[PC-BH-Integration] New to List

Tue Feb 17 10:50:49 EST 2009

Text from Texas' Medicaid guidelines (most other states say the same thing):

A visit is a face-to-face encounter between an FQHC client and a physician,
PA, NP, certified nurse-midwife (CNM), visiting nurse, qualified clinical
psychologist, clinical social worker, other health professional for mental
health services, dentist, dental hygienist, or an optometrist. Encounters
with more than one health professional and multiple encounters with the same
health professional that take place on the same day and at a single location
constitute a single visit, except where one of the following conditions
exists: . After the first encounter, the client suffers illness or injury
requiring additional diagnosis or treatment. . The FQHC client has a medical
visit and an other health visit. A medical visit is a face-to-face encounter
between an FQHC client and a physician, physician assistant, NP, CNM, or
visiting nurse. An other health visit includes, but is not limited to, a
face-to-face encounter between an FQHC client and a qualified clinical
psychologist, clinical social worker, other health professional for mental
health services, a dentist, a dental hygienist, an optometrist, or a THSteps
medical check up. (italics in original text)

http://www.tmhp.com/File%20Library/File%20Library/Provider%20Manuals/Texas%2
0Medicaid%20Provider%20Procedures/2008%20TMPPM%20Individual%20files/21_TMPPM
08_Federally_Qualified_Health_Center_(FQHC).pdf

Bill Schlesinger
Project Vida
3607 Rivera Ave
El Paso, TX 79905
(915) 533-7057 x 207
(915) 490-6148 mobile
(915) 533-7158 fax
bschlesinger.pv at tachc.org

  _____  

From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Bill
Schlesinger
Sent: Sunday, February 15, 2009 9:03 PM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] New to List

I don't know a lot about your situation, but how many Medicaid vs. uninsured
children does the FQHC see?  Is the FQHC aware that they can bill for a
mental health visit and a medical visit on the same day?  The FQHC should be
able to report the Medicaid encounter and then receive the prospective
payment ('wraparound') from Medicaid at their full rate - with no upcoding
required.  Also, beginning in October, CHIP will also provide the
prospective payment to FQHC's.   The FQHC is also eligible to apply for
Mental Health Service Expansion (applications just went in last month on the
latest round) for up to $150,000 a year to cover 'unfunded' mental health
services.

Bill Schlesinger
Project Vida Health Center
3607 Rivera Ave
El Paso, TX 79905
(915) 533-7057 x 207
(915) 490-6148 mobile
(915) 533-7158 fax
bschlesinger.pv at tachc.org

  _____  

From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Jody Rowell
Sent: Saturday, February 14, 2009 8:55 AM
To: pc-bh-integration at lists101.his.com
Cc: pc-bh-integration at nccbh.net
Subject: Re: [PC-BH-Integration] New to List

Hi, our primary care integration with a FQHC is failing.  As an LCSW I am
there for 4 hours a week.  I have been providing consultation to the medical
clinicians, seeing kids and their parents briefly, and hooking them up with
other MH external services as indicated.  Because I am the only child
therapist there it doesn't seem particularly helpful to do a full hour
assessment (90801) to provide a few sessions, especially since there is an
enormous amount of backlog.  In addition, I would need a translator with me
for a large majority of the assessments and treatment.  Currently there are
over a 100 kids on the shared list.  Our MH clinic is billing the FQHC for
my time.  The FQHC is struggling financially and is feeling that they cannot
continue to pay for my presence even though they find it valuable.  I am not
billing enough to cover my time there.  Upcoding through FQHC codes is
nearly impossible because most of the peds are reluctant to do the 10 min
warm transfer because of their own insane schedules.  

If I sound a little desparate it is because I am worried that all the work
we have done combined with the incredible need means we will loose this
project.

Any ideas would be very much appreciate.  Jody

On Fri, Feb 13, 2009 at 3:24 PM, Jaffy Phillips <jaffy at pobox.com> wrote:

Hi,

I've just recently signed up to join this list-serve. My impression is that
I am to send an email to this address by way of introduction? If so, here
goes:

I've been practicing as a psychotherapist for several years, and am
currently back in school for a Master's in Public Health, focussing on
health policy. I have a strong interest in collaborative care, and I am
currently working on a research paper for the Massachusetts Health Data
Consortium, exploring the barriers to and possibilities for implementation
of shared electronic medical records between behavioral and non-behavioral
providers in Massachusetts.

Thanks for letting me join in the conversation.

Jaffy

Jaffy Phillips, MA
Psychotherapist in private practice
Health Policy Intern: Massachusetts Health Data Consortium
MPH student: Boston University School of Public Health

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-- 
Jody L. Rowell, MSSW, LCSW, Advocate
Clifford W. Beers Guidance Clinic 
93 Edwards Street
New Haven, CT 06511 
(203)772-1270 x-238 (203)772-0051 (F)
jrowell at cliffordbeers.org

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