Medicaid and Community Prevention

Webinar on Medicaid and Community Prevention

Description
The purpose of this Webinar was to highlight a new opportunity for funding community-based prevention services. As of January 1, 2014, a new Medicaid rule now allows reimbursement for preventive services delivered by non-licensed providers, upon referral from a licensed Medicaid provider. Presenters discussed implementation requirements for states and communities, examples of successful strategies for preventive service delivery by non-licensed providers such as Community Health Workers, and collaboration with state Medicaid agencies and Managed Care Organizations to pursue coverage for new reimbursement. Challenges discussed included implementing programs with non-licensed providers and developing partnerships with Medicaid. Presenters offered steps to overcome these barriers. This Webinar also included a discussion around identifying multiple opportunities for partnerships to address chronic disease prevention and establish long-term funding for sustainability.

Learning Objectives
By the end of this Webinar, awardees were expected to be able to:
• Describe the new opportunity for reimbursement of community prevention related to the Medicaid rule change.
• Identify at least two tools/resources for guidance on working with Medicaid agencies and how to pursue Medicaid reimbursement or coverage for preventive services post-Webinar.
• Initiate discussion around developing multiple partnerships for sustainability of chronic disease prevention efforts.

Presenters
• Anne De Biasi, Director of Policy Development, Trust for America’s Health
• Pam Keach, Strategic Lead, CA4Health, a Community Transformation Grant initiative of the Public Health Institute, University of California, San Francisco
• Michael E. Rhein, President and CEO, Institute for Public Health Innovation

TFAH and Nemours Meeting Summary: Medicaid Reimbursement for Community-Based Prevention

Description

TFAH and Nemours hosted a convening on October 31, 2013 to discuss the potential impact of a new Rule on paying for prevention in Medicaid. The Medicaid Rule clarifies that states can reimburse for preventive services “recommended by a physician or other licensed practitioner…within the scope of their practice under State law”. Previously states were restricted to reimbursing only licensed providers. TFAH and Nemours had partnered to advocate for this rule change, which became law in July, 2013.

As of January 1, 2014, the Medicaid Rule allows reimbursement for preventive services delivered by non-licensed providers, upon recommendation from a licensed Medicaid provider. This Meeting Summary includes an explanation of the new Medicaid rule and what states and providers will need to do to implement it. This meeting summary also includes a questionnaire, developed by Nemours, that can help to guide advocates seeking to implement the rule change by outlining all the information a state will need to submit the required state plan amendment.