Healthy Michigan Plan (HMP) is a health plan authorized under the Affordable Care Act via MDHHS launched on April 1, 2014. HMP is offered at a low cost to qualified beneficiaries which affords them quality health care while promoting adoption of healthy behaviors.

Healthy Michigan Plan (HMP) members have unique requirements under Medicaid.   While Healthy Michigan members have Medicaid coverage, it’s important to note that not all Medicaid members have Healthy Michigan Medicaid coverage.  Therefore, it is important to distinguish a HMP member from other members assigned to you.

HMP members can be easily identified in the portal when checking eligibility based on the Benefit Plan.  Review the Benefit Plan under Benefit Plan Information. The benefit plan will display as 111-M10000. HMP members can also be identified on the member roster, noted as Healthy MI under the Benefit Plan.

NOTE:  While Healthy Michigan members have Medicaid coverage, it’s important to note that not all Medicaid members have Healthy Michigan Medicaid coverage.

The Healthy Behaviors Incentive Program is an initiative that plays an important role in the Healthy Michigan Plan. The Program strives to encourage members to engage in healthy behaviors leading to an overall healthy lifestyle. According to the MDHHS website:

• Beneficiaries work in collaboration with their health care provider (PCP) to complete a standardized HMP Health Risk Assessment (HRA) and identify healthy behavior goals.
• Beneficiaries are expected to remain actively engaged in their health by establishing at least one healthy behavior goal each year they are in the Healthy Michigan Plan.
• There is a Healthy Behavior incentive for beneficiaries who agree to address or maintain healthy behaviors on the Healthy Michigan Plan HRA, which can be a reduction in required cost-sharing.

HMP members must schedule an appointment and complete the Health Risk Assessment form within 60 days of their effective coverage date. (Refer below to see accommodations during COVID).

• A follow up visit must occur annually along with the completion of reassessment HRA form within 11-15-month timeframe of the initial visit. HRA is ineligible if done sooner than 11 months from prior date.
• Sign/date HRA form, then fax to THC 844-842-4968 or submit through the CHAMPS website of michigan.gov/mibridges.com. Each fax should include a cover sheet indicating the number of HRAs that are being submitted, as well as contact information for the provider in case of missing information.
• The physician will receive a $25 incentive when reporting 96160 with an office visit on the claim and the completed HRA has been received by THC within 90 days of the visit.
• Contact THC Customer Services with questions 800-826-2862.

To facilitate completion of the Healthy Michigan Plan (HMP) Healthy Behavior requirements during the COVID-19 Pandemic, MDHHS currently allows health plans to work directly with members to telephonically complete the HRA.  Accordingly, effective 6/1/2020, Total Health Care staff began to perform telephonic outreach to our members for this purpose.  This change in process is designed to align with social distancing, and recognizes that member access to primary care for the purposes of preventive services and HRA completion has been reduced during the COVID-19 pandemic.  Because MDHHS has not removed the requirement for completion of the HRA, allowing THC to facilitate completion of the HRA is a means to assist the PCPs because of limited availability, not to undermine the PCP relationship.  This is, however, a time-limited exception for completing HMP HRAs with our members until we are notified by MDHHS that the exception has ended.

• PCPs can continue to work directly with members to complete the HRA telephonically, and bill according to the appropriate guidelines noted below. PCPs can use CHAMPS to determine the need for HRA completion.
• HMP members will not be terminated for failure to complete the HRA during the pandemic. However, once the pandemic is over, the requirement will be reinstated, and completing the HRA now will avoid a backlog of members who require an appointment once the emergency measures have been lifted.
• Timely submission of HRA files facilitates secure sharing of HRA information with PCPs via CHAMPS.
• HRAs which are submitted to MDHHS through the Healthy Behaviors file become available to PCPs in CHAMPS within one business day.

The video resources  below provide more information on HRAs and the Healthy Beahvior Incentive program:

• Completing the Health Risk Assessment
• Submitting the HRA
• Overview Healthy Behaviors Incentive Program
• Healthy Michigan HRA

Telehealth visit codes are payable as follows for all eligible THC members. THC reimburses fee-for-service for the below listed codes when billed with POS 02 on a professional claim.  Claims will be reimbursed based on the non-FAC fee at your contractual rate as of 6/1/2020.

• Telephone Visits – Medicaid and Commercial
  • 99441
  • 99442
  • 99443
• Evaluation & Management Codes – Commercial and Medicaid
  • GT modifier is required for Medicaid