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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. Compare prevalence measures to actual

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Medicaid Waiver Work Group

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  1. Medicaid Waiver Work Group May 21, 2008 First Steps, EPSDT, Role of County Board in Mo HealthNet Initiatives, Medicaid Expansion/Waivers

  2. 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

  3. 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

  4. 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

  5. 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)

  6. 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

  7. 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

  8. Cyber Access • Secure website with access to 2 years of paid claims history • Access with Medicaid number (DCN) • No charge to providers

  9. 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

  10. 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

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