Steps to Enrollment

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MHCP to Enroll Community Health Workers (CHWs)

On December 19, 2007, MHCP received federal approval to reimburse services provided by community health workers (CHWs) enrolled as fee-for-service (FFS) MHCP providers effective for dates of service on and after July 1, 2007.

Coverage of CHW services for enrollees of managed care organizations (MCOs) will begin on or after February 18, 2008. Contact the MCO about enrollment requirements and coverage before providing services.

CHWs provide patient education in clinics, outpatient and community settings to increase access to health care and promote health and disease prevention.

Enrollment Criteria

To enroll as an MHCP provider, a CHW must:

• Meet one of the following criteria:
  • Have a certificate from the Minnesota State Colleges and Universities (MnSCU) approved community health worker curriculum
  • Have at least five years of supervised experience with an MHCP-enrolled physician or advanced practice registered nurse (APRN) providing education services. CHWs under this provision must complete the MnSCU certification program before January 1, 2010, to continue to provide CHW services.
• Complete and sign the Applicant Assurance Statement (DHS-5308)
  
  • If the CHW has a MnSCU certification, attach a copy of the certification to the form
    
  • If the CHW has supervised experience, the MHCP enrolled supervising physician or APRN must sign the form and document the dates CHW was supervised
    
• Complete and sign the MHCP Provider Agreement (DHS-4138) and MHCP Enrollment Application (DHS-4016)
• Submit all signed and completed forms to MHCP
  Fax:           (651) 431-7462
  Mail:          DHS – MHCP Provider Enrollment
  PO Box 64987
  St. Paul, MN 55164-0987

MHCP requires your enrollment so CHWs are represented on the claim as the person who provided the services.

Tribal Community Health Representatives (CHRs) may be enrolled as CHWs if they complete the MnSCU certification or meet the five years of supervised experience as stated above. MHCP and MnSCU will work with tribes and IHS to determine how CHR training might be used to meet CHW requirements. MHCP will notify providers about this information in a future update.

MHCP Provider Enrollment will notify each applicant within 30 days of receiving signed and completed application, agreement, and applicant assurance statement.

Covered CHW Services

MHCP will cover supervised, diagnosis related patient education services provided by a CHW with the following criteria:

• The CHW is supervised by an MHCP-enrolled physician or APRN
• A physician or APRN must order the patient education service(s) and must order that they be provided by a CHW
• A physician order or care plan signed by an MHCP-enrolled physician or APRN is in the recipient’s record and specifies whether group and/or individual services are ordered
  
• The CHW shall document the date of service, start and end times for each service, whether the service was group or individual and if group, number of patients present, summary of the session’s content, and the CHW’s signature and printed name
  
• The service involves teaching the patient how to effectively self-manage their health in conjunction with the health care team
  
• The service is provided face-to-face with the recipient (individually or in a group) in an outpatient, home, or clinic setting
  
• The content of the educational and training program is a standardized curriculum consistent with established or recognized health care standards. Curriculum may be modified as necessary for the clinical needs, cultural norms and health literacy of an individual patient
  
• Oral interpretation and sign language services are allowed when requirements are met. Refer to the MHCP Provider Manual, Provider Requirements section, Access Services topic for coverage requirements.

Billing

Bill MHCP for the following:

• FFS recipients: for dates of service on and after July 1, 2007
• MCO enrollees: for dates of service on July 1, 2007, through February 17, 2008

Bill the appropriate MCO for MCO enrollees for dates of service on or after February 18, 2008.

Bill MHCP using MN–ITS 837P or 837I; or the CMS-1500 or UB-04 paper claim form:

• Use the National Provider Identifier (NPI) or MHCP provider number of the hospital, clinic, physician, or APRN as the billing provider
• Use the appropriate procedure code:
• 98960: Self-management education & training, face to face, 1 patient
• 98961: Self-management education & training, face-to-face, 2 – 4 patients
• 98962: Self-management education & training, face-to-face, 5 – 8 patients
• ill in 30-minute units: limit 4 units per 24 hours; no more than 8 units per calendar month per recipient
• Bill separate lines for each day service provided
• Enter appropriate ICD-9-CM diagnosis code(s)
• Use your CHW non-pay-to Unique Minnesota Provider Identifier (UMPI) number as rendering or attending provider

Federal Qualified Health Centers (FQHC) and Rural Health Centers (RHC) bill using appropriate claim for service or MHCP program.

Additional Resources

Minnesota Session Laws 2007, Chapter 147 (HF 1078-3E):

• Article 4, section 7, subd. 49, Community health worker
• Article 5, section 17, subd.24 GAMC Community health worker

2007 Legislative Changes: Part I (Provider Update LEG-07-01, 7/3/07)
MS 256B.0625, subd. 49

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