November 2023 Provider Newsletter

America is in the midst of an epidemic. The American Diabetes Association reports that as of 2019, 37 million individuals have diabetes, and 96 million Americans have prediabetes resulting in more deaths than breast cancer and AIDS combined.

As you know, there are different types of diabetes.

Type 1 diabetes results from the body’s inability to produce insulin resulting in an absolute insulin deficiency.
Type 2 diabetes is the most common form (accounting for 90% of cases of diabetes in the United States) manifest by an elevation of blood sugar reflecting either insulin resistance or deficiency and indicating the body’s inability to utilize insulin properly.

October 2023 Provider Newsletter

Breast Cancer awareness month aims to educate women with an understanding of breast cancer and in particular the risk factors, methods of early detection, types of breast cancer, treatment and resources available. Breast cancer is the 2nd most common cancer in women after skin cancer and is the 2nd most deadly cancer for women behind lung cancer.

September 2023 Provider Newsletter

Good cholesterol, bad cholesterol, too high a cholesterol value, dietary modifications to impact cholesterol, medications to lower cholesterol- each every day these are topics of discussion across the globe. Statistics provided by the CDC suggests that 86 million United States adults, age 20 or older, have a total cholesterol above 200 mg/dL with 25 million adults having total cholesterol levels above 240 mg/dL. Normal cholesterol range is 125mg/dl to 200 mg/dl.

Monroe Plan for Medical Care IPA August 2023 Newsletter

When we consider breast-feeding, we invariably focus upon acknowledging that breastmilk is the best source of nutrition for most infants. If we delve deeper, we may appreciate additional benefits to the mother as well as the infant and it is with this understanding that serves as a basis to encourage breast-feeding.

July 2023 Provider Newsletter

HELP YOUR PATIENTS STAY COVERED!

The “continuous enrollment condition” for Medicaid, Child Health Plus, Essential Plan, and Managed Long Term Care coverage that began in March 2020 due to the public health emergency has ended. Most New York State residents who have coverage through these products will need to renew their health insurance over the next 12 months, depending on their coverage end dates. Providers can play an important role in helping to keep their patients’ coverage without interruption.

Monroe Plan: Featured Vendor at ACAP Conference

We are excited to share that Monroe Plan’s Healthcare Services Subsidiary, MP CareSolutions, will be a featured exhibitor at the upcoming Association for Community Affiliated Plan’s (ACAP) Conference in Washington DC, June 15-16. As one of 16 select vendors, our team is looking forward to connecting, sharing our experience, and learning more about how we can best serve the 75 plus ACAP member plans. To learn more about MP CareSolutions, visit http://www.mpcaresolutions.com.

June 2023 Provider Newsletter

Help Your Patients Stay Covered!
Auto-Enrollment is Ending: Medicaid, Essential Plan, and Child Health Plus Patients Required to Renew

The “continuous enrollment condition” for Medicaid, Child Health Plus, Essential Plan, and Managed Long Term Care coverage that began in March 2020 during the onset of the COVID-19 public health emergency (PHE) has ended. The first renewal reminders have been sent to individuals for coverage ending June 30, 2023. Most New York State residents who have coverage through these products will need to renew their health insurance over the next 12 months, depending on their coverage end dates. For many of your patients who enrolled with Molina during the PHE, renewing their health insurance each year will be a new experience

May 2023 Provider Newsletter

Help Your Patients Stay Covered!
Auto-Enrollment is Ending: Medicaid, Essential Plan, and Child Health Plus Patients Required to Renew

Monroe Plan for Medical Care, along with our partner Molina Healthcare of New York, is conducting extensive educational outreach to patients across New York State who will need to renew their health insurance for the first time in 3 years!

April 2023 Provider Newsletter

A MESSAGE FROM DR. GEORGE E. MATTHEWS, CMO
APRIL IS NATIONAL MINORITY HEALTH MONTH

Over 100 years ago Booker T. Washington identified a connection between poverty and poor health. It was suggested that the improvement in an African American’s way of life was not just a consequence of education but also access to better health. Now 100 years following that observation, we are confronted with concrete evidence of the factors that impact the health of minority populations.

One example of a health inequity is that of infant health and mortality identified in black and white babies born in the United States. Black mothers are more likely to have babies with low birth weight. They are also more likely to experience loss of a baby.

March 2023 Provider Newsletter

A MESSAGE FROM DR. GEORGE E. MATTHEWS, CMO
BRAIN INJURY AWARENESS MONTH

In the United States alone, 5.3 million individuals are living with permanent brain injury related disability. 2.8 million Americans experience traumatic brain injuries in the United States every year.

An understanding of brain injury begins with defining the terminology. Acquired brain injury describes those injuries to the brain that are not congenital, hereditary, or induced by birth trauma. Acquired brain injury is further sub-classified into 2 types. Traumatic brain injury, reported to be the alteration in brain function as a result of an external force. Examples of an external force include falls, motor vehicle accidents, sports injuries/concussion, assaults. Nontraumatic brain injury include damage to the brain as a consequence of an internal factor (lack of oxygen, pressure from a tumor,

exposure to toxins). Examples of nontraumatic brain injury include stroke, tumor, infectious disease/meningitis, lack of oxygen to the brain from near drowning or heart attack.

February 2023 Provider Newsletter

A MESSAGE FROM DR. GEORGE E. MATTHEWS, CMO
CPR SAVES LIVES

On January 2, 2023, during a Monday Night Football game after making what appeared to be a routine tackle, Damar Hamlin attempted to stand up and then collapsed. He had suffered a cardiac arrest. Like millions of Americans, I was stunned to see that this football player’s condition required CPR and defibrillation. Mr. Hamlin survived this event because he promptly received that appropriate initial care, CPR followed by restoration of rhythm by defibrillation. Mr. Hamlin’s chance of survival from this catastrophic event was significantly enhanced because he was in otherwise excellent physical health with no evidence of a pre-existing cardiovascular illness.

January 2023 Provider Newsletter

A MESSAGE FROM DR. GEORGE E. MATTHEWS, CMO
New Year’s Resolution: Good Health to All

As we bid adieu to 2022 and look forward to 2023, let us reflect upon the successes and accomplishments of the past year and the challenges and opportunities that the new year affords us. It is no surprise that we have weathered yet another COVID-19 experience as well as the influenza season and a particularly concerning RSV (respiratory syncytial virus) season. Our ability to deal with the threats posed by these illnesses have allowed us to look confidently toward the future with the appreciation of what we have learned from experience and what we are better prepared for to come.

Provider Bulletins

Click here to download the Monroe Plan-YourCare IPA Laboratory 2023 Fee Schedule

Monroe-Plan-YourCare-IPA-Laboratory_Fee_Schedule-Effective-Jan-01-2023

TO: Participating Monroe Plan IPA and YourCare IPA Network Providers

FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department

DATE: December 1, 2022

SUBJECT: New York State Benefit Changes Effective 1/1/2023 for Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Essential Plan (EP), and Child Health Plus (CHP) Products

In accordance with New York State requirements, this notice is to provide updated member benefit information effective January 1, 2023, regarding the products referenced above as administered by Molina Healthcare of New York Inc.

Please note that some benefits may have limitations and if there are questions as to whether a service is covered or requires Prior Authorization, please reference the Prior Authorization tools located on the Molina website.
For additional information and a chart summary of the specific added benefits and services, please refer to the
attachment to this notice as well as visiting Molina’s website link below at:
https://www.molinahealthcare.com/providers/ny/medicaid/comm/bulletin.aspx
This notice and the updated grid will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.

As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.

Click here to review benefit changes. 

 

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers                       

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department 

DATE:            February 8, 2023 

SUBJECT:      Molina Availity Essentials Provider Portal

 

Beginning March 28, 2023, Availity Essentials will be the official secure provider portal for Molina Healthcare providers. Molina’s legacy portal will no longer be available for direct transactions. Please register on Availity to ensure that you have uninterrupted access to all your portal information, tools, and functions. 

To register visit: https://www.availity.com/molinahealthcare

 This notice and the updated grid will also be posted to the Monroe Plan website at (www.monroeplan.com)  under the IPA and Provider Services tab.

 As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information. 

 Thank you for all you do for our members and our communities at large.

 

 

 

Provider Bulletin

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers                       

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department 

DATE:            March 1, 2023 

SUBJECT:      Access and Availability Standards

 In accordance with New York State requirements, this notice is to serve as a reminder that New York State routinely completes surveillance activities to evaluate compliance with the following appointment availability standards, (Medicaid Model Contract 15.2, Appointment Availability Standards). By following the appointment availability standards established by the New York State Department of Health we can improve patient access to routine, urgent, preventive and specialty care. We also follow 24-hour access standards to measure after-hours access. 

These standards apply to  all lines of business, to learn more view our tip sheet:  Access-and-Availability-Standards_MPwebsite_TIPS_2022.pdf (monroeplan.com)

 This notice and the tip sheet will also be posted to the Monroe Plan website at (www.monroeplan.com)  under the IPA and Provider Services tab. 

As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information. 

 Thank you for all you do for our members and our communities at large.

 

 

 

 

PROVIDER BULLETIN

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department

DATE:            03/23/2023

SUBJECT:      Pharmacy Benefits Transitioning from Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program

Effective April 1, 2023, New York State Medicaid members enrolled in mainstream Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will have their pharmacy benefits transitioned from their Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program. Click the link below for information regarding the Pharmacy Benefit Transition in the October 2022 Special Edition Medicaid Update New York State Medicaid Update:October 2022 NYRx Pharmacy Benefit Transition.

Questions and Additional Information: 

Guidance for Providers NOT Enrolled in Medicaid:

  • Providers may check their enrollment status by reviewing the Medicaid Pended Provider Listing found here: Provider Verification
  • Prescribers that are not enrolled in the Fee-For-Service program must enroll, to continue serving Medicaid Managed Care members. Instructions for checking enrollment status and enrollment tips can be found on the eMedNY Provider Enrollment
  • Questions regarding the enrollment process, your enrollment status, or what you need to do to enroll, please contact providerenrollment@health.ny.gov or call the eMedNY Call Center at 1-800-343-9000
  • Enrollment policy questions should be directed to the Medicaid Pharmacy Policy

Unit by telephone at (518) 486-3209 or by email at NYRx@health.ny.gov.

Guidance for Navigating the New NYRx Pharmacy Program:

As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.

Thank you for all you do for our members and our communities at large.

Provider Relations & Network Management

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers                       

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department 

DATE:            04/03/2023 

SUBJECT:      Provider Annual Attestations

 ATTESTATION FORMS DUE MAY 1

 Each year, Medicaid managed care providers are required to complete three brief attestation forms – DO, Employee, HIV forms. These forms are a NYS Medicaid Requirement. Below is a brief description of what each form will confirm. The forms are available through the Monroe Plan Provider Portal or our Monroe Plan website. If you have not already registered for the Monroe Plan Provider Portal, you can access the portal by clicking here: Monroe Plan Provider Portal or by visiting our website: Provider Resources & Forms – Monroe Plan for Medical Care. All forms should be sent to providerrelations@monroeplan.com

If you have standard version of these forms already completed, you can submit those completed forms to providerrelations@monroeplan.com and that will satisfy this requirement.

 Below is a list of attestation forms needed and a brief description of each form. 

  • Provider Employee Attestation Form: Use this form to certify that all employees and other provider personnel are not excluded or otherwise prohibited from participating in any state or federal healthcare program. This form needs to be attested and sent to Monroe Plan yearly.
  • HIV Attestation Form: Use this form when attesting that you agree that you are an accredited HIV Provider. This form needs to be attested and sent to Monroe Plan yearly. If you are not an accredited HIV Provider, then this form can be left out of the annual attestation packet.
  • Ownership Disclosure Form: Use this form to attest disclosure of ownership and financial interest of the group or facility. This form needs to be attested and sent to Monroe Plan yearly.

 Thank you for all you do for our members and our communities at large. 

Provider Relations & Network Management

 

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department

DATE:             May 8, 2023

SUBJECT:      Provider Can Help Patients Stay Covered

Help Your Patients Keep Their Health Insurance

Medicaid, Essential Plan, Child Health Plus Benefits

Some of your patients could lose their NY State of Health Medicaid Managed Care, Child Health Plus or Essential Plan benefits if they do not complete their recertification paperwork on time. Unfortunately, your patients may not be familiar with the recertification process or how it applies to them.

We are asking for your help to boost awareness if you provide care and services to Molina members in the following plans: Molina Health Care of New York Medicaid Managed Care (MMC) Health Plan, Molina Healthcare PLUS Health Plan, Child Health Plus (CHPlus) Health Plan, or Essential Plan

Providers can play an important role in helping to keep their patients’ coverage without interruption. Please check your patients’ renewal (recert) date by going to the Molina Provider Portal (if you have not registered for the Molina provider portal, please visit this link: Molina Provider Portal and accessing the patient and eligibility details. You can also remind your patients that they will need to keep their health insurance to avoid any gaps in coverage. For more information visit: Renew My Coverage | Molina Healthcare of New York)

If members need more information they can call: Molina Healthcare at (844) 239-4911Y:711).​​​​​​​​​

Thank you for all you do for our members and our communities at large.

Provider Relations & Network Management

 

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers                       

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department 

DATE:            6/7/2023 

SUBJECT:      Required Cultural Competency Training for Participating Provider

 

Required Cultural Competency Training for Participating Providers 

The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs that can offer up to nine hours of CME credit hours. This program can be accessed at the following link: Education – Think Cultural Health (hhs.gov).

 New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement. 

Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the completed certificate to providerrelations@monroeplan.com be sure to complete this required Cultural Competency Training on or before October 1, 2023, and then annually thereafter. 

Thank you for all you do for the community at large, 

Provider Relations & Network Management

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Primary Care Providers                      
FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department 
DATE:            June 22, 2023 
SUBJECT:      GoMo Health Assists in Outreach with Patients with Gaps in Care 

GoMo Health 

As the healthcare landscape continues to change, so too has the approach to patient care. Beginning April 2023 Monroe Plan for Medical Care rolled out a personalized text messaging campaign on behalf of our providers using GoMo Health to patients with select Gaps in Care.

This targeted approach to patient engagement, using an easy-to-use platform, has proven successful in the past. Through text, your patients are encouraged to connect with you to make appointments, escalate barriers to our care navigators for assistance, and participate in the creation of a plan of care that increases their health management skills.

Breast Cancer Screening                    Behavioral Health Follow Up
Cervical Cancer Screening                 Well Child Visits
Colorectal Cancer Screening              Diabetes Testing

You may receive communication from Monroe Plan staff regarding appointments for patients OR you may receive calls from patients stating they’ve received a text message and need to schedule an appointment.

We welcome your feedback! Please reach out to Quality@monroeplan.com with any questions or comments. 

Finally, if you desire to not have your Moline Healthcare assigned patients receive these texts, please complete the attached Opt-Out Form and e-mail or fax to the contact information listed.

Thank you for all you do for the community at large,

Provider Relations & Network Management 

Participating Monroe Plan IPA and YourCare IPA Network Primary Care Providers

OPT-OUT OF IPA GAPS-in-CARE TEXTING PROGRAM to ASSIGNED PATIENTS 

Practice Name:                                                                                                                   

Practice Tax ID #:                                                                                                                                                          
Authorized Signature:                                                                                                      

Name and Title:                                                                                                                

Date:                                                                                                                                                                                   

E-Mail to:                   pfmemails@monroeplan.com                       
or 
Fax Number:             716-748-6987

TO:                  Participating Monroe Plan IPA and YourCare IPA Network Providers                       

FROM:            Monroe Plan for Medical Care and YourCare IPA Provider Relations Department 

DATE:            9/15/2023 

SUBJECT:      Required Cultural Competency Training for Participating Provider 

Required Cultural Competency Training for Participating Providers 

The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs that can offer up to nine hours of CME credit hours. This program can be accessed at the following link: Education – Think Cultural Health (hhs.gov).

 New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement. 

Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the completed certificate to providerrelations@monroeplan.com be sure to complete this required Cultural Competency Training on or before October 1, 2023, and then annually thereafter.

 

Thank you for all you do for the community at large, 

Provider Relations & Network Management

Network Compliance

Cultural Competency Training for Monroe Plan IPA Providers

Mainstream Medicaid Managed Care Providers are required to ensure the cultural competence of practice staff and to certify annual completion of New York State approved cultural competence training curriculum. The approved training, titled Think Cultural Health, offers several provider specific programs online, at no cost: https://thinkculturalhealth.hhs.gov/education. Providers and appropriate staff should complete this training in the next 12 months and annually thereafter. Once finished, please share your certificate of completion with us at providerrelations@monroeplan.com.
Be sure to review the bulletin and resource below to ensure cultural competency and compliance!

Click here to download: NYSDOH Cultural Competency Notice

Click here to download: Are You Culturally Competent?

To be sure your practice is accurately represented in Molina’s (MHNY) Provider Directories, you will want to regularly submit updated rosters to pfmemails@monroeplan.com.

Thank you for your cooperation!

Click here to download

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