community health worker enrollment, coverage and payment...

Community Health Worker Enrollment, Coverage and Payment under Minnesota Health Care Programs December 3, 2014

Community Health Worker Enrollment, Coverage and Payment under Minnesota Health Care Programs

Welcome

• Joan Cleary, Executive Director Minnesota Community Health Worker Alliance

• Today’s format

• We will take questions at the end of the presentation.

About Success with CHWs

• A program of the Minnesota Community Health Worker Alliance

• Increase familiarity with the CHW role and its benefits to patients, families, communities and the health care system

• Share ways to integrate CHWs with members of your healthcare team to effectively address disparities

• Explore questions related to CHW scope of practice, education, financing and supervision

• Includes this colloquium, and other events, including online toolkits

• Funded by:

• The St. Paul Foundation • MN Community Measurement

Upcoming Success with CHWs Events

Thursday, December 4

8:30-11:30 a.m. CST Wellstone Center/Neighborhood House, St. Paul

The Community Health Worker Role and Behavioral Health: Current Practice and Future Opportunities This free workshop will feature Joan King, Senior Integration Consultant, The National Council for Behavioral Health, along with three Minnesota panelists discussing their work with CHWs. Tuesday, December 16

10:00-11:00 a.m. CST Teleconference on CHWs in Mental Health Further details TBD

Register at: http://mnchwalliance.org/calendar/

Community Health Worker Enrollment, Coverage and Payment under Minnesota Health Care Programs

Today’s presenter

Alex Kaiser MHCP Provider Training & Communications DHS Member and Provider Services Division

Community Health Worker Enrollment, Coverage and

Payment under Minnesota Health Care Programs

Alex Kaiser MHCP Provider Training & Communications DHS Member and Provider Services Division

December 3, 2014

Outline Overview and Definitions CHW Enrollment process Covered Services Required Documentation CHW Billing Q&A

Overview and Definitions

Minnesota Health Care Programs (MHCP)

MCHP includes: Medical Assistance (MA) MinnesotaCare Minnesota Family Planning Program Home and community-based waiver programs Medicare Savings Programs

CHW Defined A Community Health Worker (CHW) is a trained health educator who works with MHCP recipients who may have difficulty understanding providers due to cultural or language barriers. Definition from MHCP Provider Manual

Covered Services Overview MHCP will cover diagnosis-related education services provided by a CHW following certain criteria including: Supervised by an MHCP approved provider Provided face-to-face Standardized curriculum

CHW Enrollment

CHW Education Standardized CHW education is required for CHWs to receive payment under MN Health Care Programs (MHCP) Medical Assistance and MinnesotaCare. MN is the only state in the US with a statewide CHW curriculum based in higher education.

CHW Certificate Programs Currently 7 post-secondary schools offer the certificate program: Minneapolis Community and Technical College Normandale Community College, Bloomington Northwest Technical College, Bemidji Rochester Community and Technical College St. Catherine University, St. Paul South Central College, Mankato Summit Academy OIC, Minneapolis

CHW Curriculum This CHW certification curriculum is competency-based, and includes: Core Competencies: 9 credits Role, Advocacy and Outreach – 2 Organization and Resources – 1 Teaching and Capacity Building – 2 Legal and Ethical Responsibilities – 1 Coordination and Documentation – 1 Communication and Cultural Competency – 2

Health Promotion Competencies: 3 credits

Practice Competencies – Internship: 2 credits

Supervision Requirement Having a CHW Certificate is not enough to provide CHW services. MHCP requires general supervision by an MHCP-enrolled: Physician Advance Practice Registered Nurse (APRN) Certified public health nurse Dentist Mental health professional

Rendering vs. Ordering Providers MHCP requires CHW enrollment so they are represented on a claim as the provider who provided the services (Rendering Provider). CHWs are supervised by MHCP enrolled providers that assign them to provide certain educational services (Ordering Provider).

UMPI vs. NPI A National Provider Identifier (NPI) is a unique 10

digit issued to health care providers by the Centers for Medicare and Medicaid Services (CMS).

A Unique Minnesota Provider Identifier (UMPI) is

issued by MHCP to providers that do not qualify for an NPI (i.e. CHWs, PCAs, etc.)

Forms for CHW Enrollment The forms below are required for CHW enrollment with MHCP: MHCP Provider Agreement (DHS-4138) MHCP Enrollment Application (DHS-4016) MHCP Applicant Assurance Statement (DHS-5308) A copy of the CHW certificate

MHCP Provider Agreement Form The MHCP Provider Agreement (DHS-4138) is a form submitted by all enrolling MHCP providers that details the responsibilities and obligations inherent to serving as an MHCP provider.

MHCP Enrollment Application

The MHCP Provider Enrollment Application (DHS-4016) is the other form required for all MHCP providers. It has providers disclose: Provider Type Individual Practitioner Personal Profile Practitioner Licenses/Board Certifications Practitioner Specialty (N/A for CHWs) Practitioner Specialty Certifications Primary Office Location Alternate Mailing Address Remittance Sequence Group Affiliation Information Disqualification Information Contact Information Provider Statement

CHW Applicant Assurance Statement (DHS-5308)

CHW Certificate This is the certificate provided upon completion of one of the CHW programs offered from one of the institutions detailed above. The certificate must be submitted with the other forms at the time of enrollment.

Individual Practitioner MHCP Provider Profile Change Form The Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) is not required for initial enrollment. It is used for changing: Contact info Professional affiliations MHCP enrollment status

Locating Enrollment Forms 1. Go to the MN DHS homepage (http://mn.gov/dhs/). 2. Click on the Partners and Providers tab.

… Forms, P&P Tab 3. From the Partners and Providers tab select Health Care from the list on

the left or from the page.

… Forms, Health Care Page 4. On the Health Care page, click the MHCP enrolled providers link in the

body of the page.

… Forms, MHCP Enrolled Providers Homepage

5. From the MHCP enrolled providers homepage select Community Health Worker from the SELECT YOUR PROVIDER TYPE drop down menu and click GO.

… Forms, CHW page 6. From the CHW page click the link for Resource Documents/Forms.

… Forms, CHW Access 7. All necessary enrollment forms for CHWs are available under the Forms

section.

Submitting enrollment forms Completed forms can be sent to:

FAX (preferred): 651-431-7462 Or

DHS-MHCP Provider Enrollment PO Box 64987

St. Paul, MN 55164-0987

Processing time & Notification MHCP will process your application within 30 days.

When approved, you will receive a confirmation

notice in the mail that will include your UMPI.

Covered services

Approved Ordering Provider Types Patient education services must be ordered to be provided by a CHW by a: Physician APRN Dentist Certified Public Health Nurse Mental Health Professional

Covered Education CHW service involves teaching patients how to effectively self-manage their: Physical health Oral health Mental health

Covered Settings CHW services are provided face-to-face with the recipient (individually or in a group) in an: Home Outpatient clinic Other community setting

Criteria for Covered Services The content is a standardized curriculum consistent with established health or dental health care standards. However, curriculum may be modified as necessary for: Clinical needs Cultural norms Health literacy

Non-covered Services MHCP does not cover social services such as: Enrollment assistance Case management Advocacy

Required Documentation

Service Order Documentation The recipient’s record must contain an order for services signed by an MHCP-enrolled provider (of appropriate type) specifying: The number of units ordered Whether the services were to be provided to a group

or individual

CHW Documentation The record must also include documentation from the CHW specifying: Date of service Start and end time of service Group or individual service Number of patients present Summary of the sessions content CHW’s signature and printed name

CHW Billing

APRN Clinic Community Health Clinic Critical Access Hospital Dentist Family Planning Agency Federally Qualified Health Center (FQHC) Hospital Indian Health Service (IHS) Facility Mental Health Professionals Physician Public Health Clinic Nurse Rural Health Center (RHC) Tribal Health Facility

Eligible Billing Providers

Billing Units Bill in 30-minute units: Limited to 4 units per 24 hours No more than 8 units per calendar month per recipient No more than 8 recipients can present for the service

at a given time

CHW billing in MNITS Bill MHCP electronically using 837P

Use CHW non-pay Unique Minnesota Provider

Identifier (UMPI) number as rendering provider Bill separate lines for each day service is provided (only

one calendar month of service per claim)

CHW billing codes 98960 – Self-management education & training, face-to-

face, 1 patient 98961 – Self-management education & training, face-to-

face, 2-4 patients 98962 – Self-management education & training, face-to-

face, 5-8 patients

CHW Rates 98960 – $19.44 per unit

98961 – $9.09 per unit

98962 – $6.56 per unit

(Rates are subject to change. Always consult the most recent Fee Schedule for current rates)

Consulting the Fee Schedule To consult the Fee Schedule: 1. Navigate to the MHCP Enrolled Providers homepage (follow steps 1-5

detailed above), and select Billing Resources from the menu on the left

… Fee Schedule, Billing Resources 2. From the Billing Resources page click the Fee Schedule icon on the

menu on the left

MHCP Fee Schedule 3. On the MHCP Fee Schedule page, select your desired format (PDF or

Excel) to view the Fee Schedule

MCO billing When billing a Managed Care Organization (MCO), contact the appropriate MCO for rates and procedures.

Contact Info Provider Call Center:

651-431-2700 Or

1-800-366-5411

Q&A

For more information, please contact Joan Cleary, Executive Director Minnesota Community Health Worker Alliance joanlcleary@gmail.com www.mnchwalliance.org