To enroll in Minnesota Health Care Programs (MHCP), a clinic must have a federal employer’s identification number (FEIN) and must report the number to the Provider Eligibility and Compliance Unit.

Covered and Noncovered Services

For covered and noncovered services, refer to the individual services sections, such as Physician and Professional Services and Dental Services in the MHCP Provider Manual.

Community Health Clinic (CHC)

A CHC must meet the following requirements:

· Have nonprofit status as specified in applicable Minnesota Statutes.

· Have tax-exempt status as provided for in the Internal Revenue Code 501(c)3.

· Be established to provide health services to low-income population groups.

· Assure the facility meets the definitions of a CHC required by Minnesota Statutes, 256B.0625, subd. 30 and Minnesota Rules, 9505.0255 subp.4.

A CHC must document the following in its 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, refer to the Community Health Clinic Enrollment Criteria and Forms section.

CHC Eligible Providers

· Physicians

· Physician assistants (PA)

· Advanced practice registered nurses (APRN). APRNs 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: PAs and APRNs who choose not to enroll with the Minnesota Department of Human Services (DHS), or genetic counselors, registered nurses and licensed acupuncturists.

CHC 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

Refer to specific supervision and reporting requirements for Physician Extenders in the Physician and Professional Services section of the Provider Manual.

Tuberculosis Case Management and Directly Observed Therapy
MHCP covers case management and directly observed therapy services for MHCP members infected with tuberculosis (TB) enrolled in major programs that receive federal funding. Eligible providers employed by a Community Health Board must administer TB case management and directly observed therapy. Refer to Definitions.

· TB case management services are covered by any of the clinic types listed on this page 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.

TB 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.

· Providing directly observed therapy.

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

Community Health Worker (CHW) Patient Education
CHW patient education services can be provided at each of the clinic types listed on this page.

CHWs are eligible to enroll as fee for service (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 Community Health Worker section of the MHCP Provider Manual for FFS covered services, and CPT procedure code billing requirements. Refer to Community Health Worker Enrollment Criteria and Forms for information about enrolling.

CHWs providing diagnosis-related patient education services to enrollees of a managed care organization (MCO) must contact the MCO for enrollment requirements and CHW coverage policies.

CHC Billing

Go to the Physician and Professional Services section of the Provider Manual for billing instruction.

TB Case Management and Directly Observed Therapy Billing
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. Bill electronically using MN–ITS 837P.

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. Refer to Public Health Clinic Enrollment Criteria and Forms to enroll.

PHC 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, or genetic counselors, registered nurses and licensed acupuncturists.

PHC 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

· TB case management and directly observed therapy

· CHW patient education services (diagnosis related) provided by a CHW under the supervision of a certified public health nurse

Refer to Physician Extenders section of the MHCP manual for specific supervision and reporting requirements for physician extenders.

PHC Billing

Visit the Physician and Professional Services section of the Provider Manual for billing instruction and the Billing for Public Health Clinic, PHNC and School-Based PHNC Services table. Review TB Case Management and Directly Observed Therapy Billing for billing instruction.

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 member’s home.

PHNC Eligible Providers

· Public health nurses

· Licensed registered nurses practicing in a PHNC who are supervised by a public health nurse

PHNC Covered Services

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 and Professional Services and Diabetic Self-Management Training manual sections for coverage information and requirements on in-depth nutritional counseling and diabetic education programs.

· Medication support: 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: Assessment that includes an evaluation of health behaviors and risk factors and is performed within the scope of practice of a licensed registered nurse.

· TB case management and directly observed therapy

· CHW patient education services (diagnosis related) provided by a CHW under the supervision of a certified public health nurse.

PHNC services that are typically provided in the clinic setting may also be performed in the member’s home on an intermittent basis. The services must be necessary to ensure that the member receives the necessary care.

PHNCs using evidence-based models to provide prenatal and post-partum visits are eligible for an enhanced payment. These programs must be able to verify they have met the United States Department of Health and Human Services criteria as an evidence-base model.

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. Refer a member who needs traditional home care to a Medicare Certified Home Care Agency.

PHNC 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, blood pressure, and client history

· Services of a child who has an individualized education plan (IEP) or individualized family services plan (IFSP)

PHNC Billing

Go to Billing for Public Health Clinic, PHNC and School-Based PHNC Services table.

School-Based PHNC

School-based public health nursing clinics must meet the same requirements as a PHNC. They must be a 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.

Schools must enroll with MHCP as a Public Health Nursing Clinic. Schools must use the PHNC national provider identifier (NPI) for billing.

School-Based PHNC eligible providers must be licensed registered nurses, supervised by a public health nurse or licensed school nurse and practicing in a public school setting that is enrolled as a PHNC.

Supervision is defined as being supervised by a public health nurse who is assigned to oversee the individuals and operations of the PHNC.

Public health nurses may be contracted through a local public health agency.

School-Based PHNC Covered Services

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

· Health promotion and counseling. This service could include, but is not limited to, chronic disease management, behavioral and mental health, sexual health, vision loss, hearing loss and oral health.

· Medication support. This service could include, but is not limited to, medication management for chronic illness, medication administration which includes nursing assessment such as diabetes, seizures, anaphylaxis, opioid overdose and asthma exacerbation.

· Note: Medication support does not include simple medication administration if nursing assessment is not performed.

· Nursing Assessment. This service could include but is not limited to assessment and follow up for failed vision or hearing screening, individual health plan or emergency care plan development by the registered nurse or public health nurse, immunization administration, assessment and follow up for mental health symptoms or screening.

School-Based PHNC Noncovered Services

For services that are not covered under school-based PHNC, review PHNC Noncovered Services.

Billing for School-Based PHNC

Refer to the following billing table for school-based PHNC billable HCPCS codes T1015, S9445, S9446 and S9123.

The school-based PHNC are responsible to ensure all coordination of services and that documentation is completed.

Billing for Public Health Clinic, PHNC and School-Based PHNC Services

Bill electronically using MN–ITS 837P.

Public health nurses must bill using the NPI of the PHNC.

Code	Description	Unit	Qualifying Information
T1015	Clinic visit or 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 the drug.
S9445	Patient education only, non-physician provider, individual	1 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 or encounters. · Ensure proper documentation is attached with the claim as previously mentioned under PHNC services on this page.
S9446	Patient education only, non-physician provider, group	1 session
S9123	Nursing care, in the home or place of residence, by a public health nurse or registered nurse. *If a Skilled Nurse Visit is being provided by a Medicare certified agency, refer to the MHCP Provider Manual- Home Care Services section for billing information.	1 Visit	· Although S9123 is a per hour service, MHCP allows 1 unit per date of service regardless of the actual time spent providing the service. · The administration of injections is included in the home visit. Bill appropriate HCPCS code for the drug. · Use the U8 modifier for billing evidence-based home visits · Per CPT guidelines, an hour is attained when 31 minutes of face-to-face time with each client has elapsed. · An ordering provider must be listed on the claim.
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
H1002	At-risk care coordination	1 encounter
H1003	At-risk prenatal education	1 encounter
H1004	At-risk enhanced service	1 encounter

See TB Case Management and Directly Observed Therapy Billing for billing instruction.

Definitions

Community Health Board: A board of health established, operating and eligible for a subsidy (from the Commissioner of Health). The board has a 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.

Individuals Infected with TB are:

· Infected with latent or active tuberculosis who have a positive TB skin test.

· Have a negative tuberculin skin test, but a positive sputum culture for the TB organism.

· Have a TB test that is negative, but whose physician's certifies the individual requires a TB-related drug or surgical therapy or both.

Directly Observed Therapy: Physically watching the person take the drugs prescribed for TB. TB services can be provided at each of the clinic types listed on this page.

Legal References

Minnesota Rules, 9505.0395 (Rural Health Clinic Services and FQHC Services)
Minnesota Statutes, 256B.0625, Subdivision 4 (Physician Clinic)
Minnesota Statutes, 256B.0625, Subdivision 30 (Community Clinic)
Minnesota Rules, 9505.0255 (Community Health Clinic Services)
Minnesota Rules, 9505.0380 (Public Health Clinic Services)
Minnesota Statutes, 256B.0625, Subdivision 40 (Tuberculosis-related services in Public Health Clinic)
Minnesota Statutes 256B.0625, Subdivision 49 (Community Health Worker)
Title XIX, Section 1905(l) of the Social Security Act
Minnesota Rules, 8710.6100 (School Nurse)

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