Important Updates

Published October 2023

Providers from Mohawk Valley Medical Associates (MVMA) IPA share some innovative programs that have had a positive impact on their patients.

In 2020, MVMA launched Program Innovation and Excellence. Can you elaborate on the goals of this initiative?

Can you provide examples of programs that have been implemented and what successes have been achieved?

We thank the contributors of this discussion for sharing their innovative solutions for the continued health of their patients:

• Richard B. Toll, MD, MVMA President & CEO
• Robert Halbig, MD, MVMA Medical Director
• Arthur Ostrov, MD, Co-Director of IBD Center, President Emeritus, Saratoga Schenectady Gastroenterology Associates
• Cory Czajka, MD, Orthopedic Trauma, Capital Region Orthopedics
• Jeffrey J. Bettinger, PharmD, Pain Management Clinical Pharmacist, Saratoga Hospital Medical Group
• Dee Adkins, Executive Director, Certified Allergy & Asthma Consultants
• Debbie Zadrozny, RN, MVMA Executive Director

About MVMA

Mohawk Valley Medical Associates (MVMA) IPA and was founded in Schenectady, New York in 1983 by a small group of community-minded physicians. The goal was to lay the groundwork for a local, Schenectady-based HMO in response to market pressures both in the Capital District and beyond. MVMA has grown to over 3200 physicians in 9 counties that include the Capital District and surrounding counties in New York State.

Published October 2023

Over the past several years, Providers have had to overcome the challenges presented by COVID-19, as well as environmental events that have impacted us all.Children and young mothers are often among the most vulnerable to these life-changing events, both physically, but equally as important, mentally.

MVP reminds Pediatric and Maternal Health Providers that there are resources available that may help to bridge any gap in the emotional well-being of your patients.

Project TEACH, a program funded by the NYS Office of Mental Health, aims to strengthen, and support Providers in delivering care to children, adolescents, and young adults up to 22 years of age who experience mild-to-moderate mental health concerns, including anxiety, depression, and ADHD. Project TEACH offers consultation, referrals, and CME training at no cost to NYS pediatric Primary Care clinicians.

Maternal depression and related mood and anxiety disorders are prevalent and have serious impacts on parents and their babies. Addressing these conditions early leads to better health outcomes for mothers and children.

To find out more about the consultation services and educational resources, visit projectteachny.org.

Published October 2023

OnTrackNY is a mental health treatment program for adolescents and young adults that specializes in early psychosis to help them achieve their goals for school, work, and relationships. There are currently no wait lists for referrals. For more information, visit ontrackny.org.

Published October 2023

Bridging the digital divide 

MVP understands some Members may face barriers accessing digital tools. Our goal is to support those Members with available resources, including the federal Affordable Connectivity Program (ACP), in support of their health journey. That’s why MVP has been strategically referring eligible Members to Human-I-T, a third-party organization to bridge the digital divide with step-by step support to enhance access to virtual health care services.

Through this referral opportunity, Human-I-T links eligible Members with the Affordable Connectivity Program (ACP) to receive federal funding which provides:

• Low-cost internet that will vary by Member. Actual rates and eligibility terms will be answered by Human-I-T
• One time discount of $100 towards a qualifying digital device. These devices include reduced cost Chromebooks, which have the capability to support MVP apps

If your patients receive government benefits, they may be eligible and will need to provide documentation and proof of these benefits. To learn more, contact Human-I-T by calling 1-888-391-7249 or visit human-i-t.org/acp.

Published July 2023

Providers from Saratoga Hospital and Open Door Family Medical Center shared challenges in closing gaps in care in the pandemic/post-pandemic world and some creative strategies to help overcome them.

What have you learned over the last year that might be helpful to your colleagues when dealing with closing gaps in care for their patients?

At Open Door, our clinicians stress preventive care at every visit, regardless of the visit reason, to take advantage of each opportunity to discuss immunizations, required screenings, or other services that the patient may need. There is also an organizational expectation that preventive care is discussed during a visit, and this is evaluated during the clinician peer review process. Each of our sites conducts quarterly staff meetings which include a review of quality measures and scores so there is heightened clinician awareness on the importance of gap closure. Open Door has expanded the role of team-based care compared to last year due to the Dramatic Performance Improvement project with Coleman Associates, which promotes a team approach to caring for patients.

Saratoga Hospital has expanded the dietitian's role to provide Annual Wellness Visits, Intensive Behavior Therapy for weight loss, diabetic retinopathy screening, as well as other screening appointments and functions. Our registered dietitian is a valued part of the team and is collaborative, pitching in to help wherever needed. This approach helps to support the practice's model of preventive care. It is equally important that the care team has routine case conference meetings to discuss complex cases, barriers to care, and quality metrics. This supports closing gaps in care in a timely manner and reinforces with all staff the need to address the barriers to care that our patients may experience. These creative solutions have served as the "launching pad" for program development supporting our patients' disease management goals.

Since many people have recently delayed preventive care, how have you overcome the obstacles and stay connected with your patients?

Open Door used CareMessage, a text messaging platform, to contact patients that had gaps in care. For example, during the summer of 2022, Open Door texted adolescents that had not had a well visit in the calendar year. We asked them to schedule an appointment prior to the upcoming school year and offered backpack incentives to get them in.

We also utilize “Patient Visit Planning Reports” to address care gaps for patients that come into the health center for an appointment. Over the past year, we have prioritized the need for morning huddles between the clinicians and their support staff to review gaps in care and plans for addressing them at the time of the patient visit.

One of the strategies we had at Saratoga Hospital was to convert our Nutritional Services to telehealth, which kept our visit volumes about the same as before the pandemic. Registered Dieticians (RD) conducted telephonic outreach to make sure patients had what they needed; food, medications, etc. This began our virtual Nutrition Prescription Program where patients can learn the curriculum via telehealth. “Preventive health” as it relates to the most common chronic disease conditions was the overarching learning component throughout our 12-week course. This patient-focused approach to disease management supports continuing self-care and adoption of new methods for living healthy lives.

Saratoga Hospital is performing very well in closing cancer screening measures such as cervical, breast and colorectal. Can you share your approach?

Addressing food security during the pandemic helped us to build trust with our patients. These connections through telehealth counseling allowed regular contact with them and presented opportunities to discuss other health screenings. We kept visits in person when appropriate (for cervical cancer screening), but we also utilized screening strategies that did not require an in-office procedure such as Stool DNA testing. This screening follows U.S. Preventive Services Task Force(USPSTF) guidelines and can be collected at home. Many eligible patients elected to take advantage of these screenings.

Open Door has had success engaging populations that may have challenges receiving childhood immunizations. What strategies did you implement to be so successful?

We have a workflow in place where a nurse checks the New York State Immunization Information System (NYSIIS) vaccination registry for children who come in for a visit for any reason, not just a physical examination. If the child needs vaccination(s), the clinician discusses it with the parent or guardian, and the immunizations are given during the visit. We also use vaccine templates to assist in documentation. There is now reimbursement for vaccine counseling which pays for the work and time clinicians dedicate to discussing vaccines with patients, parents, or guardians.

Our nurses also use the Relevant database to periodically outreach patients, both adults and children, who are missing vaccines per the Advisory Committee on Immunization Practices (ACIP)vaccine guidelines. We receive all ACIP recommended vaccines from Vaccine for Children (VFC) and Vaccine for Adults (VFA) which enables Open Door to offer free vaccines to our uninsured patients. We always have ample stock of vaccines on hand to close gaps in care.

For school-aged children, Open Door has eight School-Based Health Centers (SBHC) which provide preventive primary care as well as acute care. The SBHC clinicians use the Relevant reporting system at Open Door to identify and close gaps in care, including immunizations.

Saratoga Hospital is particularly good at getting patients with Diabetes to engage in condition management (eye exams and HbA1c testing). What do you attribute to your success?

Providing Medical Nutrition Therapy (MNT) and Diabetes Self-Management Training (DSMT) services by an RD on-site, embedded into the practice makes a significant impact on patient engagement and clinical outcomes. The registered dietitian at the Community Health Center, Stephanie Samascott, completes warm hand offs from the primary care provider (PCP). This immediate connection to a new member on the patient's care team is instrumental in strengthening the patient's investment in their health. Injection education and diabetes technology training with patients coupled with chronic disease management classes and the Nutrition Rx program has been the magic formula to meet the needs of our patients with diabetes. Our registered dietician also works to improve the practice's quality measures by monitoring patient's lab results and notifying the providers when patients are due for updated labs.

Open Door has performed well in prenatal/post-partum measures. What are the key drivers in this success?

We have a Midwifery program with six midwives who provide prenatal and post-partum care. There is no access issue for these services. The midwives collaborate closely with each other to provide team-based care. There are dedicated prenatal and women's health nurses who track and reschedule appointment cancellations and no-show visits to ensure continuity of care for our patients.

We thank the contributors of this discussion for bringing ideas, creativity, and patient-centered solutions for the continued health of their patients:

Saratoga Hospital

• Dr. Renee Rodriguez-Goodemote, MD, FAAAP
• Dr. Karin Borrelli, MD
• Stephanie Samascott, MS, RD, CDN - Registered Dietitian
• Lisa Hodgson, RD, CDN, CDCES - Clinical Nutrition Manager

Open Door Family Medical Center

• Dr. Daren Wu, Chief Medical Officer

As a Federally Qualified Health Center, Open Door provides top-notch health care to those who are hardest to reach, regardless of their ability to pay. Often, Open Door serves patients who may not otherwise have access to care – including low-income families and individuals without insurance.

Saratoga Hospital is the Saratoga region's leading health care provider and the only acute-care facility in Saratoga County. The hospital’s multispecialty practice, Saratoga Hospital Medical Group, provides care at over 20 locations, delivering the programs and services that can have the greatest impact on individual and community health.

Published July 2023

MVP is excited to share that we have expanded Medicaid, Health and Recovery Plan (HARP), Child Health Plus, and Essential Plan coverage options into eight New York State counties: Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Montgomery, and St. Lawrence. Individuals have begun enrolling July 1, 2023 for coverage effective August 1, 2023. With the expansion of the service area, MVP will increase its ability to offer great care for individuals and families. MVP Medicaid, HARP, Child Health Plus, and Essential Plan coverage includes no co-pays for preventive care, including annual physicals and covered immunizations, $0 virtual care services, access to high quality doctors and hospitals, coverage for prescriptions, emergency coverage, and more. Along with our trusted Provider Partners, MVP is committed to serving the health and wellness of communities in these new areas. If you have questions about this expansion, please contact your MVP Professional Relations Representative.

Published July 2023

As of July 1, 2023, dual eligible individuals began enrollingin the new MVP DualAccess Complete (HMO D-SNP) plan. The MVP DualAccess Complete plan includes integratedbenefits for dually eligible enrollees (IB-Dual). IB-Dual is a DualSpecial Needs Plan (D-SNP) that offers Medicare Advantageand Managed Medicaid benefits with the same carrier.Members who receive Medicare Advantage and Medicaidbenefits through the same carrier have access to increasedintensive care coordination and efficient plan management. This is MVP’s second D-SNP plan. The Centers for Medicare &Medicaid Services (CMS) has awarded MVP’s D-SNP plan with 5stars for 2023, which is the only 5-star ranking in New York State. The new IB-Dual plan will be offered in the Capital District(Albany, Columbia, Greene, Rensselaer, Saratoga, andSchenectady counties), the Hudson Valley (Dutchess, Orange,Putnam, Rockland, Sullivan, Ulster, and Westchester counties),and Monroe county with benefits effective August 1, 2023. Providers can learn more at mvphealthcare.com/DSNPeducation. Members may visit joinMVPmedicare.com.

Published April 2023

Public Health Emergency Unwind could put your patients’ coverage at risk

Making sure that your patients continue to have the health coverage and access to care that you provide is our top priority.

During the COVID-19 Public Health Emergency (PHE), patients enrolled in Medicaid, Child Health Plus (CHP), Health and Recovery Plan (HARP) and the Essential Plan(s) (EP) did not have to recertify their health insurance due to PHE continuous coverage requirements. This was part of the Families First Coronavirus Response Act that went into effect in March 2020.

This is about to change. Recertification notices are being sent to enrollees starting this spring. These notices include deadlines for recertifying their insurance or risk being without coverage. Deadlines will be based on the enrollees’ enrollment end dates and will range from June 30, 2023, through May 31, 2024.

CMS estimates 17% of enrollees may lose coverage as the products requiring recertification are based on meeting financial hardship requirements. Please be aware that for enrollees that are no longer financially eligible for Medicaid, CHP, HARP, or EP coverage, MVP offers Individual products through NYSOH, and premium assistance through the government may be available when purchasing an Individual plans. If your patient has questions, they can contact the MVP Customer Care Center at the number listed on the back of their MVP Member ID card.

Outreach to MVP Members

MVP is proactively contacting Members to ensure they receive important notifications from NYSOH regarding their recertification. Additionally, we are asking Members to be sure their mailing address, phone number, email address, and other contact information is up to date with NYS Medicaid and MVP, so that they receive important notifications.

Let’s Collaborate to Keep Patients Covered

MVP would like to:

• Craft a plan with your practice or facility to address the health insurance enrollment, education, and advocacy needs of your patients and their families
• Work with your practice or facility onsite to deliver MVP Plan Guides, conduct outreach, participate in events, and participate in the recertification and enrollment activities

Together, we can minimize the negative impact of coverage gaps by working together to raise awareness with your patients. Please contact your MVP Professional Relations Representative with questions about how MVP can work with you and your staff.

Published April 2023

Providers participating in the Medicaid Managed Care (MMC) Plan Provider network should bill family planning and reproductive health services to the relevant MMC Plan and not to Medicaid fee-for-service (FFS). All MMC Plans [including mainstream MMC Plans, Human Immunodeficiency Virus-Special Needs Plans (HIV-SNPs) and HARP include family planning and reproductive health services within their benefit package.

Medicaid FFS Providers should ensure that MMC Plans are billed for family planning and reproductive health services provided to MMC enrollees (Providers must have a contract with the MMC enrollees’ MMC Plan to do so).

Medicaid MMC enrollees may obtain family planning and reproductive health services from MVP Medicaid Provider. The following services provided to a MMC enrollee by an out-of-network Provider should be billed to Medicaid FFS:

• Birth control drugs and devices, including Intrauterine Devices (IUDs), diaphragms, and other kinds of birth control
• Emergency contraception
• Sterilization for men and women
• Pregnancy testing
• An abortion that the patient and Provider agree is needed
• HIV and sexually transmitted infections (STI) testing, treatment, counseling
• Screenings for cancer and other related problems

Questions and Additional Information

• MMC enrollment, reimbursement, billing, and/or documentation requirement questions should be directed to the enrollee's specific MMC Plan. Providers can refer to the eMedNY New York State Medicaid Program Information for All Providers: Managed Care Information document for contact information per MMC Plan.
• Medicaid FFS billing/claim questions should be directed to the eMedNY Call Center at 1-800-343-9000.

Published January 2023

MVP Health Care® (MVP) is pleased to welcome Chiropractic and Acupuncture Providers to its network in the State of New York effective January 1, 2023. To provide our Members with the highest quality care, we believe all health care should be integrated and viewed as equal components of overall well-being.

MVP had contracted with eviCore healthcare MSI, previously known as Landmark for chiropractic and acupuncture services on behalf of MVP.

Register for an MVP Online Provider Account

To get started with MVP, register for a Provider Online Account. With your account, you can check claim status, determine Member eligibility, and much more.

In 2022, MVP welcomed a new Chiropractic and Acupuncture network in the state of Vermont. We are thrilled with these partnerships.

Published January 2023

Online Resources for our new and existing Providers.

MVP has developed a dedicated MVP Provider Onboarding resource which outlines everything Participating Providers need to do to get started with MVP as well as to acclimate you to the many resources available on our website. Whether you’re brand new to our network, have added a new provider to your practice, or just need refresher, we encourage everyone to explore this information to maximize your partnership with MVP. This information can be found on our Provider Onboarding page.

Access Onboarding Resources

Our Provider Onboarding resources are broken down into three sections:

1. Getting Started
   Create an MVP Provider online account to check claim status, determine Member eligibility, and much more. You can also set up electronic claim submission and payments.


2. Required Training and Attestations 
   To make sure that all Providers are in good standing with state and federal regulations and guidelines, MVP has outlined all required attestations. Some of these trainings are required on an annual basis and some are a one-time requirement. 


3. MVP Resources 
   MVP has many resources available to help Providers stay informed and connected with us. Learn how to access our MVP Provider and Payment policies, Provider communications, forms, and more. You will also find educational materials for how to navigate your new MVP Provider Online Account and resources to help maintain your relationship with MVP.
   We hope that you find this information helpful no matter where you are on your journey with MVP, and that you bookmark this page as a resource for helpful information.

We hope that you find this information helpful no matter where you are on your journey with MVP, and that you bookmark this page as a resource for helpful information.

Published January 2023

MVP understands the increasing demands on Providers when it comes to meeting patient needs. Between the health crisis emergency we’re facing, where primary care practices do not have the ability to keep up with demand, and the over utilization of Emergency Rooms and Urgent Care facilities,the health care system is overwhelmed. To help ensure your patients get the care they need, we ask you to consider recommending Gia to MVP Members. Gia is a mobile app that allows Members to speak to doctors who can triage Members and help them get the care they need, either by answering questions, diagnosing when possible, or referring to in-person care from nearby doctors, specialists, labs, and pharmacies.

By meeting our Members’ needs, we are removing the barriers to care – so your patients stay more engaged with their health care.

Published January 2023

Effective January 1, 2023, MVP’s Managed Medicaid and HARP products will cover Gambling Disorder Treatment provided by Office of Addiction Services and Supports (OASAS) certified programs.