Provider Notice: Community Health Workers in Federally Qualified Health Centers and Rural Health Clinics (IB 22-21)
Date: 07/07/22
(Original publish date 7/1/22. Revised date 7/7/22 in italics)
Louisiana Healthcare Connections would like to inform providers of updated requirements for Community Health Workers in Federally Qualified Health Centers and Rural Health Clinics. The added coverage of services provided by CHW in FQHCs and RHCs is effective for dates on or after January 1, 2022.
Medicaid received approval from the Centers for Medicare and Medicaid Services (CMS) to reimburse services rendered by qualified Community Health Workers (CHW) in federally qualified health centers (FQHC) and rural health clinics (RHC) effective for dates of service on or after January 1, 2022.
CHW service reimbursement is based on an alternative payment methodology, which allows reimbursement outside of the current Prospective Payment System rate for CHW services provided in FQHC and RHC settings. Providers will receive payment for services at the rate on file for the date of services as published on the Professional Service fee schedule on www.lamedicaid.com.
In order to be considered for reimbursement, FQHC and RHC claims for CHW service reimbursement must include all of the following:
- A Healthcare Common Procedure Coding System (HCPCS) for the visit (T1015, H2020, or D0999);
- An evaluation and management code; and
- The corresponding Current Procedural Terminology (CPT) code for the CHW services to receive reimbursement.
FQHCs/RHCs will be reimbursed the rate on file for the encounter visit in addition to the rate on file for the CHW services for the date of service.
The policy for CHW services is located in the Professional Services Provider Manual on www.lamedicaid.com.
FQHC and RHC policy regarding the billing of CHW services is located on www.lamedicaid.com in the respective provider manuals.FQHC and RHC claims must include a Healthcare Common Procedure Coding System (HCPCS) for the visit, an evaluation and management code, and the corresponding Current Procedural Terminology (CPT) code for the CHW services to receive reimbursement. HCPCS T1015, H2020, and D0999 are allowed on the claim for the CHW services to be reimbursed.
The policy regarding CHW services is pending. The policy will be located in the Professional Services Provider Manual on www.lamedicaid.com.
FQHC and RHC policy regarding billing of CHW services is also pending. The policy will be located on www.lamedicaid.com in the respective provider manuals.
Fee-for-service (FFS) system updates are pending and this notice will be updated once system changes are implemented. Claims will be recycled upon implementation.
Louisiana Healthcare Connections is updating our system and will recycle any claims that were paid incorrectly according to this change within 60 days of this notice. Denied claims will be recycled with no action needed by the provider.
Questions regarding FFS claims processing should be directed to Gainwell Technologies Provider Services at (800) 473-2783 or (225) 924-5040. Providers can contact their dedicated Provider Network Consultant or Provider Services at 1-866-595-8133 with questions regarding managed care claims processing.
Louisiana Healthcare Connections is in updating our Provider Manual to reflect these changed in the next 30 days.