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SYSTEMS DO CHANGE: M EDICAID R EIMBURSEMENT FOR O & M S ERVICES IN M ONTANA.

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Presentation on theme: "SYSTEMS DO CHANGE: M EDICAID R EIMBURSEMENT FOR O & M S ERVICES IN M ONTANA."— Presentation transcript:

1 SYSTEMS DO CHANGE: M EDICAID R EIMBURSEMENT FOR O & M S ERVICES IN M ONTANA

2 INTRODUCTIONS Bob Maffit- Executive Director, Montana Independent Living Project Melanie Bush- Certified Orientation & Mobility Specialist, Montana Independent Living Project Jean Price- Montana Legislative Representative, HD 24 Rena Steyaert- Medicaid School Based Services Program Officer Montana Dept. of Health & Human Services National Alliance for Medicaid in Education (NAME) President Elect 2014 M ONTANA I NDEPENDENT L IVING P ROJECT, I NC. Promoting Independence for People with Disabilities

3 E XPLORING O PTIONS IN MT Melanie’s Idaho/Montana experience Exposure – Idaho/ Montana experience Connecting- MT school MILP Partnering - Bob for advocacy and Jean for options in Medicaid funding. Bob’s initiation of services Implementing –parent/school district/professional collaboration Capacity building – organizational collaborations and systems change. M ONTANA I NDEPENDENT L IVING P ROJECT, I NC. Promoting Independence for People with Disabilities

4 R EPRESENTATIVE J EAN P RICE S TATE L EGISLATIVE T IMELINE Jan.–April 2011 MT Legislative session 1/12/11- Met Melanie Bush, learned about O & M 1/18/11- Met with State Medicaid Director Mary Dalton 2/2/11- House Bill 437 (An act requiring Medicaid coverage of Orientation & Mobility services for children; amending section MCA) drafted and assigned to the House Human Services Committee. 2/14/11- ♥- Hearing before Committee 2/19/11- HB 437 was tabled 2/22/11- HB 437 blasted onto House floor and failed 3/3/11- another Fiscal Note was completed to be ready for session in 2013.

5 T IMELINE CONTINUED Interim May 2011 – December 2012 November Meetings, phone calls, between Rep. Jean Price, DPHHS officials, Legislative services staff Developmental Services Division, Governors Budget Director, Bob Maffit, Melanie Bush and State Medicaid Director Mary Dalton. 12/1/12 – confirmation that O & M services were included in Governors Budget 12/2/12 – New bill draft was requested, using same language as HB 437

6 T IMELINE C ONTINUED Jan.–April 2013, MT Legislative Session 1/4/13 – HB 113 was drafted and scheduled to be heard in the House Human Services Committee. 1/18/13 – Bob Maffit and Jean Price met with Governor Bullock and agreed that HB 113 was not necessary and putting this language in State Administrative Rule would do the job. 1/18/13 – HB 113 was withdrawn 1/20/13 thru 3/24/13 – MT DPHHS worked with Melanie, Superintendent of MT School of Deaf & Blind, Office of Public Instruction and Legislative Services to ensure implementation 3/25/13 – Health Resource Division of DPHHS provided Rule change and additional language and notification of a public hearing

7 T IMELINE F INISH May 2013 – December /15/13 – Public Hearing at Dept. of Public Health & Human Services on Administrative Rule of Montana addition and changes to its EPSDT rules 05/16/13 – Melanie worked on contacting parents, pediatric medical staff, potential providers and schools. 7/1/13 – Rule change went into effect 8/19/13- MT Medicaid Program Officer-- Rena Steyaert-- provided training for Certified Orientation and Mobility Specialist’s and how to deliver service and receive Medicaid reimbursement for clients birth to 20 years of age per EPSDT requirements and MT Medicaid Provider requirements.

8 S TATE M EDICAID I MPLEMENTATION Schools have been able to provide service and obtain reimbursement from Medicaid for health related services for Medicaid eligible clients since the 1990’s Parts that allowed this to happen: Title XIX of Social Security Act Early Periodic Screening & Diagnostic Treatment (EPSDT) Individuals with Disabilities in Education Act (IDEA) Individual Education Plan (IEP)

9 P ARTS D EFINED Title XIX of SSA Enacted in 1965 and established regulations for the Medicaid program. State participation in Medicaid is voluntary and each state designs & administers its own Medicaid program. School services and EPSDT services were not a part of this initial offering of Medicaid services.

10 P ARTS D EFINED C ONTINUED EPSDT Came into the SSA in Ensures that periodic checkups & early detection will find & prevent children's health problems Federal mandated set of services for individuals under age 21. Vision, Dental & Hearing services are mandatory at a minimum. Other services are required that are coverable and found to be necessary to treat, correct or reduce illnesses & conditions discovered.

11 P ARTS D EFINED C ONTINUED EPSDT & Medicaid The Federal law of EPSDT including statutes, regulations and guidelines- requires that Medicaid cover a very comprehensive set of benefits & services for children, different from adult benefits. Each state’s Medicaid program has state plans that are approved by the governing body of CMS ( Center for Medicare/Medicaid services) & they must adhere to these plans and EPSDT is one of those plans.

12 P ARTS D EFINED C ONTINUED IDEA (Individuals with Disabilities in Education Act) Was first enacted in 1975 as Education for All Handicapped Children Act. Changed to IDEA in 1989 Federal law that governs how states & public agencies provide early intervention & special education to children with disabilities defined as a child with intellectual disability, hearing impairments, speech/language impairments, visual impairments, serious emotional disturbances etc…. Addresses the educational needs of children with disabilities from birth to 18 or 21. The Act required that schools create Individualized Education Programs (IEP) for each student found eligible under federal and state disability standards.

13 A LL PARTS TIED TOGETHER MEAN WHAT For Medicaid eligible services offered to Medicaid eligible children age birth to 2 years old-----Montana Medicaid will provide these services as outlined in our State Plan of EPSDT services (O & M Specialist are included in EPSDT State Plan). For Medicaid eligible services offered to Medicaid eligible children age 3 to 20 years old in a state funded school and on an IEP-----Montana Medicaid will provide these services as outlined in our State Plans of the other multiple services like Therapies, Private Duty Nursing, Psychological services and Orientation & Mobility Specialist (the EPSDT state plan). Schools would typically contract some of these service providers if the school could not afford to hire them as school employees.

14 Thank you for your attention and are there any questions?

15 C ONTACT I NFO Bob Maffit-- Melanie Bush– Rep. Jean Price– Rena Steyaert


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