NECTAC in collaboration with ITCA

1. Accessing EPSDT for Part C ServicesAchieving 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)

2. Virginia’s Experience in Accessing EPSDT for Part C Services 2 2

3. 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 3

4. Part C Eligibility Children 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 4 4

5. 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.

6. 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. 6

7. 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 7

8. 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!

9. 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 9 9

10. 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

11. 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.)

12. 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

13. 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

14. Enrollment Growth

15. EI Expenditure Growth

16. 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). DMAS EI Covered Services 16

17. 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. 17

18. 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 18 18

19. 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

20. 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

21. 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

22. Contact Information Tammy Whitlock, DMAS Contact 804-225-4714 Tammy.whitlock@dmas.virginia.gov Beth Tolley, Infant & Toddler Connection of Virginia 804-371-6595 Beth.tolley@dbhds.virginia.gov 22

23. 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