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Part C System Georgia ITCA Fiscal Initiative Cohort 1 2014.

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Presentation on theme: "Part C System Georgia ITCA Fiscal Initiative Cohort 1 2014."— Presentation transcript:

1 Part C System Georgia ITCA Fiscal Initiative Cohort

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

3 Georgia's Fiscal Structure Presented by: Dionne Denson, Deputy Chief Financial Officer Service Delivery Model Presented by: Phyllis Turner, Part C Coordinator (Acting) Data Systems Presented by: Tiffany Fowles, Senior MCH Epidemiologist Challenges Presented by: Beverly Stanley, Deputy MCH Director Current Initiatives Presented by: Phyllis Turner, Part C Coordinator (Acting)

4 Georgia’s Funding Model

5 Program Cost Drivers 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 Low Care Management Organization (CMO) Enrollment – Results in over utilization of the special instruction – No CMO coverage for service coordination.

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7 Caseload by Fund Source

8 Georgia's Fiscal Structure Presented by: Dionne Denson, Deputy Chief Financial Officer Service Delivery Model Presented by: Phyllis Turner, Part C Coordinator (Acting) Data Systems Presented by: Tiffany Fowles, Senior MCH Epidemiologist Challenges Presented by: Beverly Stanley, Deputy MCH Director Current Initiatives Presented by: Phyllis Turner, Part C Coordinator (Acting)

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

10 Georgia's Fiscal Structure Presented by: Dionne Denson, Deputy Chief Financial Officer Service Delivery Model Presented by: Phyllis Turner, Part C Coordinator (Acting) Data Systems Presented by: Tiffany Fowles, Senior MCH Epidemiologist Challenges Presented by: Beverly Stanley, Deputy MCH Director Current Initiatives Presented by: Phyllis Turner, Part C Coordinator (Acting)

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 Authorized IFSP services Claims Data Payment History Ad Hoc Reports 1.Assistive Technology (AT) Expense by District 2.All Claims-claims which have completed the payment process cycle 3.Claims Awaiting Update- claims which have not completed the process cycle

13 Georgia's Fiscal Structure Presented by: Dionne Denson, Deputy Chief Financial Officer Service Delivery Model Presented by: Phyllis Turner, Part C Coordinator (Acting) Data Systems Presented by: Tiffany Fowles, Senior MCH Epidemiologist Challenges Presented by: Beverly Stanley, Deputy MCH Director Current Initiatives Presented by: Phyllis Turner, Part C Coordinator (Acting)

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.

18 Georgia's Fiscal Structure Presented by: Dionne Denson, Deputy Chief Financial Officer Service Delivery Model Presented by: Phyllis Turner, Part C Coordinator (Acting) Data Systems Presented by: Tiffany Fowles, Senior MCH Epidemiologist Challenges Presented by: Beverly Stanley, Deputy MCH Director Current Initiatives Presented by: Phyllis Turner, Part C Coordinator (Acting)

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


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