Maternal and Infant Health Social Work Services Presentation
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Transcript Maternal and Infant Health Social Work Services Presentation
Maternal and
Infant Health
Social Work
Services
OHCA Rules and Policies
August 15, 2008
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
–
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)
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)
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
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
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
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
MIH Social Workers:
Provide short term problem
focused counseling
Assess maternal emotional well
being
Maternal –infant bonding and
interactions
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
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
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
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
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
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
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
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
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
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
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
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)
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
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
OHCA Contacts
Child Health Unit
– Terrie Fritz, LCSW, Director of Child Health
405-522-7377
[email protected]
– Shelly Patterson, CPH, Perinatal Coordinator
405-522-7332
[email protected]
OHCA Provider Representative
– 1-877-823-4529 option 2
OHCA website
– www.okhca.org
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
SoonerRide
1-877-404-4500
Patient Advice Line
1-800-530-3002
Questions?