Healthy Kids

1
Healthy Kids

• Title V Medicaid partnering to improve EPSDT in
  Nevada

2
Healthy Kids (EPSDT) Status

• Weak levels of partnering across state agencies
  low level of screening
• High number of FQHC in Nevada
• Due to frontier status number of providers to
  residents
• Lack of awareness when green form went away due
  to HIPAA initiation

3
Getting Started

• Low numbers of screens and need identified by
  Medicaid and Title V agency
• HRSA technical assistance- Sept. 2006
• Raise awareness 26 topics identified as in need
  of change
• Improve communication across agencies
• Improve communication to families
• Improve communication to community organizations
• Workgroups met to address priorities (2007)

4
Workgroups formed

• Workgroups formed during the September Leadership
  Workshop (facilitated by K. Johnson J. Resnick)
• Tribal/FQHC/Co/MCO
• Parent Support Education
• Auto Newborn
• Cross-Linkages
• The groups progress is reported to the Maternal
  and Child Health Advisory Board (Title V)

5
Tribal/FQHC/County/MCO

• Proposed activities provider capacity, outreach
  to low-income children, MCO network adequacy of
  payment for screens
• Addressed
• Communication among these entities- typically did
  not cross paths prior to these meetings
• Provider training/awareness billing training
• Work on subcontracts to be in MCO network
• Work with Parent group for creative outreach

6
Parent Support Education

• Proposed activities support parents in their
  role through education, motivation and knowledge
  of how to use the health care system culturally
  appropriate materials
• Addressed
• Family developed brochure
• Grass-root notification to parents
• Review of letters sent by state system upon
  enrollment

7
Auto Newborn

• Proposed activities Review federal requirements
  and Nevadas policy, streamline enrollment
  notification and reduce time since birth to
  receive screens support for electronic birth
  certificate capacity
• Addressed
• Medicaid corrected computer system to allow
  earlier reception of screens
• Electronic Birth Certificates passed legislation
• Improve education to pregnant women for early
  enrollment process

8
Cross-Linkages

• Proposed activities Review effective data
  sharing, policy, and communication across
  agencies such as EIS, Child Welfare, Mental
  Health, Head Start
• Addressed (this group did not meet formally,
  decided for staff to work within own positions
  and pull together administration of each division
  to resolve)
• Ongoing activity for improved data sharing
• Notification of who to contact for specialty
  screening
• Education about Immunization as component of
  Healthy Kids screen (tie to existing priorities)

9
Overall Challenges

• Maintaining focus on specific issues to resolve
  multiple areas in need of addressing
• Inadequate service infrastructure to build upon
• Low level of participation by state agency
  determining eligibility (in NV, not by Medicaid)
• Lack of data sharing of data timely enrollment
  notification
• Some issues too loaded to address in a public
  meeting forum

10
Overall Successes

• Improved communication/awareness
• Strong MCO involvement in workgroups new
  contract had incentives
• Revival of welfare notification to families of
  newly enrolled children (procedure had been
  skipped-staff turnover)
• Networking of state agencies with community-based
  organizations
• Website www.health.nv.gov matrix modeled after
  Michigans EPSDT toolkit
• More providers understand the components of the
  screen more billing staff code properly

11
Future Activities

• Formal process to inform parents (Iowa model)
• Continued monitoring of systematic notification
  process via welfare mailers and eligibility
  worker staff training
• More effective data sharing agreements
• Monitoring/training of coding
• Return of the screening form for providers
  (improves consistency of screen billing
  notification data recording)

12
Q A

• Judith Wright
• Chief, Bureau of Family Health Services,
• Nevada State Health Division
• jwright_at_health.nv.gov
• 775-684-4285