Implementing a Nurse-Family Partnership Medicaid Billing Project

Grantee Name

Fund for Public Health in New York

Funding Area

Special Projects Fund

Publication Date

September 2014

Grant Amount

$131,195

Grant Date:

December 2010 – March 2012

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The Nurse-Family Partnership (NFP) is a rigorously tested nurse home-visiting program for first-time mothers that helps low-income, high-risk families reduce poor health and social outcomes.

The New York City Department of Health and Mental Hygiene (NYCDOHMH) is responsible for implementing NFP in New York City and maintaining its fidelity to the national model. An opportunity to facilitate the financial sustainability of the New York City Nurse-Family Partnership (NYC NFP), the largest NFP site and a model for other NFP sites across the State, emerged when the federal Centers for Medicare & Medicaid Services approved Medicaid funding for the Targeted Case Management component of NFP services. To maximize Medicaid reimbursement, it was critical for NYC NFP to develop and implement effective billing systems, as well as train employees to adhere to these new systems.

In 2010, NYHealth awarded the Fund for Public Health in New York (FPHNY), on behalf of the NYCDOHMH, a grant to support the operational changes needed to implement a functional Medicaid billing system at NYC NFP sites.

Outcomes and Lessons Learned

Provided all seven NYC NFP sites with training and ongoing technical assistance. As a result of delays in obtaining a required State license, only six of the seven NYC NFP sites completed full implementation of a Medicaid billing system by the end of the grant period;
Conducted monthly site visits and audits to monitor and ensure compliance with Medicaid and NYCDOHMH policies;
Created a new, automated data management system after recognizing the need for more accurate and timely data; and
Established strong relationships with the NYCDOHMH billing department, NYSDOH, NFP NSO, and NFP of Monroe County.

Medicaid reimbursed $342,965 from July 2010 through June 2011 for all NYC NFP sites. This figure was much lower than projected, which the grantee attributed to both changes in State reimbursement rates and a lack of familiarity and comfort by nurses with the new Medicaid billing systems.

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