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Frequently Asked Questions


 

FAQ's
1. What is the Maryland Healthy Kids Program?
2. How do I apply for a Medical Assistance Provider Number? 
3. Who needs to be “Certified” by the Maryland Healthy Kids Program?
4. How do I become Healthy Kids “Certified”?
5. Will my Healthy Kids Certification end when I leave my current practice?
6. What is a Managed Care Organization (MCO)?
7. How can I provide healthcare to children and/or adolescents on Medical Assistance?
8. Can I limit the number of children on Medical Assistance and the ages of the children/adolescents that I serve?
9. How much will I be paid to provide preventive care to a child on Medical Assistance?
10. What is the Vaccines for Children (VFC) Program?
11. Why must I participate in VFC?
12. What can the Healthy Kids Program Nurse Consultants do for my practice and me?
13. How can I access the Healthy Kids Program Clinical and Administrative Manual?

 

 

  1. What is the Maryland Healthy Kids Program?

The Maryland Healthy Kids Program is the preventive, well-child, component of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program for the State of Maryland.  The EPSDT Program is a federal requirement that mandates that States cover certain benefits for Medicaid recipients from birth through 20 years of age, benefits that are not necessarily covered for recipients who are 21 years of age and older.  The Maryland Healthy Kids Program and the Maryland Department of Health and Mental Hygiene offer services to EPSDT providers including training and support services provided by our nurse consultants and free vaccines through the Vaccines for Children Program.

Maryland Medicaid also operates similar programs for moderate to low-income children, who are eligible for Medicaid through the Maryland Children’s Health Program (MCHP) and MCHP Premium Program.  Medicaid, MCHP and MCHP Premium provide children with the same comprehensive EPSDT benefit package and all fall under the Healthy Kids Program.

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  1. How do I apply for a Medical Assistance Provider Number?

Providers may obtain an application packet to apply for a Medical Assistance provider number by calling Provider Enrollment at 410-767-5340, or logging onto www.emdhealthchoice.org and selecting Services for Medical Care Providers.

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  1. Who needs to be “Certified” by the Maryland Healthy Kids Program?

All primary care providers who plan to serve Maryland Medicaid/MCHP children under 21 years of age must be certified by the Maryland Healthy Kids Program.  The certification requirement applies to PCPs contracted with MCOs and PCPs providing care to recipients not enrolled with an MCO (commonly referred to as “fee-for-service” and using a red and white Medical Assistance card).  Providers needing certification as primary care providers include solo practitioners, group practices and rendering providers within group practices who are:

Board certified providers in pediatrics, family medicine and internal medicine
Licensed physicians and osteopaths, and certified nurse practitioners
Health care providers such as federally qualified health centers, hospital outpatient  department clinics and school-based health centers.

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  1. How do I become Healthy Kids “Certified”?

Certification involves completion of the Provider Application for Certification and Participation and a face-to-face meeting with a Maryland Healthy Kids Program Nurse Consultant to review the standards of preventive health care described in the Maryland Healthy Kids Program Manual and the Maryland Schedule of Preventive Care. 

Contact the Maryland Healthy Kids Program at 410-767-1683 to schedule a certification visit with the Program consultant in your area or to check your current certification status.  A follow-up letter of certification is sent to you and your contracted MCOs that should be saved as a reference for future MCO credentialing.

Please note that Healthy Kids certification is the same as EPSDT certification, as noted on Maryland’s Uniform Credentialing Form.  There is no distinct certification number.  Your certification is attached to your Maryland medical assistance number, and this number can be used as your EPSDT certification number.

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  1. Will my Healthy Kids Certification end when I leave my current practice?

Once you are certified and demonstrate compliance with the Healthy Kids Program, the certification stays with you, as long as you continue to provide services to children/adolescents on MA, regardless of whether you change practice sites or open your own private practice.  Therefore, it is important to notify the Healthy Kids Program nurse consultant in your area of any changes to your practice.

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  1. What is a Managed Care Organization (MCO)?

Managed Care Organizations (MCOs) are health care organizations that provide health care services to Medicaid recipients in Maryland, under the direction of the HealthChoice Program.  MCOs are responsible for providing, or arranging for, the full range of health care services.  These organizations contract with a network of providers to provide covered health services to their enrollees.  There are currently 7 MCOs participating in HealthChoice.

 

AMERIGROUP Maryland, Inc.
Diamond Plan from Coventry Health Care
Helix Family Choice
JAI Medical Systems
Maryland Physicians Care
Priority Partners
UnitedHealthcare/AmeriChoice

 

Additional Information on HealthChoice and MCOs may be obtained by visiting the HealthChoice website at www.dhmh.state.md.us/mma/healthchoice/.  Contact information for the individual MCOs is available on this site.

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  1. How can I provide healthcare to children and/or adolescents on Medical Assistance?

PCPs establish individual contracts with one or more of the seven MCOs.  The contracted MCOs assign member Medical Assistance recipients to that provider.  Providers who wish to enroll in one or more MCOs should contact each MCO’s Provider Relations Department.  The contacts for each MCO can be found in the Maryland Healthy Kids Program Clinical and Administrative Manual at: www.dhmh.state.md.us/epsdt/healthykids/

manual/table_contents.htm.  Locate Section 7 – Appendix V and click on Managed Care Organizations.     

HealthChoice regulations require that MCOs assign recipients younger than 21 years of age to a Healthy Kids certified PCP.  The regulations that govern the Medicaid HealthChoice Program are 10.09.62-74 and can be viewed at www.dsd.state.md.us/comar.  Specific information about each of the MCOs, including preauthorization phone numbers, customer service lines, 24 hour Nurse Help Lines, as well as pharmacy, vision, and dental services vendors, can also be found in Section 7- Appendix V of the Maryland Healthy Kids Program manual (location information noted above).

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  1. Can I limit the number of children on Medical Assistance and the ages of the children/adolescents that I serve?

Yes.  You will need to indicate the number of children and/or adolescents, as well as the minimum and maximum ages, you want to serve for each of your contracted MCOs.  Since recipients with a Maryland Medical Assistance Fee-For-Service card (the red and white card) are not assigned to specific providers, your practice can determine whether to accept these recipients as they call to make an appointment.

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  1. How much will I be paid to provide preventive care to a child on Medical Assistance?

Each MCO that you contract with will set their reimbursement rates, but those rates must at least meet the compensation rates set by Maryland Medicaid Fee for Service.  Information on the reimbursement for care provided to Maryland Medicaid Fee-For-Service recipients can be found on the Maryland Medicaid Provider Information page at www.dhmh.state.md.us/mma/providerinfo by selecting the most recent Physicians Services Provider Fee Manual.  This page also contains additional information for providers who serve, or are considering service to Maryland’s children on Medical Assistance.  

Vaccines are provided through the Vaccines For Children (VFC) Program for patients up to 19 years of age.  At present, the State and MCOs reimburse the provider for administrative costs associated with administering VFC supplied vaccines.  Currently, Medicaid pays an administration fee of $10 (maximum) per VFC vaccine.  

For vaccines not included in the VFC Program, such as Meningococcal Polysaccharide Vaccine (CPT Code 90733) and other medically necessary vaccines, as well as for vaccines for patients 19 – 20 years of age, Medicaid will reimburse the acquisition cost of vaccines purchased by the provider and administered to “fee for service” recipients. An administration fee will not be paid for these vaccines. The “fee for service” CPT Codes are listed in Section 6 – Billing and Encounter Data Reporting of the Maryland Healthy Kids Program Clinical and Administrative Manual.  Check with each MCO for their vaccine reimbursement rates.

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  1. What is the Vaccines for Children (VFC) Program?

The Vaccines for Children Program is a federal initiative begun in October 1, 1994 that provides vaccines to health care providers, at no cost, for children/adolescents under 19 years of age who qualify in at least one of the following ways:

Eligible for Medical Assistance
Uninsured, without health insurance
Under-insured, covered by private insurance that does not pay for immunizations, or
Native American Indian or Alaskan Native

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  1. Why must I participate in VFC?

The Maryland Healthy Kids Program requires that providers enroll in the Maryland VFC Program, regardless of whether the provider is participating with a MCO or fee-for-service with the State.  The cost of vaccines, available through the VFC Program, will not be reimbursed either through “fee-for-service” or by the MCOs.  Only an administration fee, $10 maximum, will be reimbursed for vaccines available through the VFC Program.

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  1. What can the Healthy Kids Program Nurse Consultants do for my practice and me?

Healthy Kids Program Nurse Consultant can:

Orient and train staff in Program standards and procedures;
Certify new providers entering group practices or establishing new solo practices;
Distribute applicable Clinical and Program manuals/materials;
Explain Medicaid health policies and federal/state regulations;
Assist in the improvement of the practice’s performance through medical record reviews;
Assistance with Medicaid billing and MCO encounter data reporting issues; and
Educate providers about MCO and Local Health Department referral process for outreach and health related services.

 

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  1. How can I access the Healthy Kids Program Clinical and Administrative Manual?

The Healthy Kids Program Clinical and Administrative Manual can be viewed at: www.dhmh.state.md.us/epsdt/healthykids/ and click on Provider Manual.  Many selections in the manual can be downloaded in the PDF format.

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