nectac in collaboration with itca
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Accessing EPSDT for Part C Services Achieving a Better Fit Between the EI Philosophy and Allowable Medicaid Covered Services. NECTAC in collaboration with ITCA - PowerPoint PPT PresentationTRANSCRIPT
Accessing EPSDT for Part C ServicesAchieving a Better Fit
Between the EI Philosophy and Allowable Medicaid Covered Services
NECTAC in collaboration with ITCAwelcome you to our webinar for Part C Coordinators and their designated staff, OSEP, and members of the National Alliance for Medicaid in Education (NAME)
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Virginia’s Experience in Accessing EPSDT
for Part C Services
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DBHDS and the Early Intervention
Program
Virginia’s early intervention (EI) system is governed by Part C of the Individuals with Disabilities Education Act (IDEA)
The EI system is managed by the Department of Behavioral Health and Developmental Services (DBHDS)
DBHDS’ program is called the Infant & Toddler Connection of Virginia
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Part C EligibilityChildren from birth to third birthday who
meet one or more of the following criteria:
Developmental Delay
Atypical Development
Diagnosed physical or mental condition that has a high probability of resulting in a developmental delay
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Early Intervention Service
Early intervention services are developmental supports and services that are performed in natural environments, including home and community based settings in which children without disabilities participate, to the maximum extent possible.
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Early Intervention and DMAS BEFORE October
1, 2009
Providers billed for those services using the reimbursement codes for physical therapy, occupational therapy and speech language pathology.
Services were not always reimbursed in the natural environment.
Rates did not take into consideration the additional cost of providing services outside of the clinic.
EI funds were NOT used as a last resort.
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Early Intervention and DMAS BEFORE October
1, 2009 DMAS had no way of identifying the
children enrolled in Early Intervention. Reimbursement was not available for all
of the provider types that can deliver Early Intervention services according to federal Part C rules.
There was no provider certification process; DBHDS could not identify the providers.
Could not accurately report EI expenditures
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EI TransformationEI Taskforce was established Included EI Stakeholders, parents, and
MCO involvementAfter almost two years of work, a
new program was implemented October 1, 2009!
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TransformationAccomplishments
All providers, except physicians, audiologists and registered dietitians, must be certified by DBHDS as an Early Intervention Provider. Cannot receive reimbursement from either
Part C or DMAS without certification All federally allowed providers are
reimbursed by DMAS for EI Services
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TransformationAccomplishments
Certification requirements were written into Virginia’s Administrative Code.
Regulations support Virginia’s efforts to improve the comprehensive system of personnel development by including:
Baseline personnel requirements Requirements for continuing education for re-
certification
Infant & Toddler Connection of Virginia 10
Transformation Accomplishments
EI Certification also provides: Sign off by providers on assurances and
agreement to follow Part C regs/procedures
Mechanism to identify all providers in the EI System
Mechanism to communicate with all providers (updates, announcements, etc.)
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Transformation Accomplishments
Medicaid EI Program and Part C requirements are in sync Services in the natural environment are
reimbursed and encouraged IFSP serves as the Plan of Care IFSP certified by physician documents
medical necessity
Infant & Toddler Connection of Virginia 12
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TransformationAccomplishments
IFSPs and IFSP reviews are reimbursed EI funds are used as a last resort;
providers must bill DMAS for Medicaid/FAMIS children
EI children and their expenditures are tracked. Reports are sent to MCOs and the local lead agencies each month.
EI Services are carved-out of the MCO contracts
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Enrollment Growth
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EI Expenditure Growth
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DMAS EI Covered Services
Developmental services;
Family training, counseling and home visits;
Speech-language pathology, including sign language and cued language services;
Nursing services;
Occupational therapy;
Physical therapy; Psychological
services; Social work services; Assistive technology
related services (such as instruction or training on use of assistive technology).
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DMAS Covered Services Billed “Outside” of the EI Program Assistive technology devices; Health services; Nutrition services; Service coordination; Medical services, only for diagnostic
or assessment purposes; Audiology services, and Vision services.
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Quality Management Reviews
Quality Management Reviews (QMR) Conducted by the DBHDS Lead agencies volunteered for 3 pilot
reviews Monitoring and Supervision staff
conduct reviews and any report any retractable actions to DMAS
DMAS assisted with development of process and automated forms
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Quality Management Reviews
Results of 3 Pilots: • 62 records reviewed • Some services were provided but
not billed• Some documentation issues• 97% of records reviewed had
documentation of medical necessity
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Early InterventionTargeted Case Management
Will be implemented 10/1/2011 Developed with extensive stakeholder
involvement Was not implemented with the 2009
Medicaid EI Initiative due to uncertainty about CM at the federal level
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Early InterventionTargeted Case Management
Ensures care coordination for all EI children Establishes certification for case managers Aligns Medicaid TCM requirements with
service coordination requirements Adds quality components: increasing well
child visit rates, immunizations, and lead testing for EI kids
Acknowledges necessary coordination with the MCOs
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Contact InformationTammy Whitlock, DMAS Contact
Beth Tolley, Infant & Toddler Connection of Virginia
For more information…
Links to resources mentioned in this webinar, including the toolkit and Q&A sections from the day of the presentation are available at:
http://www.nectac.org/~calls/2011/epsdt/epsdt.asp