NC HIEA July 2021 Update July 23, 2021 Important Notice for North Carolina Prescribers: STOP Act Is Fully Enacted The Strengthen Opioid Misuse Prevention (STOP) Act of 2017 (NCSL 2017-74) requires health care providers in North Carolina who prescribe controlled substances to access a patient report from the Controlled Substance Reporting System (CSRS). Providers will need to verify a patient’s prescription-fill history of controlled substances prior to writing prescriptions for targeted controlled substances as of July 7, 2021. When Do You Need to Use the System? Prior to prescribing a new targeted controlled substance to a patient, the practitioner must query the prescription history of that patient. The CSRS report should be queried and reviewed every three months that medication is prescribed. A change in medication or dose is treated as a new controlled substance and the process should start again. What Is the NC HIEA’s/NC HealthConnex Role? The option of integrating with NC HealthConnex is made available by a partnership with NCDHHS and APPRISS allowing providers the ability to access the CSRS directly within the NC HealthConnex web-based clinical portal. This integration creates a single sign-on capability that eliminates a provider’s need to log into a separate system if their electronic health record (EHR) software is not fully integrated with the CSRS. This integration is especially helpful for health care providers who do not have an EHR that is capable of integrating directly with the CSRS using the Gateway Integration application programming interface (API). End users already accessing the NC HealthConnex clinical portal who fall under the Stop Act requirements are able to view the CSRS report, along with the risk scores, without leaving the clinical portal. This simple process does not require the user to log in to another system outside of NC HealthConnex and is integrated into the clinical portal workflow. When the provider views the report, the system automatically records the access into the audit logs, providing support for CSRS use requirements in the STOP Act. How NC HealthConnex Helps Meet the Stop Act Requirement Providers should visit https://info.apprisshealth.com/ncgatewayintegrationrequest, and select NC HealthConnex in the dropdown menu as their preference for connection within the integration request form. Note: Providers need to be full participants of NC HealthConnex to choose this option. Complete the terms and conditions agreement, which will be sent by NCDHHS to you via email within 24-48 hours. There is no fee for integration with NC HealthConnex. Submit your integration request via the integration request form link on the page noted above. Ensure that you identify a primary contact (the person leading the project within your health care organization), as well as a contact for your software vendor. You must first complete all documents before NCDHHS will review your request. Wait for your request to be approved for integration with NC HealthConnex by NCDHHS. Once approved by NCDHHS, NC HIEA will be notified and will communicate with the primary contact listed on the integration request form. All providers will also need to be registered for the CSRS website. If you are not registered you can go to http://northcarolina.pmpaware.net/login, and click on "Create an account" to register. Note: Provider information used to register with the CSRS website must match the provider's information in NC HealthConnex. Your Questions Answered: NC HealthConnex June and October Deadlines Extended to January 2023 Governor Roy Cooper signed House Bill 395 (now NCSL 2021-26) into law on May 27, 2021, to allow additional time for providers to connect to the state-designated health information exchange NC HealthConnex, among other things. The North Carolina Health Information Exchange Authority (NC HIEA) Advisory Board and the North Carolina Department of Information Technology led a collaborative effort to bring additional relief to health care providers who have been on the front lines of the COVID-19 pandemic. Extending the deadline until January 2023 will allow additional time for health care providers to complete their technical onboarding process without being out of compliance with the HIE Act. Please note that there are more than 5,000 facilities in onboarding at this time. Providers should continue to connect as we have no guarantees of additional extensions and, as noted below, the General Assembly is requiring compliance reports by March 1, 2022. Among other changes to the HIE Act, the NC HIEA Advisory Board has been tasked with developing final recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Additionally, the NC HIEA has been directed to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards, shall assist the NC HIEA with contact information and addresses for providers and entities. Additional Changes and Additions to the HIE Act Per NSCL 2021-26 (HB395 Bill Analysis): Section 1 provides that the N.C. Department of Information Technology; Department of State Treasurer, State Health Plan Division; and N.C. Department of Health and Human Services, Division of Health Benefits; have an affirmative duty to facilitate and support participation by covered entities in the Statewide Health Information Exchange Network. Section 2 allows the N.C. Department of Health and Human Services, if authorized by the NC HIEA, to submit data on behalf of Prepaid Health Plans and local management entities/managed care organizations (LME/MCOs). The section also extends connection deadlines as follows: Extends the connection deadline for most providers of Medicaid and State-funded health care services, and affiliated entities, until January 1, 2023 (currently October 1, 2021). Extends the connection deadline for physicians who perform procedures at ambulatory surgical centers, dentists, psychiatrists, and the State Laboratory of Public Health until January 1, 2023 (currently June 1, 2021). Extends the connection deadline for pharmacies and State health care facilities operated under the Secretary of the Department of Health and Human Services (State psychiatric hospitals, developmental centers, alcohol and drug treatment centers, neuro-medical treatment center, and residential programs) until January 1, 2023 (currently June 1, 2021). Sections 2 and 4 remove ambulatory surgical centers, as defined in G.S. 131E-146, from the requirements to submit demographic and clinical data but require a physician who performs a procedure at the ambulatory surgical center to be connected to the HIE Network and to submit the data. Section 5 prohibits balance billing when an in-network provider or entity with the State Health Plan for Teachers and State Employees does not connect to the HIE Network. The section specifically provides that under the State Health Plan an in-network provider or entity who renders health care services, including prescription drugs and durable medical equipment, and who is not connected to the HIE Network, is prohibited from billing the State Health Plan or a Plan member more than either party would be billed if the provider was connected to the HIE Network. Note: Providers participating in the State Health Plan network should reach out to the State Health Plan with questions regarding this provision at BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. Section 6 prohibits the NC HIEA from fulfilling requests for electronic health information from an individual, individual's personal representative, or an individual or entity purporting to act on an individual's behalf and requires the Authority to provide educational materials on accessing this information from other sources. Section 7(a) requires the Health Information Exchange Advisory Board to submit recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Section 7(b) requires the HIE Authority to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards shall assist the NC HIEA with contact information and addresses for providers and entities. Frequently Asked Questions Q. If my health care organization has completed a participation agreement but does not yet have a “live” connection, should I request an extension of the deadline to January 1, 2023? Is there a form to fill out? A. No forms or additional applications are required. Signing a participation agreement and actively engaging in the onboarding process with your technical vendor demonstrates a good-faith effort to meet the extended deadline of January 1, 2023. This extension of time allows the large queue of health care providers in active onboarding to complete the connection process. Please continue your active efforts to complete onboarding. Connecting to NC HealthConnex can take up 12 months, depending on your organization’s electronic health records software. There are no guarantees of additional time extensions to statutory deadlines, and a report of providers who have not connected is due to the General Assembly in March 2022. Q. Does the January 1, 2023, deadline automatically extend to all health care providers who had a June 1, 2020, or October 1, 2021, deadline? A. Yes. All health care providers who had an October 1, 2021, deadline now have until January 1, 2023, to meet the statutory requirement. If your health care organization has not signed a participation agreement with the NC Health Information Exchange Authority (NC HIEA), it is highly recommended to begin the process now as there are currently more than 5,000 health care facilities in onboarding. For more information, please join one of the monthly How to Connect Calls. If your organization has executed a participation agreement with the NC HIEA and is already in active onboarding, please be advised that you are expected to continue the technical integration. Failure to continue onboarding efforts will cause your organization to lose its place in the onboarding queue. If your organization has executed a participation agreement with the NC HIEA but has not started the onboarding process, be advised that the NC HealthConnex technical team will contact your organization when technical discussions are to begin with your practice. Please contact firstname.lastname@example.org with questions about your organization or if your organization needs additional guidance regarding instructions it has already received from NC HealthConnex or its technical team. Q. Does the January 1, 2023, deadline apply to local management entities/managed care organizations that had an October 1, 2021, deadline? A. No. Local management entities/managed care organizations were not included in the extension to January 1, 2023. Q. I have not completed a participation agreement with the NC HIEA. When should I begin this process now that the deadline has been moved to January 1, 2023? A. The NC HIEA encourages all providers and organizations impacted by the Health Information Exchange Act and related Session Laws passed by the General Assembly to begin the process now to initiate their good-faith effort to meet the state’s reporting requirements. Currently, more than 5,000 facilities are in onboarding, and it can take up to a year to complete the connection process. Q. My health care organization is in queue to complete onboarding. How long before we can expect to be live in production so that we can fully participate in the state’s health information exchange? A. The NC HIEA’s technical connections team is working with more than 200 disparate electronic health records vendors to build technical integrations to NC HealthConnex. Currently, more than 80 EHRs are live in production. Currently, on-premises connections take 3-4 months and cloud roll-ons take 2-4 weeks. Full participants may request expedited access to the clinical portal during the COVID-19 public health crisis to enable more informed treatment decisions at the point of care. To request access, please reach out to NC HIEA's SAS Help Desk at HIESupport@sas.com or (919) 531-2700. Q. Does the connection mandate apply to providers and organizations who do not have an electronic health record (EHR) system, but who otherwise provide services to Medicaid beneficiaries and/or other State-funded health care program beneficiaries? A. Yes. Providers and organizations that are subject to condition-of-payment connection mandate in N.C. Gen. Stat. § 90-414.4 are not exempt from the mandate because they do not presently maintain an electronic health record. To connect and submit data to NC HealthConnex, a provider or organization must have an EHR that is minimally capable of sending HL7 messages, version 2 or higher. The NC HIEA is working with more than 200 electronic health records vendors, including vendors submitting data. We encourage you to procure an EHR as soon as you are able so that you can begin the connection and onboarding processes. Connecting to NC HealthConnex can take up 12 months, depending on your EHR software. Q. If I’m an in-network provider with State Health Plan for Teachers and State Employees and decide to not connect to NC HealthConnex, will I be able to bill my patients directly to recoup payments that I would have received if I had connected to the health information exchange? A. No. An in-network provider with State Health Plan for Teachers and State Employees who renders health care services, including prescription drugs and durable medical equipment, and does not connect to NC HealthConnex, is prohibited from billing State Health Plan or a plan member more than would be billed if the provider was an NC HealthConnex Participant. See N.C. Gen. Stat. § 90-414.4(b1). Providers participating in the State Health Plan network should reach out to the State Health Plan with questions regarding this provision at BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. Q. Do updated statutory deadlines to the Statewide Health Information Exchange Act’s connection mandate affect the Hardship Extension process that the NC Department of Health and Human Services facilitates? A. Before Session Law 2021-26 extended certain providers’ NC HIEA connection deadline to January 1, 2023, the North Carolina General Assembly passed Session Law 2019-23 in June of 2019. The earlier Session Law modified the Statewide Health Information Exchange Act and gave NCDHHS the authority to grant a temporary Hardship Extension to classes of providers for whom acquiring and implementing an electronic health record (EHR) system and connecting to the HIE Network would constitute an undue hardship. The Hardship Extension delay gave certain eligible providers and practices until as late as Dec. 31, 2022, to connect to the NC HIEA. Now, pursuant to both Session Laws 2019-23 and 2021-26, the operative deadline for many providers and their organizations to connect to NC HealthConnex and submit mandated data is January 1, 2023. Providers and entities with questions about the Hardship Extension process should contract the NC DHHS Division of Health Benefits Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. Q. When should I plan to connect to NC HealthConnex now that the deadline has been extended? A. Now. The extension of the connection deadline until January 1, 2023, allows additional time for health care providers to complete their technical onboarding process without being out of compliance with the HIE Act. However, please note that there are more than 5,000 facilities in onboarding at this time. Providers should continue to work diligently to connect to NC HealthConnex. The NC HIEA will be providing the General Assembly with a compliance-related report concerning providers’ and organizations’ connection efforts by March 2022. See N.C. Gen. Stat. 90-414.1 et seq.; S.L. 2020-26 (extending deadlines for certain providers/entities till January 1, 2023; instituting changes that impact ambulatory surgical centers); S.L. 2019-81 (revising connection deadline for Prepaid Health Plans); and S.L. 2019-23 (among other things, identifying certain providers and organizations as “voluntary connections” to the NC HIEA). For information on who is currently connected to NC HealthConnex, visit the NC HealthConnex Participant Map. For providers who would like to inquire about their organization’s connection status, please email HIESupport@sas.com. For questions regarding the State Health Plan network, please contact BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. For questions regarding Medicaid, please contact Medicaid.ProviderOmbudsman@dhhs.nc.gov. All other questions may be directed to email@example.com. Need Training? The NC HIEA and North Carolina Area Health Education Centers (NC AHEC) offer a library of virtual training modules for health care providers on various NC HealthConnex services. These virtual offerings provide health care professionals with an introduction to NC HealthConnex or help brush up on NC HealthConnex knowledge. For more detailed instructions on how to use the training software, visit our Training and Resources webpage. NC*Notify Service Continues to Expand and Online Enrollment Is Open Now! As a part of the NC HealthConnex Suite of Services, the HIE offers a subscription-based notification service, NC*Notify, where providers can receive near real-time notifications as their patients seek services across the care continuum. NC HealthConnex now offers online enrollment for the notification service. The NC*Notify online enrollment form allows participants to easily begin the enrollment process. Participants will find the NC*Notify online enrollment form here. Enrollment in the latest version of NC*Notify includes new notification features and updates to the service. Based on admission, discharge and transfer data received from more than 100 participating hospitals, plus encounter data from more than 6,900 ambulatory care settings, the NC*Notify near real-time event notifications provide care teams with valuable information that spans geographic and care settings and supports state and federal efforts to focus on patient-centered care. The service is now monitoring more than three million patients for participating provider organizations. The latest version of NC*Notify includes COVID-19 lab result alerts, allowing subscribers to react to positive cases in a more timely manner. In addition to the COVID-19 lab result notifications, the new alerts that are now available include: High utilizer alert – This notification helps providers identify frequent visitors to emergency departments (two or more visits in 90 days or less) or patients at high risk for readmission (four or more admissions in 12 months). Dental alerts – Providers are alerted when patients visit the emergency department for dental care. Care team change alert – Providers are informed when a new organization has subscribed to their patient. Diabetes diagnosis alert – Providers are alerted upon a new diabetes and/or pre-diabetes diagnosis for patients they are monitoring. Chronic care management alert – Providers receive an alert when a patient meets the Centers for Medicare and Medicaid Services' chronic care management services criteria. Additionally, in March of this year the Centers for Medicare and Medicaid Services (CMS) released new notification guidelines for hospitals across North Carolina as part of the Condition of Participation (CoP) requirements for Medicare and Medicaid. NC*Notify can help hospital participants meet the CMS CoP requirements and provide timely insights for primary care, behavioral health and other community providers who are instrumental in care coordination for their patients. For more information, visit https://hiea.nc.gov/services/ncnotify. All other questions may be directed to firstname.lastname@example.org. Upcoming Events How to Connect Call Monday, July 26, 2021, at 12 p.m. To register for this call, click here. NC HealthConnex August Teletown Hall – Controlled Substance Reporting Program Wednesday, August 11, 2021, at 12 p.m. To register for the Teletown Hall, click here. In the News 5 Reasons A Digital Front Door is a Healthcare Must-Have – Healthcare leaders have seen an incredible increase in telehealth adoption over the past year alongside the continued growth of patient expectations for self-service, access, and convenience. https://hitconsultant.net CMS Plans to Expand Home Health Value-Based Purchasing Model Nationwide – The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that expands the Home Health Value-Based Purchasing Model nationwide effective Jan. 1, 2022. www.hcinnovationgroup.com Are You Up to Speed? The North Carolina Broadband Survey is designed to gather information on locations in the state without adequate internet access and speeds. The information gathered from the survey will: Provide clear data to guide investment of funds through the state’s Growing Rural Economies with Access to Technology grant program Inform research and policy recommendations Support strategic targeting of additional funding streams The survey is a collaboration between the N.C. Department of Information Technology’s Broadband Infrastructure Office and the Friday Institute for Education Innovation at NC State University. The survey takes about 5 minutes to complete and is available in both English and Spanish. Participants are encouraged to also take the optional internet speed test to connect survey data with broadband speed information. Take the survey.