Health Initiatives : MCAC BZ Giese, RN July 16, 2013 HeART - - PowerPoint PPT Presentation

BZ Giese, RN July 16, 2013

Health Initiatives : MCAC

HeART Initiative - Charleston Promise

Neighborhood (CPN)

• SCDHHS is working with CPN and IFS to review data and

Medicaid eligibility within their four schools: James Simons Elementary, Sanders-Clyde Creative Arts, Mary Ford Elementary, and Chicora School of Communications

• SCDHHS will help facilitate a shared eligibility worker

for the 4 CPN schools and possibly the entire Charleston County School District

• SCDHHS will offer a training session on How To bill Medicaid

for the service provider

• CPN hiring a Nurse Practitioner 8/1

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HeART Initiative - Charleston Promise Neighborhood (CPN)

• SCDHHS is developing a turn-key packet to describe the

sustainability model for other schools in the state to replicate from start to finish

• Model supports PCMH concept by ensuring the primary care

practice receives school/NP report of each visit

• CPN and SCDHHS will partner to host a fall health fair to

engage parents and the community in the CPN program while encouraging Medicaid enrollment

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Obesity

• SPA to recognize Licensed Dietitians as a new provider type is currently under

review by CMS

• On June 20th SCDHHS hosted an external stakeholder meeting to review our

current status on obesity. Attendees included but not limited to MCO/MHN’s, LD’s, and Physicians

• Clemson/MMIS and MCO aligning systems for payment
• *Physicians will utilize two codes:

*After 6 visits SCDHHS will require internal medical review

The provider will be required to use the 5A’s as recommended by the US Preventative Task Force during the initial exam –

Assess, Advise, Agree, Assist, Arrange

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G Code Modifier Service Per Fiscal Year G0402 U5 Initial Preventative physical exam provided by a Practitioner 1 G0402 U6 Subsequent Preventive service provided by a Practitioner 5

Obesity

• Licensed Dietitians will utilize two codes:

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*After 6 visits SCDHHS will require internal medical review

ICD-9 codes listed below must be included with the G code or S code to monitor and

evaluate a patient’s progress through tracking their Body Mass Index Program Participation starts at BMI of <30 V85.30 BMI 30.0-30.9 V85.36 BMI 36.0-36.9 V85.31 BMI 31.0-31.9 V85.37 BMI 37.0-37.9 V85.32 BMI 32.0-32.9 V85.38 BMI 38.0-38.9 V85.33 BMI 33.0-33.9 V85.39 BMI 39.0-39.9 V85.34 BMI 34.0-34.9 V85.40 BMI 40.0-44.9 V85.35 BMI 35.0-35.9

S Code Service Per Fiscal Year S9470 Nutritional counseling, dietitian visit service provided by a licensed dietician 1 S9452 Nutrition classes, non-physician provider, per session service provided by a licensed dieticians 5

Obesity

• SCDHHS in final review of a How to Enroll as a Medicaid

Provider (will apply to all providers and on website)

• SCDHHS is working closely with the SC Academy of

Nutrition and Dietetics during this process and creating a list of all LD’s

• SCDHHS to initiate a statewide education campaign

with provider offices throughout the state

• Anticipated launch date: October 1, 2013

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