Maternal and Infant Health Social Work Services

1. Maternal and Infant Health Social Work Services OHCA Rules and Policies August 15, 2008

2. Who is OHCA? • Oklahoma Medicaid Agency • SoonerCare (Name of Insurance Program) • SoonerCare Traditional • SoonerCare Choice • Insure Oklahoma/OEPIC • Oklahoma Cares (BCC) • TEFRA • SoonerPlan (Family Planning) • Soon To Be Sooners

3. Member Eligibility • Two-prongs for eligibility • Low income individuals (based on federal poverty level percentages) • Categorical need (i.e., children, pregnant, disabled) • Eligibility determined by Oklahoma Department of Human Services (OKDHS)

4. SoonerCare and Perinatal Services • Large percent of births are paid by SoonerCare • FY 2007—SoonerCare paid for over 32,000 deliveries (57% of Oklahoma births)

5. Prenatal Care Benefits • Routine OB care—prenatal visits, labs, prescriptions, deliveries • Smoking cessation counseling • Prenatal assessment • Limited ultrasounds • High risk pregnancy services • Limited dental care • Genetic counseling • Lactation consultant services • Maternal and infant health social work services • Soon To Be Sooners

6. MIH Social Work Services • Direct face to face service provided to pregnant/postpartum SoonerCare members with psychosocial concerns that may impact pregnancy outcomes and/or the health of the infant--include but not limited to: • Domestic violence • Substance abuse • Lack of basic resources • Mental Illness

7. MIH Social Workers: • Connect women with necessary services which will promote optimal pregnancies and best outcomes for the infant • Help ascertain the best fit for the individual woman

8. MIH Social Workers: • Assist the woman in emotionally understanding and accepting the need for services or treatment • Ensure she follows through on all needed care • Follows up to see if the care she received met her needs

9. MIH Social Workers: • Provide short term problem focused counseling • Assess maternal emotional well being • Maternal –infant bonding and interactions

10. Eligible Providers • Licensed Clinical Social Workers (Licensed in the state services are provided) • Must have a current OHCA contract • Need to demonstrate current license • Six hours of continuing education or technical assistance in area of MIH

11. Coverage • Pregnant and/or up to 60 days postpartum SoonerCare &/or Soon To Be Sooners members • Existing psychosocial condition that may negatively impact the pregnancy/well-being of newborn • Condition identified by OB provider during prenatal care assessment or during Social work assessment

12. Coverage • Self referred or referred by any provider (no formal referral needed) • Services must be provided in office, home or other confidential clinic setting • Face to face and individual service • No separate reimbursement for inpatient services • Separate facility fee not reimbursed

13. Billing Codes/Reimbursement Rates Use CPT codes: • 96150-Health and Behavior Assessment $16.79 per 15 minutes • 96152-Health and Behavior Intervention, Individual $15.41 per 15 minutes • 96154-Health and Behavior Intervention, Family with Patient Present $15.13 per 15 minutes

14. Maximum Units of Service • 32 total units per pregnancy/postpartum (unit=15 minutes) • Maximum of 6 units per day/session • Any combination of the three codes as clinically appropriate • Billing time = time spent in face-to-face contact with the client

15. Contracting Information • Go to www.okhca.org and choose: • Providers • Enrollment • New contracts • Maternal and Infant Health LCSWs • Download contract and follow instructions • Mail in completed contract with required professional documentation • Will take a couple of weeks to process/receive provider number • Call 800-522-0114 for help

16. OHCA Contract Requirements • Attach copy of certification • Show 6 hours of CEUs or technical assistance in MIH social work • Complete 6 hours CEU/technical assistance each calendar year • Maintain confidential records • Service records must be readily accessible for OHCA audit/inspection for 6 years from date of service

17. Getting started—Referral resources • Members may self-refer, no formal referral needed • Once contracted, obtain a list of contracted SoonerCare OB providers in your area • Outreach to OB providers, inform them you are a SoonerCare contracted provider and of your services • You may wish to discuss how you will share information regarding the patients • You should discuss how the OB provider will make referrals to you

18. Getting Started—Billing • Welcome packet from EDS (OHCA’s fiscal agent) • Field rep contact info • Free, on-site training or register for bi-monthly training in OKC or Muskogee • SoonerCare basics • Secure website • Training registration

19. Secure website • No cost (need internet access) • Verify member eligibility • Immediate notification of claim status • Denied claims resolution resources • Call center • Provider reps • Weekly payment cycle • If you file weekly, you get paid weekly

20. Third Party Liability • Third Party Liability (TPL) means another party is responsible for paying health care costs before (& sometimes after) SoonerCare pays • SoonerCare is the payer of last resort • About 10% of Sooner Care members have another insurer in addition to SoonerCare

21. TPL • Ask your clients if they have other insurance coverage • If so, get insurance carrier info from them • It is unlikely you will run into this situation, BUT if you do, help is available • Call OHCA--we will happily walk you through the process! • 1-800-522-0114 option 7 (TPL)

22. Documentation • Services must be documented in medical record to include: • Date of service • Start and stop time for each session • Service provider signature and credentials • Documentation of referral source

23. Documentation • Treatment plan including problems, goals and/or objectives • Methods to be used to address problems, goals and objectives • Progress made • Client response to the session/intervention • Any new problems, goals or objectives identified

24. OHCA Contacts • Child Health Unit • Terrie Fritz, LCSW, Director of Child Health • 405-522-7377 Terrie.Fritz@okhca.org • Shelly Patterson, CPH, Perinatal Coordinator • 405-522-7332 Shelly.Patterson@okhca.org • OHCA Provider Representative • 1-877-823-4529 option 2 • OHCA website • www.okhca.org

25. Helpful OHCA Numbers • OHCA Call Tree(Provider)1-800-522-0114 • OHCA Call Tree(Member)1-800-522-7171 • SoonerCare Helpline (Member)1-800-987-7767 • Behavioral Health 1-800-652-2010 • SoonerRide1-877-404-4500 • Patient Advice Line1-800-530-3002

26. Questions?