Pediatric Primary Care - Coronavirus Relief And Response

Medicaid Pediatric Healthcare Recovery Program SFY 2023

Program Overview

The Medicaid Pediatric Healthcare Recovery Program will continue to provide payments to non-FQHC pediatric practices, family medicine practices, or any other such primary care practice that provides primary care to children insured by Rhode Island Medicaid and seen by an MD, DO, PA, or NP with a subspecialty in pediatrics or family medicine. Non-FQHC practices located in Rhode Island are eligible to apply.

Payments will be calculated based on the number of children insured by RI Medicaid served by the practice and will be contingent on practices providing a Practice Improvement Plan; achieving performance and/or improvement targets on at least three out of four immunization and lead screening measures; and participating in at least four out of six Behavioral Health Learning Initiative sessions. Detailed information on quality benchmarks and the payment schedule is included within the program guidance document.

Program Timeline

  • Online applications will go live September 20, 2022.
  • Applications and Performance Improvement Plans are due on October 11, 2022 by 5pm EST.
  • EOHHS will make every effort to disburse the first payment to qualifying providers by October 31, 2022. Payments will coincide with Medicaid fee-for-service payment cycles.
  • Behavior Health Initiative Learning Sessions, inclusive of practice case presentations will occur starting in January 2023 and continue through June 2023. Sessions will occur on the following dates, in all cases from 7:30-8:30am:
    • January 26, 2023
    • February 22, 2023
    • March 23, 2023
    • April 26, 2023
    • May 24, 2023
    • June 22, 2023

Program Application

By 10/11/22, please complete the application in its entirety here. A PDF version of the application is available below.

In addition, applicants must: 1) Complete the Performance Improvement Plan and 2) sign the Financial Agreement. Upload both documents following the instructions included in the online application above. Blank copies of the Performance Improvement Template and Financial Agreement are available below.

Other Program Documents

Please email OHHS.PediRelief@ohhs.ri.gov if you have additional questions that are not addressed in the program’s guidance or application instructions.

 

Medicaid Pediatric Healthcare Recovery Program

Program Overview

In 2020, EOHHS implemented the Pediatric Primary Care Relief Program and the Pediatric Primary Care Rate Supplement to support system resiliency, improve immunization rates, and overcome COVID-19 related barrier to access. Disruptions caused by COVID-19 continue to persist and create barriers to essential preventive healthcare services.

Therefore, the Medicaid Pediatric Healthcare Recovery Program will provide payments to non-FQHC pediatric practices, family medicine practices, or any other such primary care practice that provides primary care to Rhode Island Medicaid covered children by an MD, DO, PA, or NP with a subspecialty in pediatrics or family medicine. Non-FQHC practices located in Rhode Island are eligible to apply. Payments will be calculated based on the number of Rhode Island Medicaid covered children served by the practice, and contingent on demonstrating pay-for-reporting and performance improvement on a standardized measure of child and adolescent to well-child visits and participation in technical assistance related to developmental, psychosocial, and behavioral health screening. Detailed information on quality benchmarks and the reporting schedule is included within the program guidance document.

Program Timeline

  • Online applications will go live February 23, 2022.
  • Applications are due on March 9, 2022 by 5pm EST.
  • Baseline data for the Child and Adolescent Well Care Visits measure are due by Tuesday, March 15, 2022. Providers will report this using an online tool available here: https://www.tfaforms.com/4965083 [tfaforms.com]
  • EOHHS will make every effort to disburse the first payment to qualifying providers by March 31, 2022. Payments will coincide with Medicaid fee-for-service payment cycles.
  • Subsequent reports will be due April 15, 2022 and July 15, 2022. Providers will report this data using the same online tool, available here.
  • Practice attendance/participation in 1 or more Psychosocial and/or Behavioral Health Technical Assistance sessions is to occur by May 31, 2022. 

Program Application

  • Application
  • A PDF version of the application is available below.

In addition, applicants must sign the Financial Agreement and upload it following the instructions included in the online application above. A blank copy of the Financial Agreement is available below.

Other Program Documents

Please email OHHS.PediRelief@ohhs.ri.gov if you have additional questions that are not addressed in the program’s guidance or application instructions.

Medicaid Pediatric Primary Care Rate Supplement - Program Closed

Program Overview

In July of 2020, EOHHS and OHIC implemented the Pediatric Primary Care Relief Program, which issued one-time grant payments to pediatric primary care providers to support system resiliency to improve immunization rates following COVID-19 related disruptions in care and practice cashflow. While pediatric primary care offices have re-opened following initial closures, social distancing and COVID-19 prevention measures have constrained practice capacity and created barriers for members to access care (e.g., transportation, perceptions of safety). These barriers are anticipated to persist as the state continues to respond and adapt to the COVID-19 pandemic. As such, EOHHS is implementing the Medicaid Pediatric Primary Care Rate Supplement through the end of calendar year 2020, to provide monthly financial incentives to pediatric primary care practices to ensure all children are up to date with the full array of essential, preventive healthcare services by overcoming COVID-19 related barriers to access.

Pediatric primary care has been deferred for many families because of the COVID-19 Public Health Emergency. During April of 2020, pediatric claims filed were down 44% compared to April of 2019. While utilization has increased slightly, claims filed were still 10% lower during June 2020 compared to June 2019. It is critical that the state supports Pediatric Primary Care Providers to encourage patient participation for care that was deferred during the Spring virus surge and continue to build capacity throughout the phases of reopening to ensure all Medicaid covered children have access to these critical preventive services. As such, Medicaid Pediatric Primary Care Rate Supplement payments will be contingent upon providers demonstrating measurable improvement in access to care. 

The Medicaid Pediatric Primary Care Rate Supplement will provide monthly payments to pediatric practices, family medicine practices, or any other such primary care practice that provides primary care to Rhode Island Medicaid covered children by an MD, DO, PA, or NP with a subspecialty in pediatrics or family medicine. Non-FQHC practices located in Rhode Island are eligible to apply. Payments will be calculated based on the number of Rhode Island Medicaid covered children served by the practice, and contingent on demonstrating performance improvement on a standardized measure of primary care access. Detailed information on quality benchmarks and reporting schedule is included within the program guidance document. 

Program Timeline

  • Online applications will go live Tuesday 8/27/20 at 10am EST.
  • Applications are due Thursday 9/10/20 by 5pm EST. Applications received after 9/10/20 may be considered and processed subject to available funds.
  • EOHHS will make every effort to disburse payments to qualifying providers by 9/30/20 (and the end of the month following each subsequent report). Payments will coincide with Medicaid fee-for-service payment cycles.
  • EOHHS will make reporting templates available to applicants for each subsequent monthly report, which will be due on the first of each month through the remainder of 2020 (October, November, December).

Program Application

  • Application is closed

Program Documents

Please email OHHS.PediRelief@ohhs.ri.gov if you have additional questions that are not addressed in the program’s guidance or application instructions.

Medicaid Pediatric Primary Care Relief Program

Program Overview

In June 2020, Governor Raimondo announced that the state would be providing financial relief payments to pediatric primary care providers. These one-time grant payments are meant to support system resiliency and response to public health concerns brought on by COVID-19 related disruptions in primary care as well as to offset costs of business interruption and expenses incurred due to the COVID-19 public health emergency.

Pediatric primary care has been deferred for many families because of the COVID-19 Public Health Emergency, resulting in a 33% reduction in vaccines administered between March and May of 2020 compared to the same period in 2019. Delayed vaccinations have been an unfortunate and nationally documented second-order effect of the public health emergency. As such, distribution of these funds will be tied to expectations that pediatric providers will take targeted actions to ensure patients are caught up on immunizations.

The Pediatric Primary Care Relief Program will provide payments to Rhode Island practices that provide primary care services to children. Payment size will be based on the practice’s panel in a manner proportional to the number of children under 18 years of age that receive primary care services from the practice. Non-FQHC practices located in Rhode Island are eligible to apply. Out-of-state practices will not be eligible to apply.

Program Timeline

  • Applications will go live Thursday 7/2/20 at 10am EST. Please complete the application in its entirety here: (APPLICATION CLOSED)
  • Applications are due Wednesday, 7/15/20 by 5pm EST. Applications received after 7/16/20 may be considered and processed subject to available funds.
  • EOHHS will make every effort to disburse payments to qualifying providers by 7/31/20. Payments will coincide with Medicaid fee-for-service payment cycles.

Program Documents

Please email OHHS.PediRelief@ohhs.ri.gov if you have additional questions that are not addressed in the program’s guidance or application instructions.