Effective on or after July 1, 2010, the Health Care Homes (HCH) program, authorized by the Minnesota Legislature in 2008, allows qualified MHCP-enrolled providers to receive HCH reimbursement for the delivery of care coordination services to MHCP recipients who have complex and chronic medical conditions. For recipients enrolled in managed care organization (MCO), contact the MCO directly.
The development of the HCH initiative is a coordinated effort between the Minnesota Department of Health (MDH) and DHS and is driven by the Institute for Healthcare Improvement’s Triple Aim, an initiative to simultaneously achieve the following goals:
Clinics and clinicians must meet a set of standards and criteria in order to be certified as a health care home in Minnesota. Use the MDH Health Care Homes certification process to become a certified Health Care Homes provider. To receive reimbursement for HCH services, providers must:
Effective December 6, 2012, Health Care Home (HCH) clinics and providers must fax a copy of their MDH HCH certification or recertification letters to MHCP that include the following required information:
If the MDH HCH Certification – Report does not include the NPI/UMPI for the clinic or individual providers, you must provide this information using one of the following methods:
Fax copies of the MDH HCH Certification – Report that includes all required information to MHCP Provider Enrollment at 651-431-7462.
MHCP will not process requests without the NPI/UMPI and will add the certification dates to the provider record(s).
Before billing care coordination services S0281; access MN–ITS and verify the individual provider or clinic is listed on the Health Care Homes list accessible from the Provider Lists link in the left column.
Fax copies of certification including the NPI/UMPI to MHCP Provider Enrollment at 651-431-7462.
Providers can assess the overall complexity of patients by grouping them into complexity tiers based on the number of major chronic condition groups that apply to them. MHCP recipients with one (1) or more major chronic condition are eligible for HCH. The Care Coordination Tier Assignment Tool (PDF) has been developed to support complexity assessments. Based on the above methodologies, recipients with major condition groups are scored as follows:
MHCP increases HCH reimbursement for care coordination when recipients (including their caregivers): recipients (or caregivers of dependent patients) having one of the following supplemental complexity factors:
See the Care Coordination Tier Assignment Tool for how MHCP defines these factors. There will be a 15% increase for each factor; and a 30% increase when both apply. The corresponding procedure codes and modifiers for recipient tier level and the presence of supplemental factors are described below.
HCH Tier e-Tool – effective in September 2011, MN–ITS will allow health care home (HCH) eligible providers to access a new, automated HCH Tier e-Tool that:
The e-Tool groups patients into complexity tiers based on the number of major chronic condition groups that apply to them.
Use the HCH Tier e-Tool for MHCP and non-MHCP patients to:
Refer to the list of HCH eligible MHCP Organization and Individual Providers and access information.
Health Information Request (HIR) – enables clinicians to gather a more complete medical history for MHCP recipients. Use the automated HIR clinical tool to help improve care coordination, reduce duplication of services, and improve patient safety and quality of care.
Provider Alert – Practice-specific Provider Alert reports were generated for advanced primary care practices, for patients for whom a claim was submitted for an emergency room visit or hospital admission that happened in September, 2011 and was paid by the mid-October billing cycle. DHS Medicaid enrollment and claims data were used to create this report. DHS is piloting the Excel format and the content of the report, if of value to providers; the report could be distributed monthly.
Patients were assigned to the clinic they visited most frequently for Health Care Homes (HCH) care coordination (S0280/S0281) and Evaluation and Management (E&M) services, during the previous 24 months, ending on the last day of the report month. Each recipient of HCH services was assigned to the clinic associated with the most recently submitted care coordination (S0280/S0281) claim. All other patients were assigned to the clinic most frequently seen for E&M visits in the 24-month observation period. If the patient had equal numbers of E&M visits to multiple clinics, the recipient was assigned to the clinic visited most recently.
This report includes information related to coordination and continuity of care including:
This message should be directed to the health care home team member(s) who assess the patient registry to determine care coordination need. The Provider Alert file can be found in your MN–ITS Mailbox under Miscellaneous Received, in File Type: ProviderFile. Refer to the Provider Alert Reference Guide for the reports data descriptions.
To claim care coordination payment from MHCP for fee-for-service recipients
Recipients must have an E/M visit with the care coordination provider within the last 12 months from the care coordination procedure code date of service to be eligible for reimbursement. The appropriate E/M procedure code can occur on a different date of service and be billed separately from the care coordination procedure code. E/M visit procedure codes considered are 99201-99205, 99211-99215, 99324-99328, 99334-99337, 99339, 99340, 99341-99345, 99347-99350, 99381-99387 and 99391-99397.
Reimbursement is the lower of the submitted charge or when the rendering enrolled provider is either a physician or nurse practitioner, per these tiers:
Nurse practitioner or physician assistant
Tier 1: $ 10.14
Tier 1: $ 9.81
Tier 2: $ 20.27
Tier 2: $ 19.61
Tier 3: $ 40.54
Tier 3: $ 39.22
Tier 4: $ 60.81
Tier 4: $ 58.83
HCH reimbursement is dependent on verification that both the pay-to provider and treating provider are eligible for HCH and that the recipient is enrolled.
Minnesota Statute 256B.0625 Subd. 51 (provider-directed care coordination services)Report/Rate this page