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Medicaid Waiver Work Group. May 21, 2008 First Steps, EPSDT, Role of County Board in Mo HealthNet Initiatives, Medicaid Expansion/Waivers. Gap Analysis of First Steps Program. Compare prevalence measures to actual

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medicaid waiver work group

Medicaid Waiver Work Group

May 21, 2008

First Steps, EPSDT, Role of County Board in Mo HealthNet Initiatives, Medicaid Expansion/Waivers

gap analysis of first steps program
Gap Analysis of First Steps Program
  • Compare prevalence measures to actual
  • Estimated gap of 463 with DD; 1,057 with medical conditions; 533 with very low birth weight; total of 2,053 (8/07 report by Philips and Associates, Inc.)
  • Based on 50% delay – moderate standard
  • Finding of Underreporting – lack of formal pediatric measurement to aid in identification of DD
abcd consortium screening surveillance tool
ABCD ConsortiumScreening/Surveillance Tool
  • CA, IA, IL, MN & UT – develop and test strategies for improving delivery of developmental services for children at risk for or with DD
  • All demonstrated success after 3 years
  • Validated screening tools (ASQ most used)
  • Tool completed by parent
  • Referral of children who do not pass screening to Early Intervention or other resources
address provider issues
Address Provider Issues
  • Educate providers about billing for a screening
  • Adopt Dx classification designed for 0 -3 year olds (DC: 0-3); crosswalk to DSM and ICD-9 so that child has a billable Dx
  • Review Medicaid policies
  • Illinois - present at MACDDS in June
  • Comprehensive children’s health program
  • Federal standards for participation rates
  • Contractual obligations of MCO’s
  • Potential role of County Boards
  • (See Joel Ferber’s presentation)
medicaid transformation report
Medicaid Transformation Report
  • Recommendation #3 Health care home and coordinator focusing on health and wellness
  • Recommendation #4 Health risk assessment
  • Recommendation #5 Develop plan of care
chronic care improvement program ccip
Chronic Care Improvement Program (CCIP)
  • Mo HealthNet Bulletin 01/12/07 Volume 29 #18 Primary care case management system; incorporates disease management, care coordination and case management
  • Fee for Service recipients only
  • Asthma, COPD, Diabetes, Cardiovascular Disease, GERD, Sickle Cell Anemia
  • DSS assignment of recipients to provider
  • Financial incentive to provider to participate
  • Internet based program and plan of care
  • References interaction of provider with community agencies to coordinate care
cyber access
Cyber Access
  • Secure website with access to 2 years of paid claims history
  • Access with Medicaid number (DCN)
  • No charge to providers
potential role of county board
Potential Role of County Board
  • Concepts to consider:
    • Improve EPSDT screenings by follow up with eligible clients
    • Screen to identify those at risk and refer; create data base
    • MOU with primary care provider (PCP) and/or MCO regarding role of County Board
    • Create list of diagnoses to be tracked through CCIP – act as case manager for PCP
medicaid waivers expansion
Medicaid Waivers/Expansion
  • Children’s waivers: Nebraska – respite and care coordination for children under 3 in Early Intervention (EI) program who meet institutional LOC, disregard parental income; PA – under 3 in EI program, meet institutional LOC, disregard parental income; higher level of delay required - 50% in one area or 33% in 2 or more; (In PA, all uninsured under 19 years have access with premiums and copays for some)
  • Medicaid Buy-in Programs
  • Family Opportunity Act under Deficit Reduction Act – SSI eligible, <300% FPL, uninsured or underinsured, not required to meet institutional LOC