Tag: Reimbursement

MDHHS Expands Medicaid Coverage for Pharmacist-Provided Services

Member News

The Michigan Department of Health and Human Services (MDHHS) recently issued Medicaid Policy Bulletin MMP 26-20, expanding coverage for pharmacist-provided services effective July 1, 2026, pending approval of a state plan amendment by the Centers for Medicare & Medicaid Services. The policy applies to Medicaid, the Healthy Michigan Plan, MIChild, Plan First and several additional Medicaid programs.

The policy aligns Medicaid coverage with Michigan’s expanded pharmacist scope of practice and allows qualified Medicaid-enrolled pharmacists to provide and bill for additional services, including:

  • Ordering and administering immunizations.
  • Ordering and administering certain laboratory tests such as COVID-19 and influenza.
  • Prescribing antiviral treatments based on test results.
  • Counseling on and prescribing self-administered hormonal contraceptives.

Pharmacists must meet enrollment, training and documentation requirements established by MDHHS.

According to MDHHS, the policy is intended to increase access to preventive and diagnostic services, support timely treatment of common conditions and improve access to care for Medicaid beneficiaries. Members are encouraged to review the bulletin for enrollment, billing and reimbursement requirements.

Members with questions may contact Lenise Freeman at the MHA.

MDHHS Finalizes Specialty Behavioral Health Services Location Policy

Member News

The Michigan Department of Health and Human Services (MDHHS) recently finalized Medicaid Policy Bulletin MMP 26-17, effective July 1, 2026, which clarifies reimbursement requirements for specialty behavioral health services provided through Prepaid Inpatient Health Plans in home, community and residential settings. The policy applies to Medicaid and the Healthy Michigan Plan.

The final policy encourages mental health and intellectual and developmental disability services to be provided in integrated community settings, including an individual’s home, when appropriate. The bulletin also clarifies coverage requirements for substance use disorder residential treatment services, nursing facilities, child-caring institutions and children’s therapeutic group homes. For children and youth, services should be provided in the least restrictive setting appropriate to their needs.

The final policy includes several changes from the proposed policy, including:

  • New requirements related to the coordination of Early and Periodic Screening, Diagnostic and Treatment services for children residing in child-caring institutions.
  • Additional clarification regarding services available to children with intellectual and developmental disabilities.
  • Removal of a proposed section addressing Medicaid coverage in Institutions for Mental Diseases (IMDs).

The MHA submitted comments requesting clarification regarding covered services in nursing facilities, IMD coverage policies and reimbursement for services provided to children in child-caring institutions. While the final bulletin provides additional clarification, it does not address all the questions raised by the MHA.

Members impacted by specialty behavioral health service delivery and reimbursement requirements are encouraged to review the bulletin.

Members with questions may contact Lenise Freeman at the MHA.

Reimbursement for Age-Friendly Quality Data Included in FY 2025 Hospital IPPS Final Rule

Member News, Patient Safety and Quality

Included in the Centers for Medicare & Medicaid Services’ (CMS) Medicare fee-for-service hospital inpatient prospective payment system (IPPS) fiscal year (FY) 2025 final rule is a reimbursement model for hospitals submitting age-friendly quality data.

Hospitals will be asked to report on several measures to assess whether they are improving care for older patients in emergency departments, operating rooms and other settings.

Hospitals will need to report that they are:

  • Attesting annually to having procedures that enable patients’ healthcare goals, such as determining whether living wills and healthcare proxies are included in care plans.
  • Reviewing medication regimens and eliminating unnecessary prescriptions.
  • Implementing frailty screenings and interventions, such as for mobility or cognition.
  • Assessing social vulnerabilities, such as isolation or elder abuse.
  • Designating age-specialized leadership within hospitals.

The CMS will add the age-friendly structural measures to the FY 2025 inpatient quality reporting program reporting, which will impact Medicare payments in FY 2027.

The MHA Keystone Center has supported numerous age-friendly initiatives in recent years, including Age-Friendly Health Systems Action Communities, which implements the 4Ms framework (What Matters, Medication, Mentation and Mobility) – aligning with the proposed measures outlined by CMS.

Members seeking assistance implementing age-friendly policies and procedures should contact the MHA Keystone Center.

Members with questions about the IPPS final rule should contact Vickie Kunz at the MHA.

MDHHS Releases Medicaid Doula Services Proposed Policy

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy updating Medicaid coverage for doula services, effective Oct. 1, 2024. Key updates include increasing the number of covered doula visits to 12 per pregnancy, raising reimbursement rates to $1,500 for labor and delivery support and $100 per prenatal and postpartum visit. Additionally, beneficiaries may qualify for up to six extra visits if more support is needed, based on criteria such as promoting health literacy, emotional support, addressing social determinants of health and more.

These changes aim to improve maternal and infant outcomes, support birth equity and reduce disparities. Doulas provide essential emotional, physical and educational support during pregnancy, leading to better birth outcomes.

Members are encouraged to review and provide feedback on the proposed changes to Kimberly Lorick at LorickK1@michigan.gov. Comments must be submitted by Oct. 31, 2024.

Members with questions may contact Lauren LaPine at the MHA.

MHA Provides Comment on Proposed Medicaid Reimbursement for Group Prenatal Care

Member News

The MHA submitted a comment letter to the Michigan Department of Health and Human Services regarding the proposed Medicaid coverage of group prenatal care, set to begin in October 2024. The MHA expressed support for the policy, highlighting its potential to significantly improve maternal and infant health outcomes in Michigan. However, in its comment letter, while supporting the policy, the MHA requested clarification on the reimbursement rate and suggested a higher rate for sessions with larger attendance due to the increased resources required.

Members with questions may contact Lauren LaPine at the MHA.