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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 l.jpg

Medicaid Waiver Work Group

May 21, 2008

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


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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


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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


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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


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EPSDT

  • 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)


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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


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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


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Cyber Access

  • Secure website with access to 2 years of paid claims history

  • Access with Medicaid number (DCN)

  • No charge to providers


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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


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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