Child Health Incentive Payments

Child Health Incentive Payments  

Overview

As announced earlier today, in response to the ongoing COVID-19 pandemic and its impact on children’s access to preventive primary care and dental services, the Department of Health and Human Services’ Office of Maine Care Services is offering special Per Member Per Month (PMPM) incentive payments for the months of September through December 2020 to primary care and dental providers who deliver the following services to children covered by MaineCare. 

• Primary Care Preventive Services: A provider practice will receive an incentive payment for each child on MaineCare who receives both a wellness primary care visit that is appropriate to the child’s age and a vaccination (this includes a flu vaccine) from the same practice during this time period (September-December 2020).
• Dental Services: A practice will be eligible to receive an incentive payment for each child on MaineCare who receives one or more dental services (including oral health screenings and application of fluoride varnish) from the practice during the month. 

These payments will help ensure children receive critical preventive services and scheduled vaccinations that they may have missed as a result of the COVID-19 pandemic. 

The incentive payments are intended to: 

• Compensate and encourage providers to conduct outreach to re-engage child members/families;
• Compensate providers for increased costs of delivering services during the pandemic, including costs associated with ensuring safe social distancing practices, adequate personal protective equipment (PPE), and appropriate staffing;
• Provide a targeted amount of support proportional to the impact COVID-19 has had on service delivery and member access to these services.

Payments will be paid as a PMPM dollar amount for every child served. These payments will be in addition to existing fee-for-service payments for the services. 

 PMPM Payment Details

Preventive Primary Care (wellness visit and vaccine) PMPM	$31.14
Dental Care PMPM	$37.09

Providers do not need to change how they submit claims to receive these increased rates and should continue billing fee for service as usual. For each payment, we will determine for each month how many unduplicated members received the requisite service(s) and pay the PMPM accordingly. 

Providers should refer to the American Academy of Pediatrics’ Coding for Pediatric Preventive Care for relevant coding information.

Frequently Asked Questions

Q. Which MaineCare members qualify for the incentive payments?

A. Any member currently under age 21 years of age or who was under 21 as of March 1, 2020 qualifies for the incentive payments.

Q. Do the well-child visit and vaccination(s) need to occur on the same day, or within the same month?

A. No, they do not need to happen on the same day or within the same month. As long as the same practice delivers both the vaccine and the wellness visit  during the September through December time period, they will be eligible to receive the incentive payment for the month during which the second service was provided. It does not matter whether the wellness visit or vaccination occurs first.

We will assess the number of children who have received qualifying services at the end of each month from September to December 2020. For example, if a child receives a wellness visit at the end of September and then receives a vaccine the first week in October, the incentive payment will be identified as part of the November review of eligible services delivered as of October, and payment will occur at that time. If a provider administers a vaccine to a child in September and then conducts a well-child appointment for the child in December, they will be eligible to receive an incentive payment for the month of December.

                                         Service review approach

October review	Includes services provided in September
November review	Includes services provided in September and October
December review	Includes services provided in September, October, and November
January review	Includes services provided through the incentive period, September – December

Q. Are dental providers eligible to receive dental payments? 

A. Yes, dental providers are eligible to receive these payments.

Q. Are PCPs who administer fluoride varnish or provide an oral health screening eligible for the dental payment?

A. Yes. PCPs who provide fluoride varnish or oral health screening will receive the dental PMPM payment. If a PCP also provided the MaineCare member with a wellness visit and vaccine, the PCP receives two PMPMs for same patient (dental and preventive primary care).

Q. If a pharmacy administers a vaccine, will they be eligible for the incentive payments?

A. No, pharmacies are not eligible to receive incentive payments. These payments are meant to incent the coordinated provision of both a wellness visit and vaccine.

Q. If some of these services are provided via telehealth, will providers be eligible for the incentive payment(s)?

 A. Yes, MaineCare-covered telehealth services will be included in the Department’s determination of the incentive payments.

Q. Do providers need to change the way they submit claims for these services in order to receive the incentive payments?

A. No. Providers should continue to submit claims as they usually do, and we will determine the PMPM payments as part of our monthly review process.

Q. When will providers receive the payments?

A. More information on the timing and frequency of the payments will be forthcoming.