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Dial-in: , Participant Code: #

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1 Dial-in: 1-877-594-8353, Participant Code: 9131 3844#
Medicaid Coverage for the Diabetes Prevention Program: The Process to Make and Implement the Policy Change Sarah Brokaw, MPH Montana Diabetes Program Montana Incentives to Prevent Chronic Disease Grantee Conference Call March 4, 2015 MIPCD March Program Activity Webinar Sustainability Part I: Medicaid Options Meeting Agenda March 2, 2015; 3:00-4:30 p.m. (EST) Please note this call has been extended to 90 minutes Dial-in: , Participant Code: # Click the link below to join the webinar https://econometrica.webex.com/econometrica/onstage/g.php?MTID=e45fe79d92f4 ae1eea49e807748b44edc Welcome 1115 Waiver, and State Plan Amendment Overview- Econometrica TA team State Sharing: Medicaid Options (topics include 1115 Waivers, State Plan Amendments and Community Health Worker Reimbursements) NH, CT, MT, MN Question and Answers Open Forum Next Call April 6, 2015; 3:00-4:00 p.m. (EST) Adjournment Sustainability Part I: Medicaid Option Purpose/Focus: Sustainability Part I: Medicaid Options Objectives: At the end of this event, participants will: Understand the 1115 Waiver Process including State Amendments Have tools to explore Medicaid options for program sustainability beyond grant support Event Manager: Kai Baker Stringfield Part 1: Opening and Framing Operator welcome and logistics (housekeeping items) - Trevor Johnson Kai frames the event, additional logistics - Kai Baker Stringfield Part 2: Overview: 1115 Waiver and State Amendments Introduction to 1115 Waivers and State Amendments - Nancy Weller, Econometrica TA team Q&A, Facilitated by Nancy - Nancy Weller, Econometrica TA team Part 3: Medicaid Options- State Sharing Connecticut, State Plan Amendment - Carolann Kapur, Medical ASO Liaison, Connecticut Department of Social Services Q&A - Carolann Kapur, Medical ASO Liaison, Connecticut Department of Social Services Montana, State Plan Amendment - Sarah, Brokaw, Program Manager, MT MIPCD Q&A - Sarah, Brokaw, Program Manager, MT MIPCD Minnesota, Community Health Worker Reimbursements - Ellie Garrett, health services policy analyst for the MN Department of Human Services (DHS) and the DHS project manager for the WCPD project.  Q&A - Ellie Garrett, health services policy analyst for the MN Department of Human Services (DHS) and the DHS project manager for the WCPD project. New Hampshire, 1115 Waiver Process - Kelley Capuchino, Medicaid Policy Analyst, NHDHHS Bureau of Behavioral Health Q&A - Kelley Capuchino, Medicaid Policy Analyst, NHDHHS Bureau of Behavioral Health Part 4: Closing  Closing and post-webinar survey - Kai Baker Stringfield

2 Background Meeting with Montana Medicaid and Diabetes Program staff in 2010 (Administrators, Bureau Chiefs, program staff) Made case for Medicaid coverage for the DPP Showed evidence for health outcomes improvement using our own data and from the DPP literature (Tuomilehto et al. 2001, Knowler et al. 2002, Knowler et al. 2009) Demonstrated cost neutrality/cost savings based upon our own funding levels and from the cost-effectiveness literature (Herman et al. 2005, Herman 2011) CMS Medicaid Incentive to Prevent Chronic Disease Grant MT Medicaid and Diabetes Program applied together in May 2011 Received the grant in September 2011 Formalized partnership and our timeline and workplan to obtain Medicaid coverage from September 2011 to April 2012 Continued to work together closely on implementing this coverage Added ongoing support such as national recommendations from CDC

3 Montana Medicaid Policy Change
Administrative Rules of Montana rule change Rule amended: Services Provided by General Medicaid Services Rule added: Preventive Services by Medicaid Primary Care Services Source: State Plan Amendment to Preventive Services Section Draft began in 11/2011 and approved 4/13/2012 Effective 2/2/2012 Source: Reimbursement set according to fee schedule rates $21.88 weekly (Total for completion of all 16 weekly sessions = $350) $25.00 monthly (Total for completion of all 6 monthly sessions = $150) Total reimbursement of $500 per Medicaid member for 22-session DPP Source: Completing the logistics to get Medicaid coverage and reimbursement For program sustainability beyond grant support Via rule change and State Plan Amendment Rule change language written and approved. State Plan Amendment language written, reviewed by MT Medicaid, Regional Medicaid, and CMS staff. Received questions from CMS to respond to. Public hearing on March 28, 2012. Set reimbursement fee schedule with Medicaid and Xerox, the third party payor.

4 Examples of Provider Notices
Used the information to promote referrals by providers, proper billing by billing staff, and awareness among lifestyle coaches. *Note that these provider notices are currently being updated with information from the next slide

5 DPP – Claims Submission
Public Health Hospital Use the contracted NPI Bill as 837P or CMS-1500 Must bill separate lines for each date of service S9455: will pay $25.00 after co-pay S9460: will pay $21.88 after co-pay Use the contracted NPI Bill as 837I or UB-04 Must bill separate lines for each date of service S9455: will pay $25.00 after co-pay S9460: will pay $21.88 after co-pay

6 System Errors Being Corrected
Medicare Crossover Claims Xerox will update the claims system to include Revenue code 500 which will allow claims for members receiving Medicare and Medicaid to pay correctly and a Medicare denial will not be required. Critical Access Hospital (CAH) Xerox will update the claims system to allow CAHs to be paid at the same rate as all other facilities for S9455 and S9460. NPI Medicaid is working with Public Health and Xerox to update any inactive NPIs that were contracted to allow claims to pay correctly.

7 *Providers have 365 days from date of service to submit claims
The Good News Providers are currently being paid for their DPP services for DPP claims that are: submitted with an active NPI contracted with Public Health for Medicaid members only (not Medicare crossover) for all facilities excluding CAHs *Providers have 365 days from date of service to submit claims


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