Presentation on theme: "Dial-in: , Participant Code: #"— Presentation transcript:
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 ChangeSarah Brokaw, MPHMontana Diabetes ProgramMontana Incentives to Prevent Chronic DiseaseGrantee Conference CallMarch 4, 2015MIPCD March Program Activity WebinarSustainability Part I: Medicaid OptionsMeeting AgendaMarch 2, 2015; 3:00-4:30 p.m. (EST)Please note this call has been extended to 90 minutesDial-in: , Participant Code: #Click the link below to join the webinarae1eea49e807748b44edcWelcome1115 Waiver, and State Plan Amendment Overview- Econometrica TA teamState Sharing: Medicaid Options (topics include 1115 Waivers, State Plan Amendments and Community Health Worker Reimbursements)NH, CT, MT, MNQuestion and AnswersOpen ForumNext CallApril 6, 2015; 3:00-4:00 p.m. (EST)AdjournmentSustainability Part I: Medicaid OptionPurpose/Focus: Sustainability Part I: Medicaid OptionsObjectives:At the end of this event, participants will:Understand the 1115 Waiver Process including State AmendmentsHave tools to explore Medicaid options for program sustainability beyond grant supportEvent Manager: Kai Baker StringfieldPart 1: Opening and FramingOperator welcome and logistics (housekeeping items) - Trevor JohnsonKai frames the event, additional logistics - Kai Baker StringfieldPart 2: Overview: 1115 Waiver and State AmendmentsIntroduction to 1115 Waivers and State Amendments - Nancy Weller, Econometrica TA teamQ&A, Facilitated by Nancy - Nancy Weller, Econometrica TA teamPart 3: Medicaid Options- State SharingConnecticut, State Plan Amendment - Carolann Kapur, Medical ASO Liaison, Connecticut Department of Social ServicesQ&A - Carolann Kapur, Medical ASO Liaison, Connecticut Department of Social ServicesMontana, State Plan Amendment - Sarah, Brokaw, Program Manager, MT MIPCDQ&A - Sarah, Brokaw, Program Manager, MT MIPCDMinnesota, 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 HealthQ&A - Kelley Capuchino, Medicaid Policy Analyst, NHDHHS Bureau of Behavioral HealthPart 4: Closing Closing and post-webinar survey - Kai Baker Stringfield
2 BackgroundMeeting with Montana Medicaid and Diabetes Program staff in 2010 (Administrators, Bureau Chiefs, program staff)Made case for Medicaid coverage for the DPPShowed 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 GrantMT Medicaid and Diabetes Program applied together in May 2011Received the grant in September 2011Formalized partnership and our timeline and workplan to obtain Medicaid coverage from September 2011 to April 2012Continued to work together closely on implementing this coverageAdded ongoing support such as national recommendations from CDC
3 Montana Medicaid Policy Change Administrative Rules of Montana rule changeRule amended: Services Provided by General Medicaid ServicesRule added: Preventive Services by Medicaid Primary Care ServicesSource:State Plan Amendment to Preventive Services SectionDraft began in 11/2011 and approved 4/13/2012Effective 2/2/2012Source: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 DPPSource:Completing the logistics to get Medicaid coverage and reimbursementFor program sustainability beyond grant supportVia rule change and State Plan AmendmentRule 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 HealthHospitalUse the contracted NPIBill as 837P or CMS-1500Must bill separate lines for each date of serviceS9455: will pay $25.00 after co-payS9460: will pay $21.88 after co-payUse the contracted NPIBill as 837I or UB-04Must bill separate lines for each date of serviceS9455: will pay $25.00 after co-payS9460: will pay $21.88 after co-pay
6 System Errors Being Corrected Medicare Crossover ClaimsXerox 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.NPIMedicaid 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 NewsProviders are currently being paid for their DPP services for DPP claims that are:submitted with an active NPI contracted with Public Healthfor Medicaid members only (not Medicare crossover)for all facilities excluding CAHs*Providers have 365 days from date of service to submit claims