2019 IHCP 1 st Quarter Workshop Community Health

2019 IHCP 1 st Quarter Workshop Community Health Workers (CHWs) Providing health coverage to Indiana families since 1994

Agenda • Community Health Worker (CHW) • Provider Eligibility • Covered & Non-Covered Services • Billing & Authorization • Claim Example • References • MCE Contact Information • Questions 2

Community Health Worker: • Frontline public health worker • Holds close understanding of their community • Serves as a liaison between health and social services • Facilitates access to services • Builds individual and community capacity by increasing health knowledge and self-sufficiency through: – Outreach – Community Education – Informal Counseling – Social Support and Advocacy 3

Provider Eligibility CHWs must: • Be employed by an IHCP-enrolled billing provider • Deliver services under the supervision of one of the following: – Physician – Health Services Provider in Psychology (HSPP) – Physician Assistant (PA) – Podiatrist – Chiropractor – Advanced Nurse Practitioner (APN) • Demonstrate skills through certification from one of the following: – Mental Health America of Northeast Indiana (MANI) – Affiliated Service Providers of Indiana (ASPIN) – Health. Visions Midwest 4

Provider Eligibility Certification skills can include competencies such as: • • Communication skills Service coordination and navigation skills Education and facilitation skills Professional skills and conduct Certification recognition may include: • An academic degree (an associate’s degree or higher) in a healthcare-related field • Employer-based training around health promotion and community health integration 5

Covered & Non-Covered Services • Diagnosis-related patient education for members regarding self-managing physical or mental health, in conjunction with a healthcare team • Facilitation of cultural brokering between a member and the member’s healthcare team • Health promotion education to a member on behalf of the healthcare team to prevent chronic illness • Direct preventive services or services aimed at slowing the progression of chronic diseases 6

Covered & Non-Covered Services • Insurance enrollment and “navigator” assistance • Case management and care coordination • Arranging for transportation or providing transportation for a member to and from services • Direct patient care outside the level of training and certification an individual has attained 7

Billing & Authorization Billing for CHW Services 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 Coverage Limitations • Services must: – – Be provided face-to-face individually or in a group Be rendered in a community setting (i. e. outpatient or home) Not exceed 4 units (or 2 hours) per day, per member Not exceed 24 units (or 12 hours) per month, per member • Prior authorization (PA) is not required 8

Billing & Authorization Billing Guidance • Services must be billed on a professional CMS-1500 claim form. • Hospital Assessment Fee (HAF) adjustments are not available. • The supervising provider should be billed as the rendering provider on the claim. • Claims must include the name of the CHW in the claim notes. • Procedure codes for CHW services should be billed in 30 minute units. • Separate claim lines should be billed for each DOS that services are provided. • Claims must include an appropriate diagnosis. 9

Claim Example 12 -3456789 The Happy Foot People 123 Apple Boulevard Indianapolis, IN 46111 10

References Indiana Medicaid • https: //www. in. gov/medicaid/providers/index. html IHCP Bulletin • BT 201826 IHCP Professional Fee Schedule • https: //www. in. gov/medicaid/providers/678. htm Additional education and resources will be published by IHCP as available. 11

MCE Contact Information Provider Services 1 -866 -408 -6132 Fax: 1 -866 -408 -7087 Anthem. com Provider Services 1 -800 -356 -1204 Fax: 1 -877 -822 -7190 MDwise. org Provider Services 1 -844 -607 -2831 Care. Source. com Provider Services 1 -877 -647 -4848 Fax: 1 -866 -753 -7240 MHSIndiana. com 12

Questions 13