04/22/2025
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
Update - Extension of Telehealth Services for Risk Adjustment
Congress has further extended the COVID-19 public health emergency (PHE) flexibilities that were in place for Medicare plans through September 30, 2025 for telehealth services. This policy allows:
- Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through September 30, 2025.
- There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through September 30, 2025.
- Telehealth services can be provided by all eligible Medicare providers through September 30, 2025 and acceptable for Risk Adjustment Hierarchical Condition Categories (HCC) gap closure. Physicians and practitioners must use 2-way, interactive, audio-video technology to deliver Medicare telehealth services.
- Detailed information can be found at HERE.
If you have any questions regarding this update, please contact the HAP Risk Adjustment Education Team at hccgapclosure@hap.org.
Reminder – Model of Care Required Training
HAP Medicare Complete Duals (HMO D-SNP) & HAP Medicare Complete Assist (PPO D-SNP)
A Dual Eligible Special Needs Plan, or D-SNP is a special type of Medicare Advantage HMO or PPO plan. It provides health benefits to members who qualify for Medicare and are eligible for Medicaid services in their state. These members:
- Often have special health care needs such as chronic conditions.
- Have an income below the federal poverty line and receive extra help from the government to help pay for their health care costs, including health insurance premiums and prescription drugs.
- Are often transient, meaning they do not have a permanent residence and may stay with family members who can help care for them. Some may live in an institutionalized care facility.
Model of Care Training Requirement – Who Needs to Take It
Per The Centers for Medicare & Medicaid Services contracted and non-contracted providers who see HAP Medicare Duals (HMO D-SNP) and HAP Medicare Complete Assist (PPO D-SNP) beneficiaries on a regular basis are required to take our model of care training initially and annually. There are two ways to take our model of care training.
Keep Provider Information Updated in NPPES
It’s important to ensure your data in the National Plan & Provider Enumeration System (NPPES) is accurate. The Centers for Medicare & Medicaid Services (CMS) is encouraging health plans to use NPPES as a resource for online provider directories. By using NPPES database for provider directories, we could decrease the frequency we contact you for this information.
To verify your information, log in at the NPPES website. When reviewing, pay close attention to:
- Provider name
- Mailing address
- Telephone and fax numbers
- Specialty
- Taxonomy
Be sure to remove any practice locations no longer in use and only include addresses where:
- You practice
- You actively see patients
- Patients can call and make an appointment
Reminder! You can submit demographic updates directly to HAP via our Provider Change Form.