Part C System Georgia

1. Part C SystemGeorgia ITCA Fiscal Initiative Cohort 1 2014

2. Babies Can’t Wait • Georgia Department of Public Health • 18 Public health districts cover 159 counties • Georgia’s birth – three population: 406,969

4. Georgia’s Funding Model

5. 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

7. Caseload by Fund Source

9. 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

11. 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

12. 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

14. 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

15. 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

16. 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

17. 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.

19. 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

20. Current Initiatives - Taskforce • Three committees developed • Administration • Service Delivery • Finance • Recommendations to DPH Commissioner • Ongoing implementation of recommendations

21. 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

22. QUESTIONS