Illinois Early Intervention and Medicaid Presented by: Janet D. Gully, Chief & Jennifer Kepner Illinois Department of Human Services – Bureau of Early Intervention

Setting the Stage

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 child’s IFSP.

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.

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.

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.

Details of Your Medicaid Plan

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.

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.

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.

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.

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”.

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.

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.

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.

How Does it Work? (continued ) 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. Illinois is able to claim FFP for the following disciplines:

Results and Reflections

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.