Coverage and Payment of Interprofessional Consultation in Medicaid and the Children’s Health Insurance Program (CHIP)

Coverage and Payment of Interprofessional Consultation in Medicaid and the Children’s Health Insurance Program (CHIP)

CMS released a State Health Official (SHO) letter that provides guidance to states on policy for Medicaid and the Children’s Health Insurance Program (CHIP) to allow one provider to discuss a Medicaid or CHIP beneficiary’s case with a specialist, with or without the beneficiary present, and to pay the specialist for their services directly. The current policy only allows payment in this circumstance if the provider who is seeking the consultation is paid for the consulted provider’s services and then pays the consulted provider directly. This change more directly “links” routine care with specialty care, allowing more people to benefit from practitioners with specialized knowledge. For more, read the full letter https://www.medicaid.gov/federal-policy-guidance/downloads/sho23001.pdf