1. NECTAC in collaboration with ITCA
Accessing EPSDT for Part C Services Achieving a Better Fit Between the EI Philosophy and Allowable Medicaid Covered Services
NECTAC in collaboration with ITCA
welcome you to our webinar for Part C Coordinators and their designated staff, OSEP, and members of the National Alliance for Medicaid in Education (NAME)

2. Virginia’s Experience in Accessing EPSDT
for Part C Services
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END: 5:22 2 2

3. DBHDS and the Early Intervention Program
Virginia’s early intervention (EI) system is governed by Part C of the Individuals with Disabilities Education Act (IDEA)
The EI system is managed by the Department of Behavioral Health and Developmental Services (DBHDS)
DBHDS’ program is called the Infant & Toddler Connection of Virginia
START: 5:50
END: 6:52 3

4. Part C Eligibility
Children from birth to third birthday who meet one or more of the following criteria:
Developmental Delay
Atypical Development
Diagnosed physical or mental condition that has a high probability of resulting in a developmental delay
START: 6:54
END: 7:16 4 4

5. Early Intervention Service
Early intervention services are developmental supports and services that are performed in natural environments, including home and community based settings in which children without disabilities participate, to the maximum extent possible.
START: 7:17
END: 8:02

6. Early Intervention and DMAS BEFORE October 1, 2009
Providers billed for those services using the reimbursement codes for physical therapy, occupational therapy and speech language pathology.
Services were not always reimbursed in the natural environment.
Rates did not take into consideration the additional cost of providing services outside of the clinic.
EI funds were NOT used as a last resort.
START: 8:04
END: 10:28 6

7. Early Intervention and DMAS BEFORE October 1, 2009
DMAS had no way of identifying the children enrolled in Early Intervention.
Reimbursement was not available for all of the provider types that can deliver Early Intervention services according to federal Part C rules.
There was no provider certification process; DBHDS could not identify the providers.
Could not accurately report EI expenditures
START: 10:30
END: 13:14 7

8. EI Transformation EI Taskforce was established
Included EI Stakeholders, parents, and MCO involvement
After almost two years of work, a new program was implemented October 1, 2009!
START: 14:16
END: 14:46

9. Transformation Accomplishments
All providers, except physicians, audiologists and registered dietitians, must be certified by DBHDS as an Early Intervention Provider.
Cannot receive reimbursement from either Part C or DMAS without certification
All federally allowed providers are reimbursed by DMAS for EI Services
START: 14:46
END: 16:38 9 9

10. Transformation Accomplishments
Certification requirements were written into Virginia’s Administrative Code.
Regulations support Virginia’s efforts to improve the comprehensive system of personnel development by including:
Baseline personnel requirements
Requirements for continuing education for re-certification
START: 16:40
END: 17:40
Infant & Toddler Connection of Virginia

11. Transformation Accomplishments
EI Certification also provides:
Sign off by providers on assurances and agreement to follow Part C regs/procedures
Mechanism to identify all providers in the EI System
Mechanism to communicate with all providers (updates, announcements, etc.)
START: 18:36
END: 20:06

12. Transformation Accomplishments
Medicaid EI Program and Part C requirements are in sync
Services in the natural environment are reimbursed and encouraged
IFSP serves as the Plan of Care
IFSP certified by physician documents medical necessity
START: 20:08
END: 21:32
Infant & Toddler Connection of Virginia

13. Transformation Accomplishments
IFSPs and IFSP reviews are reimbursed
EI funds are used as a last resort; providers must bill DMAS for Medicaid/FAMIS children
EI children and their expenditures are tracked. Reports are sent to MCOs and the local lead agencies each month.
EI Services are carved-out of the MCO contracts
START: 20:34
END: 20:52

14. Enrollment Growth
START: 20:53
END: 24:14

15. EI Expenditure Growth
START: 24:16
END: 25:26

16. DMAS EI Covered Services
Developmental services;
Family training, counseling and home visits;
Speech-language pathology, including sign language and cued language services;
Nursing services;
Occupational therapy;
Physical therapy;
Psychological services;
Social work services;
Assistive technology related services (such as instruction or training on use of assistive technology).
START: 39:12
END: 39:52 16

17. DMAS Covered Services Billed “Outside” of the EI Program
Assistive technology devices;
Health services;
Nutrition services;
Service coordination;
Medical services, only for diagnostic or assessment purposes;
Audiology services, and
Vision services.
START: 39:54
END: 40:45 17

18. Quality Management Reviews
Quality Management Reviews (QMR)
Conducted by the DBHDS
Lead agencies volunteered for 3 pilot reviews
Monitoring and Supervision staff conduct reviews and any report any retractable actions to DMAS
DMAS assisted with development of process and automated forms
START: 40:47
END: 42:05 18 18

19. Quality Management Reviews
Results of 3 Pilots:
62 records reviewed
Some services were provided but not billed
Some documentation issues
97% of records reviewed had documentation of medical necessity
START: 42:06
END: 42:48

20. Early Intervention Targeted Case Management
Will be implemented 10/1/2011
Developed with extensive stakeholder involvement
Was not implemented with the 2009 Medicaid EI Initiative due to uncertainty about CM at the federal level
START: 49:48
END: 50:32

21. Early Intervention Targeted Case Management
Ensures care coordination for all EI children
Establishes certification for case managers
Aligns Medicaid TCM requirements with service coordination requirements
Adds quality components: increasing well child visit rates, immunizations, and lead testing for EI kids
Acknowledges necessary coordination with the MCOs
START: 50:32
END: 55:49

22. Contact Information
Tammy Whitlock, DMAS Contact
Beth Tolley, Infant & Toddler Connection of Virginia
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END: 56:20 22

23. For more information…
Links to resources mentioned in this webinar, including the toolkit and Q&A sections from the day of the presentation are available at: