactive in learning about them. Contact Beacon to learn more about these services at 781-994-7556, or go to the Massachusetts Executive Office of Health and Human Services’ website.
  • Learn ASAM’s 10 levels of care. To determine the best care setting to meet an individual’s unique needs, you should familiarize yourself with the American Society of Addiction Medicine’s 10 levels of care. These care levels allow the flexibility to deliver person-centric care in the least restrictive, most effective setting with the goal of achieving recovery in the community. This structure delineates acute care from the planned management of ongoing care. You can access training on ASAM’s 10 levels of care.
  • Receive training on administering naloxone. Naloxone is an injectable opioid antagonist (i.e., it reverses the effects of opioids and may prevent death from overdose) that first responders, particularly PCPs, should have on hand and be trained to use. For information about prescribing, view the SAMHSA’s Opioid Overdose Toolkit.

You can reach Beacon Health Strategies for more information on this or other topics of interest by calling their Provider Relations department at 781-994-7556, or sending an email to provider.relations@beaconhs.com.

Access Important Provider Reports Through Our Secure Feature at bmchp.org

A variety of provider reports, including membership panels, daily inpatient census, asthma treatment advisory and EPSDT are readily accessible through the Provider Login with your password. This secure section of our website also offers you information to help administer BMC HealthNet Plan in your office, such as member eligibility lookup, claims status inquiry and payment history.

If you need a login, please email us a request to provider.info@bmchp-wellsense.org.

Of course you can always contact your dedicated Provider Relations Consultant if you have questions about accessing your reports or want to learn more about when clinical reports are run and published for you to be able to access with your password.

Referring Patients to the Antidepressant Medication Management Member Outreach Program

Our members who recently have been prescribed antidepressants can participate in a program to improve medication adherence. The Antidepressant Medication Management Member Outreach Program is administered by Beacon Health Strategies, our behavioral health partner. Trained health coaches telephone participating members and provide therapy coaching services. Members may benefit by having a successful outcome associated with improved adherence for their newly prescribed antidepressants. As a provider, you have the opportunity to refer and enroll eligible members in this program. To qualify, the member must:

  • Be at least 18 years of age and currently eligible as a BMC HealthNet Plan member
  • Have been prescribed an antidepressant recently that was filled at a pharmacy
  • Have been diagnosed with major depression during the 60 days prior (inclusive) through 60 days after (inclusive) the date antidepressant in #2 was originally dispensed
  • Be starting a new course of prescription antidepressant treatment and thus have NOT filled a prescription for an antidepressant medication in the immediately preceding 105 days from when the new prescription was filled

Questions about this program or requests for enrollment forms may be directed to 781-994-7572 or by email at pdipamm@beaconhs.com.

Toolkit Helps PCPs with Diagnosing, Treating Patients' Behavioral Health Issues

Delivering behavioral health services in a primary care setting can help reduce the stigma and discrimination associated with mental health diagnoses. It’s also more cost-effective to treat common behavioral health disorders in primary care settings.

To help PCPs work with patients who present with behavioral health issues, Beacon Health Strategies, our behavioral health partner, has developed a toolkit to assist PCPs in diagnosing and treating mental health and substance use disorders.

This online toolkit employs well-known screening tools, as well as decision support. Condition-specific fact sheets and other patient-centered information are included for PCPs to use in educating patients about their diagnoses and taking the right steps to become and stay healthy.

The behavioral health conditions covered by the toolkit are:

  • Alcohol and other drugs
  • Anxiety
  • ADHD
  • Depression, adolescent depression and postpartum depression
  • Eating disorders
  • OCD
  • PTSD
  • Schizophrenia

The toolkit also has forms allowing PCPs to share relevant patient information with other providers, including behavioral health providers, to facilitate better care integration.

Assisting PCPs with Kids Who Have Behavioral Health Issues

The Massachusetts Child Psychiatry Access Project (MCPAP) assists PCPs with meeting the needs of young people who have behavioral health concerns by providing real-time telephone consultation with a child psychiatrist. MCPAP’s goal is to help pediatricians and family physicians to effectively meet the needs of youths with common mental health conditions such as ADHD, depression etc.

A child psychiatrist is available via MCPAP to assist with assessing, screening and diagnosing behavioral health disorders. During that phone conversation, if the psychiatrist determines that the case is complex, then he/she can provide a onetime face-to-face evaluation of the child. As part of the care coordination services, MCPAP also recommends treatment and referrals to community resources as well as helps the family schedule appointments as needed.

All MCPAP services for pediatric or family physicians begin with a telephone call to the regional team in your area:

MCPAP Regional Teams

Western Massachusetts
Bay State Medical Center

Boston/Metro Region I
Massachusetts General Hospital

Central Massachusetts
UMass Memorial Medical Center

Boston/Metro Region II
Tufts Medical Center/Boston Children's Hospital

Northeast Region
North Shore Medical Center

Southeast Region
Mclean Hospital Southeast

Please visit mcpap.com to see which region your city, town or practice is assigned.

Alert Us When You Learn of Member Ineligibility

We are obliged to notify the state when we become aware of members who are ineligible for coverage. To assist us with the process, we’re asking all our network providers to notify us as soon as possible when they learn of members’ who are not eligible and are seeking health care services. After we’re notified, we will conduct a limited investigation to confirm the information and pass it along to the state. The state is then responsible for determining the member’s eligibility.

From time to time, members become ineligible if they move out of Massachusetts. Signs that could indicate that a member may be living out of state are those who routinely request referrals to out-of-state providers, obtain services out-of-state or fill prescriptions out-of-state. We do cover out-of- state emergency services for all members as well as other services based upon an individual’s coverage. However, patterns of receiving out-of-state health care services over an extended period of time may signify that the member resides outside Massachusetts.

Please note: If you have concerns about a member who may not be eligible financially for Medicaid benefits, please notify use so we can inform the state to conduct an eligibility determination. You can alert us by one of the options below:

  • Call our Fraud Hotline: 888-411-4959
  • Email the Special Investigations Unit: FraudandAbuse@bmchp.org
  • FAX the Special Investigations Unit: 866-750-0947
  • Postal mail us:
    BMC HealthNet Plan
    ATTN: Special Investigations Unit
    Two Copley Place, Suite 600
    Boston, MA 02116

Reminder of Our Recent Postpartum Depression Screening Billing Update

It is essential that a depression screening is part of every postpartum visit (21 to 56 days after delivery).

Massachusetts regulation “105 CMR 271.000 Postpartum Depression Screening and Reporting” requires annual reporting by providers that perform or oversee screenings for Post-Partum Depression (PPD). As a result, for dates of service on or after January 1, 2015, we will accept claims with HCPCS code S3005 (Performance Measurement, Evaluation of Patient Self-Assessment, Depression) with a diagnostic range of V24 (effective October 1, 2015, ICD-10 diagnostic range of Z39).

Providers should use modifier U1 to indicate a positive PPD screen or modifier U2 to indicate a negative PPD screen.

Claims submitted with S3005 will continue to be processed as non-reimbursable and will be used for reporting purposes only. Our reimbursement policy – Obstetrical, policy number 4.105 – has been updated to include PPD screening guidelines.

Preventive Care Guidelines Endorsed

BMC HealthNet Plan has endorsed the Massachusetts Health Quality Partners Adult and Pediatric Routine Preventive Care Guidelines, which are available on our website.

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