Summary
Michigan Medicaid covers medically necessary Pediatric Outpatient Intensive Feeding Program services for eligible beneficiaries with significant feeding and swallowing difficulties, as part of the EPSDT benefit. For dates of service on or after July 1, 2018, these services may be reimbursed through Medicaid fee-for-service, including covered services carved out of the Medicaid Health Plan delivery system. The program is an onsite day program delivered by a multi-disciplinary team, and these services require prior authorization.
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What to do
Action · 6 steps
01Already effective July 1, 2018: Obtain prior authorization before providing Pediatric Outpatient Intensive Feeding Program services.
02Submit requests on form MSA-6544-B with documentation of medical necessity, such as height and weight measurements and previously attempted therapeutic interventions, and keep a copy of the prior authorization in the beneficiary's medical record.
03Request prior authorization to continue intensive treatment beyond the current authorization period, even if the beneficiary changes providers, and include a copy of the latest re-evaluation.
04Continued-treatment requests must include a summary of the previous treatment period (not to exceed 90 days prior to the requested period) with measurable progress on each short- and long-term goal, revised goals with justification for any change in the treatment plan, and a statement of parent/guardian education and training.
05Bill these services as fee-for-service claims through CHAMPS regardless of the beneficiary's health plan status, using HCPCS S0317 (disease management; per diem), reimbursed as a bundled daily rate.
06Check current applicability of this 2018 bulletin before billing.
Codes mentioned
S0317
Original notice
MSA 18-10
michigan.gov · Always check the source before changing claims.