FAQ - Title V MCH 07

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Clinical/Services

Billing/Eligibility

Administrative

 

Clinincal/Services

Can I bill for a well child visit and an acute visit for the same child same date of service? We are able to bill Medicaid for an acute visit and THStep for that visit on the same date of services. (2/2007)
TV allows you to bill for a well child visit and an acute ill visit on the same date. However, understand that TV MCH is preventive with minimal sick reimbursement. (Section III Chapter 3-C, page II-37)

If a contractor is not enrolled as a CHIP Provider and have TV MCH funds can they go ahead and bill TVMCH while they are waiting to be enrolled?(1/2007)
Per an email sent by Fouad Berrahou on December 27, 2006, to all Title V contractors and regional coordinators: "The role of Title V program has not yet been determined. Current Title V-funded contractors are expected to continue providing prenatal services to established and/or new clients until further directions are provided. However, clients showing up at Title V MCH-funded clinics should be strongly encouraged to apply for the CHIP perinatal program." This means that business is as usual. As soon as we have further guidance it will be sent out to all contractors.

This is a question that pertains to the CHIP-Perinate program. If the agency provides prenatal services during the 15 day approval waiting period, should the agency bill CHIP or TV for services received? Should they bill CHIP, and when they get notice that the client is denied eligibility, then bill TV?
Per an email sent by Fouad Berrahou on December 27, 2006, to all Title V contractors and regional coordinators: "The role of Title V program has not yet been determined. Current Title V-funded contractors are expected to continue providing prenatal services to established and/or new clients until further directions are provided. However, clients showing up at Title V MCH-funded clinics should be strongly encouraged to apply for the CHIP perinatal program." This means that business is as usual. As soon as we have further guidance it will be sent out to all contractors.

1) If a current Title V provider becomes a CHIP Perinatal provider will be able to use the DSHS lab? 2) Will we be able to bill Title V for services not covered by CHIP such as glucose monitors, lancets, and syringes?
Response: 1) CHIP Perinatal providers will be using the HMO labs. 2) Contractors will not be able to bill Title V for services not covered by CHIP such as glucose monitors, lancets, and syringes. All contractors will be informed when the Title V MCH policy revisions come out for further guidance in the transition of CHIP Perinatal.

Re: Dental coverage per Title V MCH. Last year the Amalgam 1 surface was covered for primary & for permanent teeth. On the new 185 form next to the procedure for Amalgam 1 surface, the description & code only refers to permanent teeth. What about primary teeth & code for that one? Need clarification on this please.
Code 2140 - Amalgam is supposed to be used for primary and permanent teeth.

 

Billing/Eligibility

Question: This is a Dental Title V question. If we did a composite on a Title V patient not realizing during the procedure that the patient was Title V, can we still bill the amalgam code for reimbursement with documentation of the error in the chart and on the encounter? It is the same procedure just a different material being used. This is a rare occurrence but we want to bill correctly. (07/2007)

Response: Yes, you may bill TV the amalgam code and receive the reimbursement that is listed for the amalgam code.

Question: (Scenario) An agency includes unborn children in determining family size for determining eligibility for Title V. However, an agency has an agency-wide policy that unborn children are excluded in determining family size for the purpose of identifying clients who meet their guidelines for assessing co-pays.

Question: Title V policy does not allow co-pays to be assessed from clients who are below 100%FPL. In determining family size for the purpose of determining co-pays, are agencies required to include the unborn children in the family size OR can they follow their agency-wide policy that excludes counting unborn children for the purpose of determining co-pays. (06/2007)

Response: Agencies are required to include the unborn child in the family size with screening and eligibility determination and determining co-pays. (Section II, Chapter 1, pg II-4)

A 17 year old Title X/XX client is referred to Title V for dysplasia services. Is parental consent required for Title V dysplasia services even though it was not required for the annual exam? Is parental consent required for Title V dysplasia services even though it was not required for the annual exam? (06/2007)
If the dysplasia services are paid for with Title V funds then the client must meet all Title V eligibility criteria/requirements, including the requirement for parental consent if the client is a minor.

If an agency is getting PPD for TB skin testing from the Immunization program can they still bill for administering and reading the TB skin test results under billing code #86580? (06/2007)
Yes. Contractors may ask for reimbursement for any item on the Title V Maternal-Child Services Report 185 and 186 forms.

Is there a rule regarding whether a client is considered new or established (for billing purposes) when they annually renew their eligibility but do not seek clinical services annually i.e. – client has been eligible for services but has had a break in clinical services received greater than 2 or 3 years. (4/2007)
In the 2nd paragraph under “Annual Re-certification” it states “A client can be a new client only once.” Page II-14. Under “Eligibility Determination” it is also stated that the Statement of Applicants Rights and Responsibilities does not have to be signed again unless there is a break in services longer than two years. Page II-10


For the current fiscal year, the patient is enrolled in TVMCH and delivers the baby in the hospital. While in the hospital if she wants a tubal, can we bill TV FP for the service even though she was originally enrolled in TVMCH?

(5/2007)
A Title V MCH client may simultaneously be enrolled for Title V Family Planning services. In that case, Title V Family Planning funds may be used to cover the costs of a tubal sterilization provided at the time of delivery. The Title V contractor obtains reimbursement for sterilization costs by submitting a claim for procedure code 58600, which includes all services associated with the sterilization. As with any family planning client, however, all consent requirements must be met prior to the sterilization procedure.

Can a women who has had a tubal (or is otherwise diagnosed as sterile) and meets the eligibility requirement be determined as eligible to receive dysplasia services through the Title V MCH program? (3/2007)
Yes, a woman who has had a tubal and meets the eligibility requirement may receive dysplasia services through the Title V MCH program. If a woman who has had a tubal needs a well woman exam, she cannot go to TV FP for those services.

Can I bill for a well child visit and an acute visit for the same child same date of service? We are able to bill Medicaid for an acute visit and THStep for that visit on the same date of services.(2/2007)
TV allows you to bill for a well child visit and an acute ill visit on the same date. However, understand that TV MCH is preventive with minimal sick reimbursement. (Section III Chapter 3-C, page II-37)

Regarding Completion of the Presumptive Eligibility Form. - Sometimes patients seen on a presumptive eligibility basis cannot schedule a return appointment to complete the eligibility process until they are able to check their calendar, childcare arrangements, etc. Instead of an exact time and date, can the provider staff write in something like "within 30 days" in the "Date & Time" block at the bottom of the page? If unable to document an exact date and time to return to complete the eligibility process, it is allowable to write in something like "within 30 days" in the "Date & Time" block. However, remember that the process has to be completed within 90 days or the client becomes self-pay.

Page 2 of the instructions for the Screening & Eligibility Determination Form, #2 at the bottom of the page states that a female age 12 through 45 is potentially eligible for Title V services. Is this correct? My understanding was that Title V MCH covered women who were pregnant (regardless of their age) and that Title V FP covered women of child bearing age (which could vary depending on the applicant>)
Title V MCH cares for pregnant women, regardless of age, as long as they meet the eligibility criteria. Title V FP cares for women of child bearing age, which varies in clients, as long as they meet the eligibility criteria.

If the agency is not funded by PHC, do they still have to screen for PHC on the eligibility form and refer out? Do they need to circle that on the form?
If an agency does not have PHC funds, they do not have to screen the client or family members PHC eligible. The screening and eligibility form is for the agency to screen for the eligibility of the funding sources they have and to rule out Medicaid eligibility. Mark "Not Eligible" if not screening for PHC or on blank line write "NA for PHC or PHC not screened". The same instructions would be true if an agency does not have Title V funding but do have PHC.

Would it be a finding during a review if an individual from Mexico who completes the eligibility form writes the date as they would write it in Mexico rather than the way it is written in the U.S.
No, it would not be a finding. The contractors may want to advise on how to write the numerical month, date, and year or have the client write the abbreviation for each month, then date and year.

Title V FP -Can a Medicaid card with the address of a relative taking care of a child be used as proof of guardianship as well as residency?
Medicaid card with the address of a relative taking care of a child can be used as proof of residency. (TV MCH, Section II Chapter 1, page II-6) However, the Medicaid card cannot be used for proof of guardianship. Per Regina Perez, HHSC: A family friend, who is caring for a parentless child, may have the child apply for Medicaid as an independent child. Medicaid does not require proof of guardianship when a non-parent is applying for Medicaid for the child.

The Screening and Eligibility Form, income section questions 4 asks if anyone in the household is receiving TANF, Food Stamps, etc., the policy has Food Stamps listed as income which is not counted. The instructions list Food Stamps as unearned income to be counted. (10/2006)
Each numbered item on page one is an item of its own. Number 1 is family information. Number 2 is list of the household's income. Number 3 is inquiring about health care coverage. Number 5 is inquiring whether anyone in the household is pregnant.

Number 4 is inquiring whether any household members are on TANF, Food Stamps, Workers Compensation, and/or disability benefits. This information can be used by the clinic to make appropriate referrals and is not necessarily used in determining eligibility.

Income Section, page 3, instructions, "Food Stamps" will be removed because it is not a form of earned or unearned income.

The signature block states the applicants spouse may also sign and date the form. The policy states each PHC eligible client who is a legal adult is required to sign and date the form. PHC policy, Section II-3, states: "Each PHC eligible client, who is a legal adult, is required to sign and date the form. If confidentiality of services is a concern, separate forms for spouses may be completed." (10/2006)

Signature area of page 1 on the form will have the signature instructions removed and "If applicable", will appear next to "Signature-Spouse". Clinics shall defer to funding source policy manual for spousal signature policy.

In the Eligibility Determination Section to be completed by staff, clients who are screened potentially eligible for Medicaid would they be checked as not eligible or pending determination. Wouldn't they be checked as pending determination with comment "pending Medicaid?"(10/2006)
Yes, they would be checked as pending determination with comment "pending Medicaid". "Not eligible" is only used when an individual is not eligible for any funding source.

Does the agency place a copy in the client file of the Screening and Eligibility Determination Instructions, (FPL table)? The table that is updated every April? How will we know if the QA review if they used a current table? (10/2006)
It is not necessary to require the FPL table in each chart. The table is in the instructions for the eligibility clerk to use. The QA staff will have their own FPL table to refer to if necessary. This table is updated every April and sent out to the contractors and DSHS staff.

Will we no longer collect SS#? There is no place for this? (10/2006)
We no longer require collection of the social security number. Clinics may collect if required by agency policy.

Page 2 Document any special circumstances. What would be an example of a "special circumstance". (10/2006) Screening and Eligibility Determination Form for Medical Services Assistance, page 2, "Special Circumstances" area is for the provider staff to document any special circumstances not already noted in this section if applicable per page 3 of the form instructions. PHC policy manual, Section II Chapter 1 page II-1 states "Special circumstances may occur in the disclosure of information, documentation of pertinent facts, or events surrounding the client's application for services that make decisions and judgments by the contractor staff necessary. These circumstances should be documented in the case record on the Screening and Eligibility Determination Form for Medical Services Assistance."

Type of Title V/PHC service and who is eligible. What does "Full" mean?(10/2006)
PHC clients may be eligible for full, presumptive, or supplemental services. PHC policy manual, Introduction, page v and Section II Chapter 1 page II-9 defines presumptive eligibility. PHC policy manual, Section II Chapter 1 page II-11 explains supplemental benefits. Full eligibility means the client is eligible for ALL PHC benefits.


If a person is presumptive and they will need to come back to bring back their information do they still need to give them slip with an appointment?(10/2006)
In the past they gave them the bottom portion of the presumptive eligibility form. Yes, the client is to receive a slip with an appointment to complete the eligibility process. The new Presumptive Eligibility Form is still designed to cut the bottom portion to give to the client.

Please clarify the difference between signatures for "Person who helped complete this application" and "Applicant's representative" on pg. 1 of the form and when to use each of them.(10/2006)
There is no difference between "Person who helped complete this application" and "Applicant's Representative". With this said, in the near future the form will be revised with "Applicant's Representative and 2nd Date" removed and "Relationship to client" added.

Regarding the "Type of Title V/PCH service and who is eligible box" on pg. 2 of the form, please provide clarification on completion of this box. For example, how would you complete this box if you have a family of 3 people, the mother eligible for Title V Family Planning and PHC as a supplemental, the father if eligible for full PHC; and the child is eligible for Title V MCH and PHC supplemental.
Use the letter of the appropriate family member for full, presumptive, or supplemental to save space. Can also designate if it is Title V or PHC with each letter.

Regarding the "Determined Eligible For" box on pg 2 of the form: If a mother applies for PHC and her child is on Chip, would you check the "not eligible" box or check the blank box in the "Determined Eligible" box and write in CHIP on the blank line?(10/2006)
Check the blank box in the "Determined Eligible" box and write in CHIP on the blank line. The "Not Eligible" box is only for not eligible for any funding sources.

If an applicant applies for a program, has all the verifying documentation, and is determined eligible, does the staff have to check the "Potentially Eligible" box as well as the "Determined Eligible" box. Or can they put NA in the "Potentially Eligible" box and just check the "Determined Eligible" box?(10/2006)
Just check the "Determined Eligible" box. It is acceptable to also mark NA in the "Potentially Eligible" box, however, it is not necessary.

 

Administrative

1) If a current Title V provider becomes a CHIP Perinatal provider will be able to use the DSHS lab? 2) Will we be able to bill Title V for services not covered by CHIP such as glucose monitors, lancets, and syringes?
Response: 1) CHIP Perinatal providers will be using the HMO labs. 2) Contractors will not be able to bill Title V for services not covered by CHIP such as glucose monitors, lancets, and syringes. All contractors will be informed when the Title V MCH policy revisions come out for further guidance in the transition of CHIP Perinatal.

As women are enrolled in CHIP Perinate will we be able to bill continue billing Title V if we are not yet CHIP provider and there are no other CHIP providers in the community that can accept the referral?
Policy is being worked on for the transition from TV Prenatal to CHIP Perinatal. As soon as the policy revisions are completed you will be notified.

Scenario: a child of 14 is pregnant and living with friends. The mother of the "host" family wrote a letter of support statement indicating that she supports the child of 14. Would the whole household be used when the child is screening for eligibility since the "host" family supports the 14-year old financially or would it be a household of two?
According to the Family Code, Chapter 32, Section 32.003: "A child may consent to medical…..treatment if the child is unmarried and pregnant and consents to hospital, medical, or surgical treatment, other than abortion, related to the pregnancy….". In this case the family composition is 2 - the pregnant girl and the unborn child. However, if this scenario was a 14 year old non-pregnant child, the household income would be used and the household plus the child would be the total household.

 

 

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Last updated May 07, 2010