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Clinic Services

Revised: 06-03-2016

  • Community Health Clinic Services
  • Public Health Clinic
  • Community Health Worker Patient Education
  • Tuberculosis Case Management and Directly Observed Therapy
  • Public Health Nursing Clinic (PHNC)
  • Federally Qualified Health Center and Rural Health Clinics
  • FQHC/RHC Billing Requirements
  • Legal References
  • The following clinic services are included in this chapter:

  • Community Health Clinic
  • Public Health Clinic
  • Public Health Nursing Clinic
  • Provider Requirements

    To enroll in MHCP, a clinic must have a federal employer’s identification number and must report the number to the DHS Provider Enrollment Unit. Additional requirements may apply; refer to the specific clinic section in this chapter.

    Covered and Noncovered Services

    For covered and noncovered services, refer to the individual services chapters, such as Physician and Professional Services section and Dental Services section.

    Pay-for-Performance Program

    Review information about the newly implemented Pay-for-Performance Program.

    Community Health Clinic Services (CHC)

    CHC must meet the following requirements:

  • • Has nonprofit status as specified in applicable Minnesota Statutes
  • • Has tax-exempt status as provided for in the Internal Revenue Code 501(c)3
  • • Is established to provide health services to low income population groups
  • • Assures the facility meets the definitions of a CHC required by Minnesota Statutes 256B.0625, subd. 30 and Minnesota Rules 9505.0255 subp.4
  • CHC must document the following in their clinic files:

  • • A description of health services provided
  • • Policies concerning medical management of health problems including health conditions which require referral to physicians or other health professionals and provision of emergency health services
  • • Policies for maintenance and review of health records by the physician
  • To enroll as a CHC, the facility must sign and complete:

  • MHCP Enrollment Application (DHS-4016) (PDF)
  • CHC Applicant Assurance Statement (DHS-5732) (PDF)
  • Covered Services

  • • Physician services
  • • Preventive health services
  • • Family planning services
  • • Early periodic screening, diagnosis, and treatment services, also known as Child and Teen Checkups (C&TC)
  • • Dental services
  • • Prenatal care services
  • Eligible Providers

  • • Physicians
  • • Physician assistants (PA)
  • • Advanced practice registered nurses (APRN). APRN may contract with, be a volunteer of, or an employee of a community health clinic
  • • Nurse practitioners (NP)
  • • Certified nurse specialists (CNS)
  • • Certified nurse midwives (CNM)
  • • Physician extenders: PA and APRN who choose not to enroll with DHS, genetic counselors, registered nurses and licensed acupuncturists.
  • See specific supervision and reporting requirements for physician extenders in the Physician and Professional Services chapter’s Physician Extender section.

    Provider Type Home Page Links
    Review related Web pages for the latest news and additions, forms, and quick links.


    Public Health Clinic (PHC)

    Public health clinics must be a department of, or operate under the direct authority of a unit of government. Examples of a unit of government include county and city.

    Covered Services

  • • Physician services
  • • Preventive health services
  • • Family planning services
  • • Early periodic screening, diagnosis, and treatment services, also known as Child and Teen Checkups or C&TC
  • • Dental services
  • • Prenatal care services
  • • Patient Education Services (diagnosis related) provided by a CHW under the supervision of a certified public health nurse
  • • Tuberculosis case management and directly observed therapy
  • Eligible Providers

  • • Physicians
  • • Physician assistants (PA)
  • • Advanced practice registered nurses (APRN)
  • • Nurse practitioners (NP)
  • • Certified nurse specialists (CNS)
  • • Certified nurse midwives (CNM)
  • • Physician extenders: PA and APRN who choose not to enroll with DHS, genetic counselors, registered nurses and licensed acupuncturists.
  • See specific supervision and reporting requirements for physician extenders in the Physician and Professional Services chapter’s Physician Extender section.

    Community Health Worker (CHW) Patient Education

    Effective 7/1/08, CHWs became eligible to enroll as FFS MHCP providers under the supervision of a certified public health nurse operating under the direct authority of an enrolled unit of government. CHWs may provide diagnosis related patient education and self-management to promote good health and self-management. Refer to the MHCP Provider Manual CHW section for FFS enrollment, covered services, and CPT procedure code billing requirements.

    CHWs providing diagnosis-related patient education services to enrollees of a managed care organizations (MCOs) must contact the MCOs for enrollment requirements and CHW coverage policies. CHW services coverage under the supervision of a certified public health nurse in MCOs began on or after January 1, 2009.

    Tuberculosis Case Management and Directly Observed Therapy

    The DHS Omnibus Bill provides for coverage of case management and directly observed therapy services for MHCP recipients infected with tuberculosis enrolled in major programs that receive federal funding. These services are not available for recipients enrolled in General Assistance Medical Care (GAMC). TB case management and directly observed therapy must be provided by eligible providers employed by a Community Health Board.

    Community Health Board: A board of health established, operating and eligible for a subsidy (from the Commissioner of Health). The board has general responsibility to develop and maintain an integrated system of community health services under local administration and within a system of state guidelines and standards.

    Case Management Services: Face-to-face services furnished to assist persons infected with TB in gaining access to needed medical services.

    Persons Infected with TB: Individuals infected with latent or active tuberculosis who have a positive TB skin test, or have a negative tuberculin skin test, but a positive sputum culture for the TB organism; an individual whose TB test is negative, but whose physician's certification indicates the individual requires TB-related drug and/or surgical therapy can be considered TB infected.

    Directly Observed Therapy: Physically watching the recipient take the drugs prescribed for TB.

    Covered Services

    Case management services include, at a minimum:

  • • Assessing the need for medical services to treat tuberculosis
  • • Developing a plan of care addressing those needs
  • • Assisting in accessing medical services identified in the care plan
  • • Monitoring compliance with the care plan to ensure completion of tuberculosis therapy
  • • Directly observed therapy
  • Eligible Providers

  • • Case management services are covered if provided by a certified public health nurse, employed by a community health board
  • • Directly observed therapy must be provided by a public health nurse employed by a community health board, or by a community outreach worker, licensed practical nurse or registered nurse trained and supervised by a certified public health nurse employed by a community health board
  • Drugs for Tuberculosis

    MHCP covers drugs for tuberculosis and other communicable diseases if prescribed by a licensed practitioner and dispensed by a physician or certified nurse practitioner employed by, or under contract with, a community health board for purposes of communicable disease control.

    Billing Requirements

    Use code T1016 for case management and code H0033 for directly observed therapy. These two codes should not be billed on the same day, nor should office or home visits be billed on the same day as case management. Electronically bill using MN–ITS 837P.

    Public Health Nursing Clinic (PHNC)

    Public health nursing clinics must meet the following requirements:

  • • Be department of, or operate under the direct authority of a unit of government. Examples of a unit of government include county, city, or school district
  • • Be performed at a main clinic site, satellite clinics, mobile clinic sites that are open to the public, or the recipient’s home
  • Eligible Providers

  • • Public Health Nurses (PHN)
  • • Licensed registered nurses, supervised by a PHN, practicing in a PHNC
  • Covered Services

    Clinic Visits – Clinic visits may include, but are not limited to, services in the following areas:

  • • Health Promotion and Counseling: Education and counseling to alleviate or prevent health problems. This service does not include in-depth nutritional counseling normally performed by a licensed dietician, nor does it include structured diabetic education programs. Refer to the Physician’s Services section: Nutritional Counseling and Diabetic Education sections for coverage information and requirements for in-depth Nutritional Counseling and Diabetic Education.
  • • Medication Management: Review of current medications and adherence to the prescribed medication regime. Education on proper medication use and contact with the prescribing physician when necessary
  • • Nursing Assessment Treatment and Diagnostic Testing: A health history or examination that includes an evaluation of health behaviors and risk factors, and is performed within the scope of practice of a licensed registered nurse
  • • Home Visits – PHNC services that are typically provided in the clinic setting may also be performed in the recipient’s home on an intermittent basis, when necessary to ensure that the recipient receives the necessary care
  • PHNC visits may not be used as a substitute for traditional home care, such as the type of home care that is reimbursable by Medicare. If a recipient needs traditional home care, the recipient should be referred to a Medicare Certified Home Care Agency.

    Noncovered Services

  • • Services covered by a primary insurance
  • • Services that are part of the WIC (Women, Infants & Children Food Program) clinic package, such as height, weight, B/P, and client history
  • • Services provided by a school-based PHNC, which are available at no cost to a non-MA recipient student
  • Billing for PHNC Services

    Electronically bill using MN–ITS 837P.

    Code

    Description

    Unit

    Qualifying Information

    T1015

    Clinic visit/encounter, all-inclusive

    1 visit

  • • MHCP allows one visit per date of service
  • • Administration of injections is included in the clinic visit. Bill appropriate HCPCS code for drug
  • S9445

    Patient education, non-physician provider, individual

    Patient education only, non-physician provider, individual or group

    per session

  • • May be reported on the same day as T1015
  • • Bill one unit per person for each class session. A session is one encounter; a class that meets four weeks has four sessions/encounters.
  • S9446

    Patient education, non-physician provider, group

    S9123

    Nursing care, in the home or place of residence, by PHN or registered nurse, per hour

    *If a Skilled Nurse Visit is being provided by a Medicare Certified Agency, refer to MHCP Provider Manual-Home Care Services section for billing information

    1 hour

    99501




    99502

    Home visit for postnatal assessment and follow up care—mother

    Home visit for newborn care and assessment

    1




    1

    S9443

    Lactation classes, nonphysician provider, per session

    1

    Bill one unit per person for each class session

    Legal References

    Minnesota Rules 9505.0250 (physician clinic)
    Minnesota Statutes 256B.0625, subd.4 (physician clinic)
    Minnesota Statutes 256B.0625, subd.30 (community clinic)
    Minnesota Rules 9505.0255 (community clinic)
    Minnesota Rules 9505.0380 (PH clinic)
    Minnesota Statutes 256B.0625, subd.40 (TB tx in PH clinic)
    Minnesota Statutes 256B.0625
    , subd. 49 (community health worker)
    42 CFR 491 (RHC)
    42 USC 1396d (RHC)
    Minnesota Statutes 256B.0625, subd.29 (FQHC)
    42 CFR 491 (FQHC)
    Title XIX, Section 1905
    (l) of the Social Security Act
    CR 4210
    (RHC & FQHC)

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