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 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

ABCD Consortium Screening/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

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

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)

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

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

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

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

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