Transcript Accessing EPSDT for Part C Services Achieving a Better Fit Between the EI Philosophy and Allowable Medicaid Covered Services NECTAC in collaboration with ITCA welcome.

Accessing EPSDT for Part C Services
Achieving a Better Fit
Between the EI Philosophy and Allowable
Medicaid Covered Services
NECTAC in collaboration with ITCA
welcome you to our webinar for Part C Coordinators and their designated staff, OSEP, and
members of the National Alliance for Medicaid in Education (NAME)
Virginia’s Experience in
Accessing EPSDT
for Part C Services
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DBHDS and the
Early Intervention Program
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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 Eligibility
Children from birth to third birthday who meet
one or more of the following criteria:
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Developmental Delay
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Atypical Development
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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
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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
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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 Transformation
EI Taskforce was established
Included EI Stakeholders, parents, and MCO
involvement
After almost two years of work, a new
program was implemented October 1,
2009!
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Transformation
Accomplishments
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All providers, except physicians,
audiologists and registered dietitians,
must be certified by DBHDS as an Early
Intervention Provider.
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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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Transformation
Accomplishments
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Certification requirements were written
into Virginia’s Administrative Code.
Regulations support Virginia’s efforts to
improve the comprehensive system of
personnel development by including:
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Baseline personnel requirements
Requirements for continuing education for recertification
Infant & Toddler Connection of Virginia
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Transformation
Accomplishments
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EI Certification also provides:
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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
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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
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Transformation
Accomplishments
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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
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Developmental
services;
Family training,
counseling and home
visits;
Speech-language
pathology, including
sign language and
cued language
services;
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Occupational therapy;
Physical therapy;
Psychological services;
Social work services;
Assistive technology
related services (such
as instruction or
training on use of
assistive technology).
Nursing services;
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DMAS Covered Services Billed
“Outside” of the EI Program
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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 Intervention
Targeted Case Management
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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 Intervention
Targeted Case Management
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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 Information
Tammy Whitlock, DMAS Contact
804-225-4714
[email protected]
Beth Tolley, Infant & Toddler
Connection of Virginia
804-371-6595
[email protected]
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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