HD40 - Report on Early Intervention Services for Infants and Toddlers with Disabilities


Executive Summary:
EXECUTIVE SUMMARY

DMAS is pleased to report that in the area of efforts to enhance and expand training on the availability of, access to and use of EPSDT, DMAS has:

• conducted state-wide physician training sessions in cooperation with the Virginia Department of Health (VDH),

• improved access to EPSDT training materials, tutorials, and provider manuals by making them available on the DMAS web site. The DMAS web site address is http://www.dmas.virginia.gov

• planned targeted quality assurance audits of MEDALLION providers,

• updated the EPSDT section of the Medicaid Physician's Manual,

• conducted training for school-based clinics in cooperation with the Department of Education (DOE),

• given specific training to Part C/IDEA Council Coordinators,

• contractually required increased performance standards for Medicaid providers,

• begun analysis and review of encounter data from all Medallion II providers for compliance with the EPSDT program,

• contracted with independent groups to monitor immunization status, access to care and satisfaction with services received, and

• held a one-time Early Intervention training on September 21, 1999, to discuss the Exception Process for Medallion II recipients. The training also included a brief segment on EPSDT and how the Denver II may be used for early detection of developmental delay. DMAS may hold additional trainings as necessary.

To ensure that Part C recipients have access to needed early intervention services (physical therapy, occupational therapy and speech-language pathology services), House Bill 2617 was introduced to mandate a carve out of children enrolled in Part C. This has allowed Part C recipients to disenroll from MCOs if certain criteria were met in order to obtain the needed services.

The rates reimbursed to Part C providers by the MCOs are sufficient to attract providers to the MCO networks. This is evident by the increase in the number of providers in the Medallion II region since the implementation of the Medallion II program. In 1996 with the implementation of Medallion II in Tidewater, the MCOs were reimbursing the Part C providers below their commercial rates. After the providers voiced their concerns to DMAS and the MCOs, reimbursement was increased in 1997-98 across most plans to equal their commercial rates. This has resulted in an increase in providers, which has resulted in better access and more recipient choice of providers. A table of the MCO reimbursement rates for the most frequent early intervention services is included as a part of this report.

Contracts between DMAS and Medicaid MCOs contain specific language and requirements relating to the number and types of providers to be included in the network, access and availability standards, qualifications of participating providers, and the scope of medical services to be provided by MCOs to Medicaid recipients. Adherence to these requirements and the degree of recipient satisfaction with the MCOs are monitored monthly, quarterly, and annually by DMAS.