CurrentGeisinger Health PlanPolicy 99-18-10

Enrollment of Tobacco Cessation Providers

This bulletin governs enrollment requirements for Department of Health (DOH)-approved Tobacco Cessation Program (TCP) providers who render Tobacco Cessation Counseling (TCC) services to Medical Assistance (MA) beneficiaries in North Carolina. It applies to all MA-enrolled providers delivering TCC and directs managed care providers to contact their MCO for payment questions.

Policy Summary

PayerGeisinger Health Plan

PolicyEnrollment of Tobacco Cessation Providers

Policy CodePolicy 99-18-10

Change TypeNo material changes

Effective DateJun 18, 2018

Next Review Date

Key ActionComplete DOH training and submit the DOH Pre-Approved Tobacco Cessation Registry Application to be approved as a TCP and eligible for MA enrollment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5 yearsMA service location revalidation interval

PT 37Enrollment designation for most DOH-approved TCPs

DOH trainingRequirement to be approved as a DOH TCP

All TCC providersScope of bulletin

MA Enrollment and Payment Criteria

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MA enrollment and payment criteria for DOH-approved TCPs

Covered when ALL of the following enrollment and documentation requirements are met:

ALL of the following

Applicant must complete DOH 'Every Smoker, Every Time' online training and submit the DOH 'Pre-Approved Tobacco Cessation Registry Application' and be approved by DOH as a Tobacco Cessation Program (TCP).
DOH approval is required before rendering TCC to MA beneficiaries.
If the DOH applicant checks 'Yes' to Medical Assistance referral on the DOH application, DOH will forward the program information to DHS to expedite MA enrollment.
DOH will automatically send the program information to DHS when DOH approves the applicant as a TCP.
If the DOH applicant checks 'No' (or DOH does not forward) the DOH-approved TCP must submit a copy of DOH's approval letter and a completed MA Provider Application to DHS to obtain MA enrollment and specialty designation.
If DHS does not receive DOH's approval letter (either from DOH or from the DOH-approved TCP), DHS will not add provider specialty 370 nor enroll the provider as Provider Type 37 and will not pay for Tobacco Cessation Counseling (TCC) services rendered by that TCP.

DHS enrolls most DOH-approved TCPs as Provider Type (PT) 37 with provider specialty 370; certain existing provider types (for example: home health agencies PT 01, clinics PT 08, certified registered nurse practitioners PT 09, psychologists PT 19, dentists PT 27, physicians PT 31, certified nurse midwives PT 33) with specialty 370 are handled distinctly.

Providers must maintain MA enrollment: revalidate MA enrollment for each service location every 5 years and submit revalidation applications at least 60 days prior to the revalidation date.

Operational requirement for ongoing enrollment maintenance.

Providers participating in managed care should contact their MCO regarding payment for TCC services.

Provider Enrollment Actions and Consequences

Prior Authorization

DOH-to-DHS referral option

DOH-approved TCP applicants may check the Medical Assistance referral box on the DOH application; if the applicant checks "Yes," DOH will automatically forward the program information to DHS when DOH approves the applicant as a TCP to expedite MA enrollment.

Denial Risk

Enrollment and payment consequence

If DOH does not send, or DHS does not receive, the DOH approval letter, DHS will not add provider specialty 370, will not enroll the provider as PT 37, and will not pay for TCC services rendered by that DOH‑approved TCP.

If the applicant checked "No" on the DOH application, the applicant is responsible for sending a copy of DOH's approval letter and a completed MA Provider application to DHS.
DHS maintains the DOH approval letter in the provider's enrollment file; absence of that letter prevents specialty 370 addition, PT 37 enrollment, and payment for TCC services.

Key Terms

inv-05: TCC — TCC (Tobacco Cessation Counseling)

TermTCC (Tobacco Cessation Counseling)

PurposeServices provided to Medical Assistance (MA) beneficiaries by providers approved as Tobacco Cessation Programs (TCP) to assist with tobacco cessation.

Enrollment prerequisiteProvider must complete DOH 'Every Smoker, Every Time' online training and be approved by DOH as a TCP to render TCC to MA beneficiaries.

Related MA bulletinsReferences include MA Bulletins 99-02-02, 99-07-02, 99-04-11, and 99-12-09 regarding coverage and procedure codes for TCC.

ScopeApplies to any individual or entity approved by DOH as a TCP seeking to enroll in the MA Program to provide TCC services.

inv-06: DOH-approved TCP — Tobacco Cessation Program approved by the Department of Health after completion of DOH online training and application

TermDOH-approved TCP (Tobacco Cessation Program)

Approval stepsComplete DOH 'Every Smoker, Every Time' online training and submit the 'Pre-Approved Tobacco Cessation Registry Application' for DOH approval.

Expedited MA enrollment optionApplicants may check 'Yes' in the DOH application to be referred to DHS for MA enrollment review; DOH will forward approved TCP information to DHS to expedite enrollment.

Consequence if not forwarded/receivedIf DOH does not send or DHS does not receive the DOH approval letter, DHS will not add specialty 370, will not enroll as Provider Type 37, and will not pay for TCC services.

DOH resourcesDOH training, application, and contact information are available on the DOH Pre-Approved Tobacco Cessation Registry web page (link updated from prior bulletins).