WV Birth to Three NECTAC Medicaid Conference Call December, 2006

1. WV Birth to Three NECTAC Medicaid Conference Call December, 2006 Presented by Pamela Roush, Director WV Birth to Three

2. WV Birth to Three System Structure • Lead Agency – DHHR/BPH/OMCFH • 8 Regional Administrative Units (RAUs) – system points of entry with local lead agency functions • Individuals providing services are enrolled directly with, and credentialed by, WV BTT • Integrated Central Finance Office structure • Bureau for Public Health and Bureau for Medical Services are located within DHHR

3. Services Reimbursed By Medicaid In addition to other state plan services, early intervention services are: • Evaluation/Assessment • Therapeutic Intervention • Teaming/Treatment Planning • Service Coordination • These services are covered when provided by WV Birth to Three in accordance with the requirements of Part C of the Individuals with Disabilities Education Act

4. Why Access Medicaid Funding for Part C Services? • Federal law (IDEA) requires that Part C funds be used as funds of last resort • IDEA directs states to establish interagency agreements for coordination of resources and services • Depending on the State’s FFP and other factors, Medicaid may be a major source of funding for Part C services • WV – 75% FFP ( match rate for Medicaid)

5. Why Did WV Pursue a Change in Accessing Medicaid Funding? • Late 1990’s - services delivered through ‘dedicated’ agencies – one agency per region- shortage of services • Provider agencies raising concerns about funding – some threatening to stop providing services • Agencies billed directly to Medicaid – little input from OMCFH/BTT regarding Medicaid service definitions and rates

6. How Did WV Pursue a Change in Accessing Medicaid Funding? • Finance Committee members of the ICC attended NECTAC finance workshop in NC – 1998/99 • Used funding concerns as the impetus to do complete evaluation of how WV was implementing Part C of IDEA • Needed to know what we wanted to fund before asking for more money

7. How Did WV Pursue a Change in Accessing Medicaid Funding? • Used outside consultant group (Solutions) to assist BTT and the ICC to conduct a comprehensive system evaluation • 50 person Task Force • Family and Provider Focus Groups • Surveys/chart reviews • Conducted structured activities and communications to keep DHHR administrators fully informed of all steps

8. BTT System Evaluation Task Group • Evaluated how Part C of IDEA was being implemented in West Virginia • Identified strengths and areas for improvement • Identified ‘vision’ for effective system, with recommendations for achieving • Established process for coordinating funding sources – Central Finance Office

9. Funding the Desired System Structure • Investigated options for funding sources/structures that would support the desired system design • Decided to build upon the federal statutory relationship between Title XIX ( Medicaid) and Title V (Maternal, Child and Family Health) • Established interagency agreement between Medicaid and OMCFH/BTT (both agencies are within DHHR)

10. Note: What Works in One State Will Likely Not Work Exactly the Same In Another • Each state structure is unique • What will work in one state will not necessarily work in another • Often, it is the combination of several components that work together to make the funding option feasible ( i.e. Title V/ vendor based system/ BMS and BPH in same lead agency, etc)

11. West Virginia’s Title XIX/Title V Interagency Agreement • Title XIX/Title V agreement recognizes OMCFH/BTT as ‘the’ provider of Part C services for Medicaid eligible children • WV BTT enrolls specialists as needed to meet IDEA requirements– based on standards and credential process • Title XIX/Title V federal statutory relationship allows: • Title V to identify populations of children to be served • Medicaid to reimburse Title V ‘at cost’ for needed services delivered to eligible population • (See section of Medicaid regulations – ‘Relations with State health and vocational rehabilitation agencies and title V grantees”)

12. Medicaid Regulations Reference to Relationship With Title V • Section 431.615 (c) State plan requirements • Describe cooperative arrangements with the State agencies that administer, or supervise the administration of, health services and vocational rehabilitation services designed to make maximum use of these services; • Provide for arrangements with title V grantees, under which the Medicaid agency will utilize the grantee to furnish services that are included in the State plan; • Provide that all arrangements under this section meet the requirements of paragraph (d) of this section; and • Provide, if requested by the title V grantee in accordance with the arrangements made under this section, that the Medicaid agency reimburse the grantee or the provider for the cost of services furnished recipients by or through the grantee.

13. West Virginia’s Title XIX/Title V Interagency Agreement • WV Birth to Three provides needed early intervention services for Medicaid eligible children • Medicaid reimburses BTT for the following services when provided to Medicaid eligible children in accordance with Part C of IDEA: • Evaluation/assessment • Therapeutic Intervention • Teaming/Treatment Planning • Service Coordination

14. West Virginia’s Title XIX/Title V Interagency Agreement • BTT specialists bill to a single entity – BTT Central Finance Office • Common reimbursement codes and rates across all funding sources – promotes equity • Services authorized through the Individualized Family Service Plan (IFSP) • Standard practice requirements and documents statewide

15. West Virginia’s Title XIX/Title V Interagency Agreement • Bureau for Medical Services reimburses WVBTT for the total cost of providing the identified services • Legislature established a special fund account for BTT • Medicaid revenue is deposited in the state BTT account • Legislature allocates match dollars directly to Bureau for Medical Services line item

16. What is Working? • Increased Accountability • More stable funding • Funding sources support Lead Agency responsibility under Part C • Families typically have some choice of person to provide identified service • Specialists have options for their participation in BTT

17. What Are the Challenges? • Establishing the State BTT system as the ‘provider’ of service requires more administrative oversight and resource commitment on the state level (a trade off for more influence and control) • Overall system design promotes identification of eligible children – which results in increased resource requirements

18. Anticipated Changes? • In the upcoming year, WV Birth to Three will investigate the use of private insurance and/or a system of family payments • WV BTT may need to request additional state funds • The integrated data system will support accessing additional funding sources

19. Questions For questions or more information, please contact Pam Roush: 304-558-6311 or by email pamroush@wvdhhr.org For more information about WV Birth to Three, visit our website at www.wvdhhr.org/birth23