TO: All Providers
RE: Nurse-Family Partnership (NFP)
The
Alabama Medicaid Agency (Medicaid) received approval from the Centers for
Medicare and Medicaid Services (CMS) for statewide coverage of Nurse-Family Partnership
(NFP) related services effective January 1, 2022. NFP is a nationally
recognized, evidence-based program that provides prenatal, postpartum and
infant home visiting services until the child reaches age two.
Eligibility criteria for these
services include Medicaid eligible women who are first-time mothers and/or have
a high-risk pregnancy. High-risk pregnancy includes consideration of the
mother’s age (less than 17 or older than 35), previous negative pregnancy
outcomes, and those with existing medical conditions prior to becoming pregnant
(e.g., high blood pressure, diabetes, sexually transmitted diseases).
Goals of the NFP program
·
Improving
health outcomes for mother and child
·
Decreasing
total Medicaid expenditures among families who receive NFP services
·
Increasing
healthy spacing between births to 24 months
·
Reducing
infant and maternal mortality
NFP has been available to
Alabama families since 2008 through a grant from the Alabama Department of
Early Childhood Education. Currently, three providers serve nine counties: NFP
Easter Seals of West AL (Tuscaloosa); NFP of Central Alabama (Jefferson, Walker
and Fayette); and Gift of Life NFP (Autauga, Elmore, Macon, Montgomery, and
Russell).
Providers interested in the NFP Program
· Email Matthew Richardson from the National Service Organization (NSO) at matthew.richardson@nursefamilypartnership.org
to learn about the NFP provider certification process.
· NFP certification must be completed before
enrolling as a NFP provider with Medicaid.
· Additionally, NFP providers will be required to pay an application fee in
compliance with CMS requirements.
·
Eligible
NFP providers can enroll in Medicaid via the Electronic Provider Enrollment Application
Portal beginning on April 1, 2022 at https://medicaid.alabama.gov/content/10.0_Contact/10.3_Provider_Contacts/10.3.4_Provider_Enrollment.aspx.
·
Resource
to assist NFP providers with the online application: https://medicaid.alabama.gov/documents/5.0_Managed_Care/5.3_NFP/5.3_NFP_Resource_Provider_Enrollment_4-1-22.pdf.
Reimbursement Information
NFP services will be
reimbursed once per month, per participating family unit/NFP Client ID in the
amount of $765.47. The first date of service eligible for payment will be July
1, 2022.
Below are the procedure
combinations to include on claims for NFP reimbursement:
Procedure Code
|
*Modifier
|
*Modifier
|
Applicable Service
|
T2023
|
HD
|
U1
|
Prenatal
|
T2023
|
HD
|
U2
|
Postpartum
|
T2023
|
HD
|
U3
|
Infant/Child
|
*Use of
both modifiers will be required for reimbursement.
Additional information is
required for claims submission (this information will be listed in the July
2022 edition of the Alabama Medicaid Provider Billing Manual. Claims paid in
error will be subject to recoupment.
For more information related
to the NFP Program, please visit https://medicaid.alabama.gov/content/5.0_Managed_Care/5.3_Nurse-Family_Partnership.aspx.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2022
American Medical Association and © 2022 American Dental Association (or such other date publication of CPT
and CDT). All rights reserved. Applicable FARS/DFARS apply.