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Part C System Georgia. ITCA Fiscal Initiative Cohort 1 2014. Babies Can’t Wait. Georgia Department of Public Health 18 Public health districts cover 159 counties Georgia’s birth – three population: 406,969. Georgia’s Funding Model. Program Cost Drivers.

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part c system georgia

Part C SystemGeorgia

ITCA Fiscal Initiative Cohort 1

2014

babies can t wait
Babies Can’t Wait
  • Georgia Department of Public Health
  • 18 Public health districts cover 159 counties
  • Georgia’s birth – three population: 406,969
program cost drivers
Program Cost Drivers

Low Care Management Organization (CMO) Enrollment

Results in over utilization of the special instruction

No CMO coverage for service coordination.

  • Special Instruction
    • Non-Reimbursable
    • Heavy reliance in rural area
  • Increasing Caseload
    • 1.27% in federal fiscal year 2008 to 1.85% in federal fiscal year 2012
  • Service Coordination
    • Traditional Fee-for-Service (FFS) reimbursement only
georgia s service delivery model
Georgia’s Service Delivery Model
  • Primary Service Provider (PSP) model
    • Strong reliance on teaming
  • Teams composed of public and private providers
    • Weekly or bi-weekly meetings
  • 99% of services delivered in natural environment
data systems
Data Systems
  • BIBS (Babies Information and Billing System) database
    • Contracted service cost
  • Uniform Accounting System (UAS)
    • Used to manage local level (district) cost for infrastructure cost, and private (employee) providers
data system bibs
Data System-BIBS

Provider Account Management

Ad Hoc Reports

Assistive Technology (AT) Expense by District

All Claims-claims which have completed the payment process cycle

Claims Awaiting Update-claims which have not completed the process cycle

  • Authorized IFSP services
  • Claims Data
  • Payment History
challenges
Challenges
  • Decrease in federal funds (↓ 9% for current fiscal year)
  • Flat State funds
  • Significantly increased caseload
  • Lack of Medicaid CMO reimbursement for Service Coordination - approximately 34% of the direct services cost for FFY 12
  • Lack of Medicaid reimbursement for Special Instruction - approximately 22% of direct service cost for FFY12
challenges cmo
Challenges - CMO
  • Low CMO provider enrollment in certain areas due to complex, lengthy CMO enrollment processes
  • Provider dissatisfaction with CMO reimbursement rates
  • Over utilization of special instruction ( due to low provider enrollment) at significant cost to the program
  • Delays in obtaining physician prescriptions and CMO authorizations for payment of Part C services impacts the ability of local programs to meet IFSP timeliness and timely service delivery requirements
challenges1
Challenges

In FFY 2012 experienced fiscal challenges due to:

  • Ongoing cost of provider positions previously funded by ARRA
  • Challenges with Medicaid provider/District enrollment
  • Lengthy delays in Medicaid fund recovery
challenges2
Challenges
  • In January 2013, state changed to a provider “chase and pay” system of reimbursement; BCW only pays:
    • After provider claims are billed and denied by other funding sources
    • When BCW funds are the only payment source for a service such as special instruction
  • Third party fund recovery is no longer a function of the state data and billing system.
current initiatives taskforce
Current Initiatives - Taskforce
  • BCW Strategic Taskforce: A statewide group of internal and external stakeholders organized in Fall 2013
    • Define a high quality BCW program that is fiscally responsible with long-term financial stability
    • Improve provider relations
    • Reduce duplication
    • Establish efficient use of resources
    • Develop public relations campaign
current initiatives taskforce1
Current Initiatives - Taskforce
  • Three committees developed
    • Administration
    • Service Delivery
    • Finance
  • Recommendations to DPH Commissioner
  • Ongoing implementation of recommendations
current initiatives other
Current Initiatives - Other
  • Medicaid: Working with Medicaid to improve provider enrollment and reimbursement
  • Standing weekly conference calls with the state’s vendor for BIBS
  • Dedicated state fiscal resource for BCW