Part C System of Payments Study: Consultant Update Community Service Board Leaders April 29, 2008.

Part C System of Payments Study:

Consultant Update

Community Service Board LeadersApril 29, 2008

Outcomes for Today

Participants will:• Understand the evolution of the System of Payments

initiative and its implications upon the 0-3 service delivery system including but not limited to financing;

• Understand the system analysis and findings to date;• Understand the system change proposals, implications

for Local Lead Agencies (LLAs) and early intervention practices in all arenas; and

• Have the opportunity to pose questions, discuss potential implications for LLAs and plan next steps for positive engagement and support of this initiative.

Slide 2

Consultant Commitment

• Think SYSTEMS: Research and study the issues comprehensively.

• Ask probing, sometimes “hard” questions, and listen to answers.

• Give you an honest opinion and options based upon research, other state experiences, etc.

• Honor that you make we advise.– We can’t support anything illegal related to any regulatory

source• In finance work, construct policy and procedures which

avoid any possibility of recoupment or payback by providers or LLAs or state.

• In all services, produce outcomes that keep both the state administrators and stakeholders and us out of jail.

Slide 3

Consultant Request

• Acknowledge that the way you are now funding your EI system will change for a variety of reasons beyond your control or the consultant’s influence

• Suspend consideration of the current barriers of the current system– Write them down if you have to

• Focus on what’s good for families and kids– What would you LIKE to do but CAN’T due to funding

limitations?

Slide 4

The Road to Here: Where we have been and

how we got hereEvolution of Infant & Toddler

Connection of Virginia

“System of Payments” Study

The Sequence of Events

• Solutions’ Technical Assistance through NECTAC– Key issue: What rate (provider cost or

negotiated rate) should be used in the assignment of Part C Ability To Pay (ATP)?

RESULTS

Slide 7

Step ONE:WHAT RATE IS USED IN

THE ASSIGNMENT

OF ATP?

Virginia History,

Philosophy and VA Code re:

FamilyService

Payment

A Variety ofReimburse-ment Rates and Items

ISSUES raised re:

Provider and Family Equity and Parity

RESOLVE:Use Provider CONTRACTED

Rate

Ability To Pay:Policies,

Procedures & Documentation

INCONSISTENCIES IDENTIFIED

STILL REMAINED

Slide 9

Step TWO:Ability To Pay:

Policies, Procedures & Documentation

VARYING RATES

Covered VS.

Uncovered Services

Local Lead AgencyAnd Provider:

Timelyand

Adequate Reimbursement

Federal Requirements

Re:POLR, MOE, Non-Supplanting

OSEP, VA

General Assembly

Monitoring and

Reporting Requirements

SYSTEM OF

PAYMENTS

ATP Linkage with

Private Insurance, Medicaid

The Sequence of Events - 2• 1st Solutions Contract (3/06-1/07) (6 on-site visits)• February 15, 2007

– Solutions’ Report Issued with 5 Q&A documents, Appendices

– Proposed Initiatives:• Update of 2003 Fiscal Study

– Development of new Allocation Formula for State/Federal Funds to LLAs

– Identification of Common Rates for Reimbursement

• ITOTS Evaluation• Final Family Cost Participation Developed• EI Medicaid Initiative (to include MCOs, Insurance Legislation)• Interagency Agreements

RESULTS Slide 11

Ability To Pay:Policies,

Procedures & Documentation

Part C Federal, State and

Local Fund Application

Medicaid Early

Intervention Initiative

Establish a SystemWith Commonalities

(Rates, Provider Quals, Services

& Supports)

Step THREE:SYSTEM

OF PAYMENTS

MCO’s

Private InsuranceLegislative

Improvements

The Sequence of Events - 3

• Solutions’ Proposal for 2nd Contract Developed– 08/13/07 CMS REHAB NPRM– 08/07 OSEP Draft Financial Monitoring Tool

• 2nd Solutions’ Contract 9-07-12/08 (7 on-sites to date)– 09/07/07 CMS Admin Claiming NRPM (9/08

Implementation)– 12/04/07 CMS TCM/CM NPRM (March 3, 2008

implementation)

Slide 13

LSM/VICC Presentation Slide 14

Today’s Topics

• The Medicaid Early Intervention (EI) Initiative– System infrastructure – state and local level– Service Coordination– Part C Entitled Services

• Fiscal Study Update– Rates Recommendations– Funding Allocation Revisions

• ITOTS Evaluation• Family Cost Participation (formerly Ability to

Pay to ATP)

The Medicaid Early Intervention (EI) Initiative

Slide 15

Your Reality Now

• The way that Part C “does business” with Medicaid cannot continue as is:– TCM/CM reimbursement must change

• IDEA Related services plus IFSP• CMS will not pay for “blended” SC• CMS requires reimbursement in 15 minute units

– Rehab vs. Habilitation• Part C services must be relocated in VA Medicaid State Plan

to EPSDT from Rehab Services Option (RSO)• Family Choice of Provider is a CMS requirement (since

1965)

Slide 16

What Now Is …

• There is no Medicaid reimbursement for the Medicaid-related administrative services provided by Part C (state and local level functions)

• Service Coordination is a Medicaid covered service under the SPO

• Most (not all) EI Services are covered under the Rehab Services Option

• Different agreements exist with the MCOs and LLAs including reimbursement, who provides the service, how referrals are received, etc.

Slide 17

In Construction: Administrative Claiming

• Administrative Claiming Agreement between Part C Lead Agency and DMAS– 50% FFP/50% State Match

Certification– Will require time sampling

to document expenditures, monthly child enrollment to verify Medicaid %

– Could include service coordination (intake and ongoing)

LEAD AGENCY:State and/or Local Agency ultimately responsible for the

overall program administration and

compliance.

RESOURCE AND REFERRAL

(R&R)/CENTRAL

DIRECTORY

Screening and Evaluation/Assessment Services to determine

eligibility, child and family needs

PLAN OF CARE

PUBLIC AWARENESS PROGRAM:Advertising,

“Name Brand” recognition

CHILD FIND:Locating and identifying

eligible children, informing

referral sources

PERSONNEL STANDARDS:Who can be a

provider, teacher, administrator in the

program?

INTERAGENCY AGREEMENT/

DISPUTE MECHANISM

DATA COLLECTION,

REPORTING AND UTILIZATION

STATE AND/OR LOCAL

INTERAGENCYCOORDINATING

COUNCILS/ADVISORY COUNCILS

FINANCIAL MATTERS, INCLUDING RATES,

THIRD PARTY LIABILITY, PROVIDER CONTRACTS

OR AGREEMENTS PAYMENT

FAMILY AND PROVIDER RIGHTS, OPPORTUNITIES AND RESPONSIBILITIES

(PROCEDURAL SAFEGUARDS/COMPLAINT

RESOLUTION)AND SYSTEMIC PROBLEM

IDENTIFICATION AND RESOLUTION

TRAINING AND TECHNICAL

ASSISTANCE at the state and local levels

to ensure well-prepared providers, participants and the delivery of quality

services

SUPERVISION/MONITORING-- CONTINUOUS

IMPROVEMENT AND SURVEILLANCE

SERVICE COORDINATION/CASE MANAGEMENT

SERVICES

COMMUNITY BASED, FAMILY

CENTERED SERVICES

EMPHASIZING THE STRENGTHS OF

THE FAMILY AND CHILD

ELIGIBILITY DEFINITION:

Who is eligible?

TRANSITION(into, within

and from program)

VIS

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SERVICE DELIVERY

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PART C COMPONENTS

Developed by Solutions Consulting Group, LLC 2002

In Construction:Service Coordination

• Option *– Administrative Claiming (earlier slide) for intake

service coordination

• Option *– Establish new TCM for EI

• Could include intake, ongoing service coordination

• Option *– Include Service Coordination under EI Services

Chapter in EPSDT (next slide)• May include Intake Service Coordination or not

Slide 19

In Construction: Direct Services

• Establish EI Services Chapter in EPSDT– Includes all Part C services– Reimbursement related to functions:

• Screening• Multidisciplinary Team Services

– Evaluation for Eligibility– Assessment for Service Planning– Team Meetings

• EI Services • Service Coordination OPTION (see earlier slide)

Slide 20

Early Intervention Services (not an inclusive list!)

• Assistive Technology devices and services

• Audiology• Family Training,

Counseling and Home Visits

• Health Services• Medical Services only for

diagnostic or evaluation purposes

• Nursing Services

• Nutrition• Occupational Therapy• Physical Therapy• Psychological Services• Social Work Services• Special Instruction• Speech/Language

Pathology• Transportation• Vision Services

Considerations in Direct Services Configuration

• “Match” of Part C and EPSDT obligations

• Compliance

• Primary Provider Model/Services and Supports document

• Consideration of “best practice”

Slide 22

Sequence of Events

Complete Conceptual FrameworkIdentify current DMAS expenditure (match)• Develop State Plan Amendment (SPA) in

coordination with CMS (In progress)• Develop cost estimates; determine potential

budget impact (nearly complete)– “Gap” analysis– If needed, identify additional “match”

• Submit SPA to CMS

Slide 23

Implementation:DMAS Responsibilities

• Regulations development

• Interagency Agreement Part C/DMAS

• Software updates to accommodate service codes, rates

• Provider enrollment based upon Part C provider qualifications (highest entry level standard)

• Training

Slide 24

Implementation:Part C Responsibilities

• Forms revisions/updates

• Services & Support document update

• Policies and Procedures updates

• Develop Provider database

• Training/Technical Assistance

• Implementation must be statewide; assures access, equity, consistency and standardization

Slide 25

REFERRAL RECEIVED AT SPOE

ORIENTA-TION ANDINTAKE

EVAL-UATION

FOR ELIGIBI-

LITY

ASSESS-MENT FOR SERVICE

PLANNING

IFSP/IEP DEVELOP-

MENT

Begin development of comprehensive EI

Record

ElectronicallyRecord Referral

Meet with family, share system information verbally

and in writing. Obtain informed, written parental

consent to proceed; Start Intake including

releases of information.

Request existing screening, medical and other

information to assisting evaluation for eligibility.

If eligibility can't be determined with existing

documentation, discuss and plan any necessary

assessment(s) required for eligibility determination.

Assemble eligibility determination

documentation, including comprehensive

developmental screening, medical information, parent

report, observation and assessment summary(s).

Multidisciplinary team determines eligibility.

CHILD ELIGIBLEDiscuss and plan any

necessary assessments for IFSP/IEP development.

Develop composition of Multidisciplinary Team for

eligibility determination purposes. Intake

Coordinator facilitates; must have at least two different disciplines selected based upon presenting child and

family concerns.

Carry-out necessary assessment activities needed for IFSP/IEP

development.

Intake Coordinator and Family develops

composition of IFSP/IEP Development Team.

Schedule and plan IFSP/IEP development meeting,

notify all participants in writing.

Conduct IFSP/IEP Development Meeting,

complete development of the IFSP/IEP.

Obtain informed, written parental consent to proceed

and implement IFSP/IEP.

Process Authorization(s) for IFSP/IEP services; Service Coordinator to assist family

in IFSP/IEP implementation.

Assist family in completion of CSHCN/Title V, Medicaid, SCHIP

applications to determine eligibility, assistance.

NO

NO

REFERRED STATUS INTAKE/ELIGIBILITY STATUS ENROLLED STATUSDAY 1 45/60 DAYS

Acknowledge referral in writing

with referral source

NO

NO

Intake Coordinator makes initial contact with family. Schedules appointment,

location at family's convenience.

NO

State Develop-mental

Tracking System

Contact/Ensure there is primary medical care

provider for child.

Intake Coordinator meets with family to discuss IFSP/IEP process, document and

assists the family in preparation including family

assessment of CPR, identification of natural

environments, and family input for IFSP/IEP

components.

NO

Intake Coordinator assists the family in selecting a

Service Coordinator

With the assistance of the Service Coordinator, family selects IFSP/IEP service

provider(s).

Parent: Parent

Parent: Parent

Parent: Parent

Parent: Parent

Parent: Parent

CHILD NOT ELIGIBLE

SURRO-GATE

PARENT

Implement IFSP/IEP: Monitor, Review and Conduct Annual Re-

determination of Eligibility,

Identification of Family Needs,

Develop new IFSP /IEP-- CYCLE


Tracking System

NO

NO


Tracking System

NO

NO

© Copyight 2002 SOLUTIONS Consulting Group, LLC

Fiscal Study Update

Common Rates

Distribution of Funds

Slide 27

Common Reimbursement• Non-third party covered direct services between

the DMHMRSAS and each of the 40 LLAs. • Reimbursement by DMAS for Part C services

delivered to children covered by non-HMO Medicaid.

• Reimbursement structure to be woven into the contracts with the Medicaid-HMOs.

• Payment between sub-contracted providers and each Local Lead Agency (LLA).

Slide 28

2007 Fiscal Study Participation Levels Requested Received

% Received

I.

Individualized Family Service Plan 250 239 96%

II.Encounter Forms 343 199 58%

III. Salary Survey 110 34 31%IV.

Revenue Survey 110 12 11%

V. Rate Survey 40 25 63%

Virginia Early Intervention Cost Study UpdateSalary Survey - Category Totals Comparison

2007 Data 2003 DataSalary $9,673,595 $9,279,258 Benefit Total $2,396,495 24.8% $1,757,621 18.9%

Personnel Costs $12,070,090 19.9%$11,036,87

915.9%

Annual Work Hours 340,395 409,988 Compensated Hours Off

48,409 0.14 44,487 10.9%

FTE 163.7 197.1 FICA $599,763 6.2% $575,314 6.2%Medicare $140,267 1.45% $134,550 1.45%FUTA $4,224 0.04% $3,112 0.0%SUTA $6,441 0.1% $18,252 0.2%Retirement $731,563 7.6% $369,932 4.0%Health $710,413 7.3% $554,959 6.0%Other $203,824 2.1% $101,502 1.1%

Annualized Salary $13,452,736

$12,442,378

Average Hourly Amount

$28.42 $22.63

Salary Findings: Direct Service Personnel

• Both years have a comparable quantity of salaries at $9.2 and $9.6 million for 2003 and 2007 respectively.

• Average hourly personnel costs is $28.42 for 2007 and was $22.63 in 2003 without benefits.

• The 2007 average hourly cost with benefits is $35.46

• The hourly amount includes employees and contractors.

• The hourly amount represents a mix of personnel types.

• Benefits cost 24.8% of salary in 2007 and 18.9% of salary in 2003 good health and retirement generating the highest increases.

Slide 31

Employment Trends• Longevity has increased over the past four

years.– More then 47% of personnel have been

employed for greater than five years as compared to less than 30% four years ago.

– 18% of the personnel had been employed for less than one year.

– The single greatest change in the last four years occurred in the three to five year employment category.

Slide 33

All Personnel TherapistsNon-

Therapists

1Hourly Salary Amount $28.42 $36.73 $22.93

Benefit Percent of Total Employee Cost 19.9% 19.9% 19.9%Benefit Cost Per Hour $7.04 $9.10 $5.68

Total Employee Cost $35.46 $45.83 $28.61

2

Direct Service Ratio to Admin 70.0% 70.0% 70.0%Hourly Admin & Support Cost $15.20 $19.64 $12.26

Total Hourly Costs $50.66 $65.46 $40.87

3 Event/ Occasion % of Time 39% 39% 39%

Cost per Employee Direct Service Hour $129.89 $167.86 $104.79

Cost per Direct Service Hour (Updated 3/21/2008)

Description

Personnel Costs

Admin & Support Cost

Cost Per Hour - Caution

• This amount will be used to configure a reimbursement system that is intended to be a common rate across the Commonwealth and includes what is now called associated cost.

• It will be molded/adapted to the final service delivery model and structure crafted with DMHMRSAS and DMAS.

Slide 36

Stakeholder Consensus• The mechanics of computing the hourly

cost of direct service (face to face time) was a reasonable approach.

• Reimbursement should be configured in 15 minute increments (non-negotiable).

• That there should be two different rates since market wages cluster in two groups.– Therapist cost (no benefits included) at

$37/average hourly cost– Special Educators/Service Coordinators (no

benefits included) at $22/average hourly cost.

Slide 37

Stakeholder Consensus

• There were two competing discussions in the move for differential rates. – The system should move to a more

homogeneous definition of Early Interventionists.

– The market wages of therapist is notable more. – The group did reach a consensus on how to

structure the two amounts that was released in the draft report.

Slide 38

Rate Differentials

• Two other areas were considered for differential.– Salary differences which do exist in the

Northern Virginia area– Travel times across the state, especially rural,

western part of the Commonwealth– After reviewing some data sets, the group

concluded that neither of these issues created a significant enough difference for a differential to exist.

Slide 39

Slide 40

Cost of the Early Intervention System 30,000,000.00$ $30,000,000 Cost of the Early Intervention System 30,000,000.00$ $30,000,000% Not allowable by Medicaid 5% $28,500,000 % Not allowable by Medicaid 5% $28,500,000% of Children Medicaid Eligible and Enrolled 44% $12,540,000 % of Children Medicaid Eligible and Enrolled 44% $12,540,000Required Match 50% $6,270,000 Required Match 50% $6,270,000

Historically Covered Service Covered Services $12,540,000 Historically Covered Service Covered Services $12,540,000Therapies 50% $6,270,000 Therapies 60% $7,524,000DMAS Historical Match 50% $3,135,000 DMAS Historical Match 50% $3,762,000DMHMRSAS New Match 50% $3,135,000 DMHMRSAS New Match 50% $2,508,000

Medicaid Fee for Service (Match) 50% $1,567,500 Medicaid Fee for Service (Match) 50% $1,254,000Medicaid MCO (Match) 50% $1,567,500 Medicaid MCO (Match) 50% $1,254,000

Cost of the Early Intervention System 36,000,000.00$ $36,000,000 Cost of the Early Intervention System 36,000,000.00$ $36,000,000% Not allowable by Medicaid 5% $34,200,000 % Not allowable by Medicaid 5% $34,200,000% of Children Medicaid Eligible and Enrolled 44% $15,048,000 % of Children Medicaid Eligible and Enrolled 44% $15,048,000Required Match 50% $7,524,000 Required Match 50% $7,524,000

Historically Covered Service Covered Services $15,048,000 Historically Covered Service Covered Services $15,048,000Therapies 50% $7,524,000 Therapies 60% $9,028,800DMAS Historical Match 50% $3,762,000 DMAS Historical Match 50% $4,514,400DMHMRSAS New Match 50% $3,762,000 DMHMRSAS New Match 50% $3,009,600

Medicaid Fee for Service (Match) 50% $1,881,000 Medicaid Fee for Service (Match) 50% $1,504,800Medicaid MCO (Match) 50% $1,881,000 Medicaid MCO (Match) 50% $1,504,800

Model 2: Assuming System Cost at $30,000,000




Part C Early Intervention: Modeling (For Discussion Only)


Region Local Lead Agency0-3 2006

Population

2006 Medicaid Enrolled 0-3 ChildCount

% Medicaid Enrolled

% Medicaid Enrolled (ITOTS)

NV Alexandria 6,918 2,437 35.2% 38.7%Valley Alleghany-Highlands 704 484 68.8% 76.7%NV Arlington County 8,248 2,377 28.8% 28.2%RO Central Virginia 7,715 4,840 62.7% 54.1%TW Chesapeake 8,820 3,741 42.4% 40.3%RC Chesterfield 11,132 4,551 40.9% 33.0%TW Colonial 4,053 1,355 33.4% 31.5%AB Cumberland Mountain 3,006 2,532 84.2% 69.2%RO Danville-Pittsylvania 3,634 3,071 84.5% 73.3%AB Dickenson County 482 426 88.4% 33.3%TW Eastern Shore 1,964 1,750 89.1% 78.2%NV Fairfax-Falls Church 46,029 12,933 28.1% 25.7%RC Goochland-Powhatan 1,374 323 23.5% 25.0%TW Hampton-Newport News 15,181 9,019 59.4% 54.3%RC Hanover County 3,365 759 22.6% 26.9%Valley Harrisonburg-Rockingham 4,216 2,504 59.4% 60.8%RC Henrico Area 12,456 5,133 41.2% 34.1%AB Highlands 2,105 1,558 74.0% 76.2%NV Loudoun County 14,538 2,179 15.0% 15.6%


Region Local Lead Agency0-3 2006

Population

2006 Medicaid Enrolled 0-3 ChildCount

% Medicaid Enrolled

% Medicaid Enrolled (ITOTS)

TW Mid Peninsula-No. Neck 4,313 2,619 60.7% 64.8%AB Mount Rogers 3,647 2,855 78.3% 63.9%RO New River Valley 4,894 2,754 56.3% 70.1%TW Norfolk 11,748 7,294 62.1% 59.6%NV Shenandoah Valley 8,052 4,106 51.0% 47.2%RO Piedmont Regional 4,427 3,566 80.6% 74.0%AB Lenowisco 2,996 2,648 88.4% 66.0%RC Planning District 14 3,232 2,477 76.6% 71.2%RC Planning District 19 6,284 4,256 67.7% 51.2%TW Portsmouth 4,899 3,501 71.5% 61.3%NV Prince William County 21,981 9,112 41.5% 39.0%NV Rappahannock Area 13,223 5,082 38.4% 36.6%NV Rappahannock-Rapidan 5,716 2,389 41.8% 43.9%Valley Region Ten (Blue Ridge) 7,688 3,465 45.1% 39.7%RC Richmond 8,892 7,621 85.7% 65.4%RO Roanoke Valley 8,645 5,122 59.2% 52.4%Valley Rockbridge Area 1,094 660 60.3% 46.3%RO Southside 2,698 2,281 84.5% 67.6%Valley Valley 4,000 2,246 56.2% 73.9%TW Virginia Beach 19,317 6,161 31.9% 22.4%TW Western Tidewater 5,582 3,015 54.0% 54.5%

309,268 145,202 47.0% 44.0%

Percent of Medicaid Eligible and Enrollled


Local Lead Agency % Insured% Medicaid

Enrolled

% Insured Non-

Medicaid Uninsured

50% Services Covered By

Insurance @ 60% of Cost

Part C Interim Needs

Alexandria 86% 35% 50.8% 14.0% 15.2% 50%Alleghany-Highlands 95% 69% 26.1% 5.1% 7.8% 23%Arlington County 87% 29% 57.9% 13.2% 17.4% 54%Central Virginia 92% 63% 29.5% 7.7% 8.9% 28%Chesapeake 91% 42% 48.3% 9.3% 14.5% 43%Chesterfield 92% 41% 50.9% 8.3% 15.3% 44%Colonial 91% 33% 58.0% 8.6% 17.4% 49%Cumberland Mountain 91% 84% 7.2% 8.6% 2.2% 14%Danville-Pittsylvania 90% 85% 5.7% 9.8% 1.7% 14%Dickenson County 91% 88% 2.8% 8.8% 0.8% 11%Eastern Shore 81% 89% -8.2% 19.1% -2.5% 13%Fairfax-Falls Church 87% 28% 58.9% 13.0% 17.7% 54%Goochland-Powhatan 96% 24% 72.5% 4.0% 21.8% 55%Hampton-Newport News 87% 59% 27.6% 13.0% 8.3% 32%Hanover County 95% 23% 72.2% 5.2% 21.7% 56%Harrisonburg-Rockingham 89% 59% 30.0% 10.6% 9.0% 32%Henrico Area 92% 41% 51.2% 7.6% 15.4% 43%Highlands 93% 74% 19.2% 6.8% 5.8% 20%Loudoun County 88% 15% 72.9% 12.1% 21.9% 63%Mid Peninsula-No. Neck 91% 61% 30.0% 9.3% 9.0% 30%

For Discussion Only!


Local Lead Agency % Insured% Medicaid

Enrolled

% Insured Non-

Medicaid Uninsured

50% Services Covered By

Insurance @ 60% of Cost

Part C Interim Needs

Mount Rogers 91% 78% 13.0% 8.7% 3.9% 18%New River Valley 92% 56% 35.7% 8.0% 10.7% 33%Norfolk 83% 62% 20.9% 17.0% 6.3% 32%Shenandoah Valley 92% 51% 41.0% 8.0% 12.3% 37%Piedmont Regional 90% 81% 9.2% 10.3% 2.7% 17%Lenowisco 91% 88% 2.1% 9.5% 0.6% 11%Planning District 14 90% 77% 12.9% 10.5% 3.9% 20%Planning District 19 89% 68% 21.3% 11.0% 6.4% 26%Portsmouth 88% 71% 16.2% 12.4% 4.8% 24%Prince William County 88% 41% 46.9% 11.7% 14.1% 44%Rappahannock Area 91% 38% 52.4% 9.2% 15.7% 46%Rappahannock-Rapidan 92% 42% 50.6% 7.6% 15.2% 43%Region Ten (Blue Ridge) 91% 45% 46.4% 8.6% 13.9% 41%Richmond 85% 86% -0.4% 14.7% -0.1% 14%Roanoke Valley 93% 59% 33.6% 7.2% 10.1% 31%Rockbridge Area 96% 60% 35.3% 4.4% 10.6% 29%Southside 89% 85% 4.5% 10.9% 1.4% 14%Valley 91% 56% 35.3% 8.6% 10.6% 33%Virginia Beach 90% 32% 57.6% 10.5% 17.3% 51%Western Tidewater 92% 54% 37.7% 8.3% 11.3% 35%

89% 47% 42.5% 10.5% 12.8% 40%

For Discussion Only!

Current Status/Next Steps• DMAS personnel are reviewing draft rates report• DMAS has provided expenditure information for

FY 2007. • Update system costs and DMAS contributions to

assess match needs• Review infrastructure costs and match issues.• Case Management• Confirm interim insurance needs

Slide 45

Slide 46

EDGAR

Education Department Guidelines and Regulations (Sec. 74.24 Program income)– Handout– Local Program Implications– Impact Discussion– Transition Planning Discussion– Next Steps and Partnerships

ITOTS Evaluation

Slide 47

What ITOTS Does• Collects information for all referrals to the system• Captures information from the Individual Child

Data Form (ICDF) • Data updates occur primarily at referral, at initial

IFSP at transition• Maintains limited history• Includes planned services only at entry into the

system• Captures child outcome information

Slide 48

What ITOTS Doesn’t Do

• It doesn’t capture all planned services for children and families

• It doesn’t say anything about the services that actually happened

• It doesn’t provide sufficient data for Local System Managers to be effective in their responsibilities.

Slide 49

Infant & Toddler Connection of Virginia 50

In f a n t a n d To d d l er Co n n ec t io n o f

V ir g in ia

CHILD ENROLLMENT/ELIGIBILITY

-Intake based upon referral

-Eligibility determination

-Assessment of needs for IFSP

-Initial IFSP development

-EI record development

EARLY INTERVENTION SERVICE PROVIDERS -Provider Credentialing/Certification

-Provider Enrollment with DMAS

EARLY INTERVENTION SERVICE OBLIGATIONS

-Assessment/Evaluation Activities

-Annual IFSP Development

-Financial Authorization for IFSP services creates a link to the payment system

-Financial Resources for Revisions in IFSP

-Ongoing Review of Financial Commitments

-Equitable fund Distribution/Access Statewide

REIMBURSEMENT FOR SERVICES

-Standardized billing processes

-Verification of billing to to the IFSP for payment adjudication

-Use of a common reimbursement structure and amount

-Repository for all delivered services regardless of funding sources

-Contract management tool for LLAs using sub-contractors

MISCELLANEOUS ACTIVITIES

-Source Documents (EI Record)

-Forms/notification design, development and distribution

-On-line inquiry and review

-Training, technical assistance

DATA INTERFACE REQUIREMENTS

-Department of Health VISITS for referrals

-Department of Education for Children in Service and Transition

-Department of Medical Assistance Services for funding confirmation

REPORTS

-Operational reports

-Intergovernmental reports (Electronic)

-Federal, state reports

-Local Lead Agency (LLA) reports & information

-Provider reports & information

RESOURCES AND SUPPORTS

-Centralized System

-Funding Partnerships-Medicaid -Insurance-Other

-Additional fund resource inclusion

-Total System Cost

Current Status/Next Steps– Current Status

• Charter Document Complete• Internal DMHMRSAS review started• VACSB Data Committee review

– Secure project approval– Complete the requirements detail– Identify project approach– Software: Procure/Develop/Modify – Evaluate Timeline Issues– Implementation/Training

Slide 52

Family Cost Participation

Formerly Ability to Pay (ATP)

Slide 53

FCP Status Report

• One (1) meeting of Stakeholder Group under this contract held– General consensus that NOT having fees would be

desirable (some disagreed)– Reaffirmed earlier observations re: FCP– Priority in FCP Design

• Easy to administer• Doesn’t influence families in service selection, participation in

Part C

– Methods for assigning fee discussed• Multiple alternatives to be considered

Slide 54

Some Options

• Fee Structure as you now have

• A General IFSP Fee

• Annual Enrollment Fee

• Fee Per Service– Fee for Some But Not all Services

• No Fee (a la CSB “prevention” services)

Slide 55

Considerations

• Must link to utilization of private insurance• Won’t be more than the cost of service• Family Cost Participation would be implemented for all

new families entering the system and at the annual IFSP with families already in the system.

• Who conducts the process? (service coordinator or a designated financial person)

• Who collects the fees?• Training and monitoring of the process with possible

incentives provided to local lead agencies• The fee could be based on an income range or FPL• Discussed information collection, verification approaches

Slide 56

Interim Consensus

• A recap of the potential process for establishing a flat fee included:– Establishing the fee based on the federal poverty

level;– Ask the family if this is manageable for them;– Family cost would be reviewed annually;– If child is in service less than one year, payment

would only be made for the time in service;– Insurance with deductibles and co-pays must be

considered• The fee could be put on hold until insurance was established;• There would only be deductibles/co-pays or the fee, not both.

Slide 57

Parent Survey Results

• Approximately 4,500 surveys were sent to families. – 730+ responses were received. – The survey was two pages in length with the

second page consisting of open-ended questions.

– Approximately 100 individuals requested that the Family Involvement Project contact them for further follow-up.

Slide 58

Findings

• 51.9% of the families reported completing the Ability to Pay process– It was noted that many families may not have recognized the

term “ability to pay”;

• 27% of the families reported paying a fee;• 5% of the families used the appeals process

– Many families reported not knowing about the appeals process;

• 4.2% of the respondents stated that their fee was reduced following the appeal;

• Private insurance was billed in 48.5% of the cases;• Medicaid was used in 30% of the cases;

Slide 59

Next Steps, Timelines

• Integrate with final rate recommendations

• Revise (again) Policies & Procedures, documentation

• Training/orientation

• Collection of fee amounts paid, billed and unpaid, # of families who decline services or decline to participate in Part C due to fees

Slide 60

Realities of Implementation: System Redesign

Slide 61

Overall Transition Planning, Timing and Responsibilities

Solutions Consulting Group, LLC

Karleen R. Goldhammer725 Riverside DriveAugusta, ME 04330

[email protected]: 207-623-8994Cell: 207-446-8994Fax: 207-623-9793

Sue Mackey AndrewsPost Office Box 218

Dover-Foxcroft, ME 04426

[email protected]: 207-564-8245Cell: 207-408-8040FAX: 207-564-7175

Slide 63

Part C System of Payments Study: Consultant Update Community Service Board Leaders April 29, 2008.

Documents

Transcript of Part C System of Payments Study: Consultant Update Community Service Board Leaders April 29, 2008.