Community Paramedic Services

Revised: September 25, 2023

Overview

The Minnesota legislature enacted into law the profession of community paramedic to meet the health care needs of members living in underserved communities.

Eligible Providers

Community paramedics (CP) must meet the following:

· Be certified by the Minnesota Emergency Medical Services Regulatory Board (EMSRB)

· Be employed by a Minnesota Health Care Programs (MHCP)-enrolled ambulance service

· Have a service scope agreement, based on the paramedic’s skills, with the medical director of the ambulance service

To obtain a community paramedic certificate from the EMSRB an applicant must have:

· A current paramedic certification of Emergency Medical Technician-Paramedic (EMT- P)

· Two years of full-time service as an EMT- P

· Graduated from an EMSRB accredited course

Eligible Members

Members enrolled in MHCP are eligible for community paramedic services, except for members enrolled in the following programs :

AC	Alternative Care Program
EH	Emergency Medical Assistance
FP	Minnesota Family Planning Program
HH	HIV/AIDS
IM	Institution for Mental Disease
QM	Qualified Medicare Beneficiary

Covered Services

Community paramedics assist in the care of members who receive hospital emergency department services three or more times in four consecutive months within a 12-month period, or have been identified as someone who:

· Is at risk of nursing home placement.

· Is being discharged from a hospital or nursing facility.

· Is at risk of readmission to a hospital or nursing facility.

Community paramedic services are covered when they are part of the care plan ordered by the member’s primary care provider (physician, advanced practice registered nurse [APRN] or physician’s assistant). Community paramedic services do not need to be provided in a member’s home. The primary care provider consults with the ambulance service’s medical director to ensure there is no duplication of services.

Either the primary care provider or the medical director must coordinate the care plan with all local community health providers and the local public health agencies, including home health and waiver services, to avoid duplication of services to the member. Services the community paramedic may perform are:

· Health assessments

· Chronic disease monitoring and education

· Medication compliance

· Immunization and vaccinations

· Laboratory specimen collection

· Hospital discharge follow-up care

· Minor medical procedures approved by the ambulance medical director

Telehealth visits are covered when they are medically appropriate and adhere to the requirements of our telehealth policy.

Noncovered Services

The following services are not covered:

· Travel time

· Mileage

· Facility fee

· Services related to hospital-acquired conditions or treatments

Documentation Requirements

Keep complete documentation on file. Refer to the Provider Requirements section of the MHCP Provider Manual for guidelines.

Billing

Refer to Billing Policy for general MHCP billing policies. The MHCP-enrolled medical director of the ambulance service employing the community paramedic must bill the community paramedic services as follows:

· Bill using the 837P claim form.

· In the “Treating Provider” field, enter the medical director’s national provider identifier (NPI).

· Enter the clinic, hospital or ambulance service’s NPI or unique Minnesota provider identifier (UMPI) in the “Pay To” field.

· Use code T1016 with modifier U3.

· Select the appropriate place of service from the drop down in MN–ITS.

· Bill in 15-minute increments (one unit = 15 minutes).

More than half of one billing unit (eight minutes) must be spent performing the service face-to-face in order to report a unit.

Bill supplies primary to the encounter separately. Supplies used by the community paramedic in direct relationship to the illness or injury are considered incidental to the service and not separately billable to MHCP.

An example of a billable item would be the medication in a shot. Examples of non-billable items would be the syringe and needle used in that shot.

Also, see the Community Paramedic Services training video for instructions on how to bill for community paramedic services using MN–ITS.

Legal References

Minnesota Statutes, 256B.0625, subdivision 60 (Community paramedic services)
Minnesota Statutes, 144E.28, subdivision 9 (certification of community paramedics)
Minnesota Statutes 144E (Emergency Medical Services Regulatory Board)