WV Birth to Three WV Birth to Three NECTAC Medicaid Conference Call NECTAC Medicaid Conference Call

December, 2006December, 2006

WV Birth to Three WV Birth to Three NECTAC Medicaid Conference Call NECTAC Medicaid Conference Call

December, 2006December, 2006

Presented by Pamela Roush, DirectorWV Birth to Three

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WV Birth to Three System WV Birth to Three System StructureStructure

Lead Agency – DHHR/BPH/OMCFH 8 Regional Administrative Units (RAUs) –

system points of entry with local lead agency functions

Individuals providing services are enrolled directly with, and credentialed by, WV BTT

Integrated Central Finance Office structure

Bureau for Public Health and Bureau for Medical Services are located within DHHR

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Services Reimbursed By Services Reimbursed By MedicaidMedicaid

In addition to other state plan services, earlyintervention services are: Evaluation/Assessment Therapeutic Intervention Teaming/Treatment Planning Service Coordination

These services are covered when provided by WV Birth to Three in accordance with the requirements of Part C of the Individuals with Disabilities Education Act

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Why Access Medicaid Funding Why Access Medicaid Funding for Part C Services?for Part C Services?

Federal law (IDEA) requires that Part C funds be used as funds of last resort

IDEA directs states to establish interagency agreements for coordination of resources and services

Depending on the State’s FFP and other factors, Medicaid may be a major source of funding for Part C services

WV – 75% FFP ( match rate for Medicaid)

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Why Did WV Pursue a Change in Why Did WV Pursue a Change in Accessing Medicaid Funding?Accessing Medicaid Funding?

Late 1990’s - services delivered through ‘dedicated’ agencies – one agency per region- shortage of services

Provider agencies raising concerns about funding – some threatening to stop providing services

Agencies billed directly to Medicaid – little input from OMCFH/BTT regarding Medicaid service definitions and rates

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How Did WV Pursue a Change in How Did WV Pursue a Change in Accessing Medicaid Funding?Accessing Medicaid Funding?

Finance Committee members of the ICC attended NECTAC finance workshop in NC – 1998/99

Used funding concerns as the impetus to do complete evaluation of how WV was implementing Part C of IDEA

Needed to know what we wanted to fund before asking for more money

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How Did WV Pursue a Change in How Did WV Pursue a Change in Accessing Medicaid Funding?Accessing Medicaid Funding?

Used outside consultant group (Solutions) to assist BTT and the ICC to conduct a comprehensive system evaluation

50 person Task Force Family and Provider Focus Groups Surveys/chart reviews Conducted structured activities and

communications to keep DHHR administrators fully informed of all steps

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BTT System Evaluation Task BTT System Evaluation Task GroupGroup

Evaluated how Part C of IDEA was being implemented in West Virginia

Identified strengths and areas for improvement

Identified ‘vision’ for effective system, with recommendations for achieving

Established process for coordinating funding sources – Central Finance Office

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Funding the Desired System Funding the Desired System Structure Structure

Investigated options for funding sources/structures that would support the desired system design

Decided to build upon the federal statutory relationship between Title XIX ( Medicaid) and Title V

(Maternal, Child and Family Health) Established interagency agreement

between Medicaid and OMCFH/BTT (both agencies are within DHHR)

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Note: What Works in One State Will Note: What Works in One State Will Likely Not Work Exactly the Same In Likely Not Work Exactly the Same In AnotherAnother

Each state structure is unique What will work in one state will not

necessarily work in another Often, it is the combination of

several components that work together to make the funding option feasible ( i.e. Title V/ vendor based system/ BMS and BPH in same lead agency, etc)

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West Virginia’s Title XIX/Title V West Virginia’s Title XIX/Title V Interagency AgreementInteragency Agreement Title XIX/Title V agreement recognizes

OMCFH/BTT as ‘the’ provider of Part C services for Medicaid eligible children

WV BTT enrolls specialists as needed to meet IDEA requirements– based on standards and credential process

Title XIX/Title V federal statutory relationship allows:

Title V to identify populations of children to be served Medicaid to reimburse Title V ‘at cost’ for needed

services delivered to eligible population (See section of Medicaid regulations –

‘Relations with State health and vocational rehabilitation agencies and title V grantees”)

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Medicaid Regulations Reference Medicaid Regulations Reference to Relationship With Title Vto Relationship With Title V

Section 431.615 (c) State plan requirements (1) Describe cooperative arrangements with the State agencies

that administer, or supervise the administration of, health services and vocational rehabilitation services designed to make maximum use of these services;

(2) Provide for arrangements with title V grantees, under which the Medicaid agency will utilize the grantee to furnish services that are included in the State plan;

(3) Provide that all arrangements under this section meet the requirements of paragraph (d) of this section; and

(4) Provide, if requested by the title V grantee in accordance with the arrangements made under this section, that the Medicaid agency reimburse the grantee or the provider for the cost of services furnished recipients by or through the grantee.

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West Virginia’s Title XIX/Title V West Virginia’s Title XIX/Title V Interagency AgreementInteragency Agreement

WV Birth to Three provides needed early intervention services for Medicaid eligible children

Medicaid reimburses BTT for the following services when provided to Medicaid eligible children in accordance with Part C of IDEA: Evaluation/assessment Therapeutic Intervention Teaming/Treatment Planning Service Coordination

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West Virginia’s Title XIX/Title V West Virginia’s Title XIX/Title V Interagency AgreementInteragency Agreement

• BTT specialists bill to a single entity – BTT Central Finance Office

• Common reimbursement codes and rates across all funding sources – promotes equity

• Services authorized through the Individualized Family Service Plan (IFSP)

Standard practice requirements and documents statewide

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West Virginia’s Title XIX/Title V West Virginia’s Title XIX/Title V Interagency AgreementInteragency Agreement

Bureau for Medical Services reimburses WVBTT for the total cost of providing the identified services

Legislature established a special fund account for BTT

Medicaid revenue is deposited in the state BTT account

Legislature allocates match dollars directly to Bureau for Medical Services line item

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What is Working?What is Working?

Increased Accountability More stable funding Funding sources support Lead Agency

responsibility under Part C Families typically have some choice of

person to provide identified service Specialists have options for their

participation in BTT

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What Are the Challenges?What Are the Challenges?

Establishing the State BTT system as the ‘provider’ of service requires more administrative oversight and resource commitment on the state level (a trade off for more influence and control)

Overall system design promotes identification of eligible children – which results in increased resource requirements

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Anticipated Changes?Anticipated Changes?

In the upcoming year, WV Birth to Three will investigate the use of private insurance and/or a system of family payments

WV BTT may need to request additional state funds

The integrated data system will support accessing additional funding sources

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QuestionsQuestions

For questions or more information,please contact Pam Roush: 304-558-6311 or by email pamroush@wvdhhr.org

For more information about WV Birth to Three, visit our website at

www.wvdhhr.org/birth23