HCV CARE

Defining the Experienced HCV Care Provider

 

 

NYS Provider Directory

NYSDOH Dear Colleague Letter of January 2016 (click to download PDF)

Dear HCV Provider,

As you may be aware, in early 2015, the NYSDOH AIDS Institute launched a web-based public directory of experienced HIV care practitioners in New York State. We are excited to announce this directory has now been expanded to include experienced HCV care practitioners. We encourage all HCV practitioners in New York State to register for the purpose of providing the public with information about where patients living with HCV can access experienced providers within the State.

Participation in this directory is voluntary. It is compiled through provider self-identification, and includes physicians, nurse practitioners, physician assistants, and doctors of osteopathic medicine with experience in HCV care and treatment and who meet the NYSDOH definition of an experienced HCV provider. Please note that this list in no way constitutes credentialing or certification in a specialty. Inclusion in this list does not confer any endorsement by the New York State Department of Health. We confirm that practitioners are licensed to practice in New York State.

If you are interested in being listed in this directory, please follow the steps outlined below to register through our on-line registration system. We will email you annual reminders to confirm/update your contact information. You are able to withdraw your name from this directory at any time. If you already participate in the directory as an HIV provider and would also like to register as an HCV provider, simply log into HCS and update your record with your HCV-related information.

To register: First you must log on to the NYSDOH Health Commerce System (HCS). If you do not already have an account or need help accessing your HCS account, please send an email to hcsoutreach@health.state.ny.us.

Step 1: Log on to HCS at https://commerce.health.state.ny.us.

Step 2: Click ‘My Content’ -> ‘All Applications’.

Step 3: Click letter ‘H’ and select ‘HIV/HCV Provider Directory’.

Step 4: Follow the instructions as provided on the screen. Step 5: Email hivproviderdirectory@health.ny.gov with any questions or concerns.

The public listing of the directory will include providers’ names, contact information, and credentials as an HIV and/or HCV specialist (if applicable). This directory will be made available to the public online and will be updated at the beginning of each month.

Finally, please forward this invitation to any HCV or HIV care provider who may be interested in registering themselves in the directory. We thank you for your time and wish you all the best.

Sincerely,

AIDS Institute, Viral Hepatitis Section

Qualifications

The components below were developed by the New York State Department of Health AIDS Institute’s Hepatitis C Clinical Guidelines Committee to define those healthcare providers who are qualified to prescribe hepatitis C antiviral therapy.

Clinical experience and appropriate continuing education are both important to ensure that HCV medications are prescribed safely and correctly and that all patients receive the highest quality of care.

New York State Qualificiations for Prescribing HCV Antiviral Therapy

Providers must meet all three criteria.

Clinical experience:

  • Management AND treatment of at least 10 patients with HCV infection within the past 12 months OR 
  • Management and treatment of 10 patients with HCV infection in partnership (defined as consultation, preceptorship, or via telemedicine) with an experienced HCV provider who meets the above criteria.

Continuing Medical Education: At least 10 HCV-related CME credits in the last 12 months.

Licensure: A current, valid MD, DO, PA, or NP New York State license.

Questions and Answers

Why has the New York State Department of Health AIDS Institute (NYSDOH AI) developed criteria for defining the experienced HCV provider?  The NYSDOH AIDS Institute (AI) is responsible for ensuring a statewide standard of care for treatment and management of patients with HCV. The AI has developed criteria for defining experienced HCV providers to ensure that patients with HCV are treated by clinicians with the appropriate level of expertise to deliver necessary care that meets current quality standards.

Who developed the criteria for this definition? The criteria for defining the experienced HCV provider were developed by the NYSDOH AI’s Hepatitis C Clinical Guidelines Committee.

If a medical practitioner is already licensed or board certified in NYS, why are these criteria necessary? No formal certification program exists for HCV expertise or experience. Promulgation of these criteria for NYS will establish consistent criteria for determining capability and will ensure that quality treatment is delivered by experienced providers.

Does a provider need to meet both experience and CME criteria to qualify as an experienced HCV experienced provider? If a provider fails to meet these criteria, should he or she not care for or provide treatment to persons diagnosed with HCV? To qualify as an experienced HCV provider, both criteria must be met. If a provider lacks necessary experience in managing or treating HCV patients, he or she may work in partnership with an HCV-experienced provider to deliver care and treatment through consultation or mentorship. If such a co-management relationship can be arranged, patients do not need to be referred to a new HCV provider.

Do patients count toward meeting the criteria if they are being managed or treated through a mentoring, consultative, or telemedicine relationship? Yes.

How long must a provider work in partnership with an experienced HCV provider before he or she can be considered an experienced provider? Based on the criteria, it is recommended that, at a minimum, providers work in partnership until they have managed AND treated 10 patients over a 12-month period. However, the partnership should continue for as long as the provider feels it necessary. An ongoing mentoring relationship or on-demand consultations may be beneficial, even though the minimum criteria have been met. To identify resources for mentoring, providers should contact the NYS HIV, HCV and STD Clinical Education Initiative at www.ceitraining.org. In addition, the CEI Line (866-637-2342) provides clinicians free consultation with specialists to discuss HCV management.

Is there any evidence that working in partnership with an experienced HCV provider results in similar patient outcomes? Since 2010, the AIDS Institute has been funding primary care sites to integrate HCV care and treatment. In each of these settings, the model includes a primary care provider (PCP) and a multidisciplinary team to manage and treat persons infected with HCV. Each PCP works in partnership with an experienced HCV provider to gain the knowledge, skills, and experience to safely and effectively manage and treat HCV. Data from these programs demonstrate that PCPs are able to gain the knowledge and skills needed for successful HCV care [1]. In addition, Project ECHO (Extension for Community Healthcare Outcomes) is an effective model developed by the University of New Mexico Health Sciences Center that uses state-of-the-art tele-health technology, best practice protocols, and case-based learning to train and support primary care providers. This model has shown improved outcomes following coaching and mentoring by an experienced provider [2].

Do the criteria have to be fulfilled only once or every year? The criteria must be met for each 12-month period. For example, if a provider co-manages and treats the minimum number of HCV patients in 2014, that provider would be eligible to manage and treat HCV patients by him- or herself in 2015. If the provider does not meet the minimum requirements, he or she would have to continue to co-manage in 2015. The changing nature of HCV therapeutics requires that clinicians keep up to date with their use.

Do providers meeting these criteria receive enhanced Medicaid reimbursement when providing HCV care and treatment services? No. There is no enhanced reimbursement through Medicaid or other state programs for providers meeting the criteria for experience in HCV management and treatment.

How do these criteria for experienced HCV providers relate to the clinical criteria established by NYS Medicaid and the Managed Care Organizations for prior authorizations of HCV medications? The criteria for experienced HCV providers have been reviewed by both NYS Medicaid and Managed Care Organizations. On October 16, 2014, the NYS Medicaid fee-for-service (FFS) pharmacy program implemented these criteria as well as additional clinical criteria for prior authorization to prescribe HCV medication therapy. Information about the clinical criteria for HCV drug therapy can be found in the NYSDOH Medicaid October 2014 Update.

Are providers required to register as experienced HCV providers before they can prescribe HCV medications? If so, how can they register? No. As part of the prior authorization (PA) process, prescriber experience and training must be verified. To streamline the PA process, the NYSDOH developed an HCV Approved Practitioners List, which can be used by the Medicaid FFS PA call center as well as all of the Medicaid Managed Care plans. If a provider is on the list, the criteria have been satisfied. If a provider is not on the list, additional information must be provided to ascertain his or her level of experience. Providers can register to be put on the list by filling out the Medicaid Hepatitis C Practitioner Information Request Form on the NYSDOH website.

How can patients find an experienced HCV provider? The NYSDOH AI will publish a voluntary directory of experienced HCV providers in 2015 so that providers and patients can easily locate an experienced HCV provider.

Will the NYSDOH AI issue guidelines on the management and treatment of patients with HCV? Yes. The AIDS Institute is currently updating its guidelines on the management and treatment of HCV patients. The guidelines are expected to be released in 2016. They will be available on the NYSDOH Hepatitis website at and on this website.

If providers have additional questions regarding the criteria, whom should they contact? Additional questions regarding the criteria can be sent to: hepatabc@health.ny.gov.

References

  1. Flanigan CA and Hart-Malloy R. Evaluating the Quality of HCV Care and Treatment in Primary Care Settings. American Association for the Study of Liver Disease Conference, Washington, DC, abstract 2067, November 2013.
  2. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med2011;364:2199-2207. [PubMed]