Illinois Early Intervention and Medicaid

1
Illinois Early Intervention and Medicaid

• Presented by
• Janet D. Gully, Chief Jennifer Kepner
• Illinois Department of Human Services Bureau of
  Early Intervention

2
Setting the Stage
3
What Does Your Part C System Look Like?

• The Illinois Department of Human Services (IDHS)
  is the Lead Agency for the Part C Program in
  Illinois.
• The Illinois system functions similar to a
  managed care program and has been determined a
  health plan under HIPAA.
• All services are pre-authorized based upon the
  frequency, intensity and duration of the services
  that have been identified as a need in a childs
  IFSP.

4
What Does Your Part C System Look Like?
(continued)

• Providers of services must enroll with the EI
  Central Billing Office (CBO) and the state
  Medicaid program in order to receive
  authorizations to provide services.
• Illinois does not employ providers. EI providers
  function under Provider Agreements. Not
  contracts or grants. Providers must sign the
  Agreement as part of the enrollment process. The
  Agreement allows for control and influence and
  providers are monitored to ensure compliance.
  

5
What Does Your Part C System Look Like?
(continued)

• Illinois functions under a fee-for-system.
  Providers bill the EI CBO based upon date of
  service and units of service provided.

6
What Does Your Medicaid Plan Support in Your Part
C System?

• The Illinois Medicaid State Plan supports all
  services except Interpretation, Parent Liaison
  and Deaf Mentor services.
• Disciplines who provide these services are not
  required to enroll with the state Medicaid
  program, as Medicaid does not support these
  services.

7
Details of Your Medicaid Plan
8
Why Did Your State Pursue Medicaid Coverage of EI
Services and What Prompted the Pursuit?

• To maximize all resources and to prevent
  duplication of services.
• State Law required that ten state agencies who
  were providing services to the EI population work
  together to create one system of services.
• The law also required that the Lead Agency create
  one Central Billing Office to receive and
  dispense all relevant State and federal
  resources.

9
How Did You Make It Happen? What Jump Started
the Work?

• Interagency relationships began due to the
  requirements of the State law. All ten agencies
  identified in the law were represented on the
  Illinois Interagency Council on Early
  Intervention (IICEI). This included the State
  Medicaid agency.
• A finance workgroup of the IICEI was created.
  Multiple Medicaid representatives participated on
  that workgroup.

10
How Did You Make It Happen? What Jump Started
the Work? (continued)

• The Lead Agency contracted with finance
  consultants to work with the group to plan the
  billing system. The finance consultants worked
  closely with the Medicaid representatives to
  determine the best way to implement the EI CBO
  and to draw down Federal Financial Participation
  (FFP) for the EI population.
• The State Medicaid agency embraced EI because
  they were very interested in all maternal and
  child health issues and programs.

11
How Did You Make It Happen? What Jump Started
the Work? (continued)

• In 1996, the Medicaid representatives worked to
  get approval from the regional HCFA office to add
  EI services to the existing Medicaid Rehab Option
  of the State Plan. Services were defined in the
  Rehab Option as special rehabilitation
  services. Except for Special Instruction, all
  services were approved.
• In 2001, based upon the request of the Lead
  Agency Medicaid representatives made a second
  attempt to add Special Instruction to the
  Medicaid Rehab Option. The attempt was
  successful and Special Instruction was added.

12
How Did You Make It Happen? What Jump Started
the Work? (continued)

• Illinois refers to Special Instruction as
  Developmental Therapy. In the Medicaid Rehab
  Option it is referred to as Developmental
  Rehabilitative Therapy.

13
How Does it Work?

• The Lead Agency has an interagency agreement in
  place with the State Medicaid agency that
  outlines the responsibilities of each agency
  concerning EI services. Under IDHS
  Responsibilities the Lead Agency has agreed to
  request the necessary appropriation for the
  purposes of expenditures to certified IDHS-EI
  Program providers for services rendered to
  individuals eligible under the Medical Programs.
  The Medical Programs is Medicaid.

14
How Does it Work? (continued)

• IDHS as the Lead Agency gets the appropriation
  from the General Revenue Fund to pay for the
  services provided to all EI eligible children,
  including the portion of the EI eligible children
  who are also Medicaid eligible.
• EI providers whose disciplines are identified in
  the Medicaid Rehab Option are enrolled with the
  state Medicaid program as an individual and the
  EI CBO is identified as a payee on each persons
  Medicaid provider file.

15
How Does it Work? (continued)

• All providers of EI services submit their claims
  to the EI CBO for payment.
• After the EI CBO pays the claims, the EI CBO
  submits a claim to the State Medicaid agency for
  FFP. This claim is based upon the individual
  provider, child, and date of service.
• The FFP is deposited into a special EI fund with
  the State Comptroller Office.

16
How Does it Work? (continued)

• Illinois is able to claim FFP for the following
  disciplines

• Assistive Technology vendors
• Audiologists
• Speech Therapists
• Developmental Therapist
• Physicians
• Nurses
• Nutritionists
• Occupational Therapists
• Physical Therapists
• Clinical Psychologists
• Clinical Professional Counselors

• Marriage and Family Therapists
• Clinical Social Worker
• School Psychologists
• Non-clinical Social Workers
• Non-clinical Professional Counselors
• School Social Workers
• Transportation providers
• Optometrists
• Ophthalmologists and
• Service Coordination.

17
Results and Reflections
18
Briefly characterize in a bulleted list,the
following

• The whole process is working. The Lead Agency
  and the State Medicaid agency have always worked
  very closely as a team to maximize resources.
• The process of implementing the 837P HIPAA
  compliant format to submit claims to the state
  Medicaid program for FFP has caused problems for
  the EI Central Billing Office (CBO). The
  problems are in process of being addressed.
• There are no anticipated changes.