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 States 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 1990s - 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 Virginias 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 Virginias 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 Virginias 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 Virginias 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_at_wvdhhr.org
• For more information about
• WV Birth to Three, visit our website at
  www.wvdhhr.org/birth23