IHCP 2019 1Q Workshop: Community Health Workers Agenda

1. 2019 IHCP 1st Quarter Workshop Community Health Workers (CHWs)

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

3. Community Health Worker 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

4. 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) • HealthVisions Midwest

5. 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

6. Covered & Non-Covered Services 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

7. Covered & Non-Covered Services 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

8. 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

9. 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.

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

11. References Indiana Medicaid • https://www.in.gov/medicaid/providers/index.html IHCP Bulletin • BT201826 IHCP Professional Fee Schedule • https://www.in.gov/medicaid/providers/678.htm Additional education and resources will be published by IHCP as available.

12. MCE Contact Information Provider Services 1-844-607-2831 CareSource.com 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 1-877-647-4848 Fax: 1-866-753-7240 MHSIndiana.com

13. Questions