Rural Health Clinics Mississippi Medicaid

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O f f i c e o f t h e G o v e r n o r M i s s i s s i p p i D i v i s i o n o f M e d i c a i d Rural Health Clinics Mississippi Medicaid Mary Katherine Ulmer, M.S. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 1

Who is Enrolled? Children Low Income Parents/Caretakers Disabled (Supplemental Security Income) Dually eligible Family Planning Pregnant Women 692,063 Medicaid beneficiaries 46,958 CHIP beneficiaries 739,021 Total enrollment As of April 1, 2018 O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 2

RHC Services MS Medicaid State Plan (State Plan) Scope of service outlined in Attachment 3.1-A Exhibit 2b of the Mississippi State Plan https://medicaid.ms.gov/wpcontent/uploads/2014/01/attachment_3.1-a.pdf O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 3

RHC Services State Plan Services are limited to those as described in Social Security Act, Section l86l (aa). Must meet certification requirements of 42 CFR 491 Subpart A and have an approved agreement to participate in Medicaid program. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 4

RHC Services State Plan Methods and standards for establishing payment rates are outlined in Attachment 4.19-B Page 2b of State Plan https://medicaid.ms.gov/wpcontent/uploads/2017/05/attachment_4.19-b.pdf O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 5

Rural Health Clinic Services State Plan provides for reimbursement to RHC providers at a prospective payment rate per encounter. Reimbursement limited to a single encounter, also referred to as a visit, per day except as described in Attachment 3.1-A exhibit 2b. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 6

Rural Health Clinic Services Visit at an RHC can be a medical visit or other health visit. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 7

Rural Health Clinic Services Medical visit face-to-face encounter between a clinic patient and Physician, Physician assistant, Nurse practitioner, or Nurse midwife. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 8

Rural Health Clinic Services Other Health visit is a face-to-face encounter between a clinic patient and Clinical psychologist, Clinical social worker, or Other health professional for mental health services. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 9

Rural Health Clinic Services Encounters with more than one health professional and multiple encounters with same health professional which take place on same day and at a single location constitute a single visit, except: After first encounter, patient suffers illness or injury requiring additional diagnosis or treatment. Patient has medical visit and visit with mental health professional, dentist, or optometrist. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 10

Rural Health Clinic Services RHC s encounter rate covers beneficiary s visit to RHC, inclusive of all services and supplies and drugs and biologicals which are not usually selfadministered by beneficiary, furnished as an incident to a professional service. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 11

Rural Health Clinic Services Must provide six (6) laboratory services on site as outlined in MS Administrative Code Part 212: urine HGB/HCT blood glucose stool pregnancy cultures O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 12

Rural Health Clinic Documentation At a minimum, records must contain: Date of Service Beneficiary s Presenting Complaint Provider s Findings Treatment Rendered Provider s Signature O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 13

RHC Services Governing Document Administrative Code Title 23, Part 212 Division of Medicaid s Website www.medicaid.ms.gov Reimbursement for RHC Services is funded by Medicare and Medicaid O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 14 O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 14

Rural Health Clinic Services DOM defines regularly scheduled office hours as: 8:00 a.m. 5:00 p.m., Monday - Friday, excluding Saturday, Sunday and federal and state holidays DOM permits RHCs to set regularly scheduled office hours outside of these hours. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 15

Telehealth Services DOM reimburses an additional fee per completed transmission, for telehealth services provided by RHC acting as originating site, which meets requirements in Miss. Admin. Code Part 225, Chapter 1, effective January 1, 2015. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 16

Physical location of beneficiary at the time telehealth service is provided via telecommunications system. ORIGINATING/SPOKE SITE O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 17

Originating/Spoke Site Telepresenter at originating site must: Be employed by enrolled Medicaid provider, Perform tasks and activities within telepresenter's scope-of-practice and license, and Be physically present during entire telehealth visit or encounter. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 18

Rural Health Clinic Services Telepresenter must be one (1) of the following for originating site to receive originating site facility fee: Physician Physician Assistant Nurse Practitioner Psychologist Licensed Clinical Social Worker (LCSW) Licensed Professional Counselor (LPC) O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 19

Originating Site Facility Fee DOM reimburses telehealth originating site facility fee per completed transmission when: Enrolled Medicaid provider is eligible to receive originating site facility fee, and Beneficiary is located at covered originating site. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 20

Originating Site Facility Reimbursement $31.28 per unit 1 unit equals 30 minutes 2 units are allowed per day RHC originating site provider cannot bill for an encounter unless a separately identifiable service is performed. O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 21

Hospital Services If a physician employed by an RHC provides physician services at an inpatient, outpatient, or emergency room hospital setting, the services must be billed under individual physician s Medicaid provider number and payment will be made directly to physician. Claims billed by RHC provider with the following places of service will be denied: POS 21 POS 22 POS 23 Inpatient Hospital Outpatient Hospital Emergency Room Hospital O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 22 O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 22

Billing Reminders RHC should not be listed as servicing provider on claim Non-covered and invalid procedure or diagnosis codes will deny if billed $3.00 copay applies, unless exempted by policy Inpatient or outpatient hospital services are not paid to RHC Physicians employed by RHC may provide inpatient or outpatient hospital services, but physician must bill services, not RHC O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 23 O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 23

Additional Billing Information http://www.medicaid.ms.gov/admincode.aspx Provider Reference Guide Part 212 Rural Health Clinics O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 24 O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 24

Mary Katherine Ulmer, M.S. Office Director for Medical Services Walter Sillers Building 550 High Street, Suite 1000 Jackson, Mississippi 39201 Phone 601-359-9133 Fax 601-359-6147 Web medicaid.ms.gov Email mary.ulmer@medicaid.ms.gov O F F I C E O F T H E G O V E R N O R M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 25

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