Florida Medicaid and Implementation of SB 2654

Size: px
Start display at page:

Download "Florida Medicaid and Implementation of SB 2654"

Transcription

1 Florida Medicaid and Implementation of SB 2654 Shachi Mankodi Counsel to the Chief of Staff Florida Agency for Health Care Administration Autism Compact Presentation September 18, 2008

2 Overview What is Medicaid? What is the Medicaid state plan and what are waivers? What does Medicaid currently cover for people with developmental disabilities? 1

3 What is Medicaid? Medicaid is a health insurance program for certain groups of low income individuals. Medicaid is jointly financed by state and federal funds. Designated state Medicaid agency works within federal guidelines to: Establish eligibility standards. Determine benefits and services. Set payment rates. 2

4 Florida Medicaid A Snapshot Expenditures Eligibles $15.2 billion estimated spending in Fiscal Year Federal-state matching program 56.83% federal, 43.17% state. Florida will spend approximately $7,210 per eligible in Fiscal Year % of all Medicaid expenditures cover hospitals, nursing homes, Intermediate Care Facilities for the Developmentally Disabled (ICF/DD s); Low Income Pool and Disproportionate Share Payments. 10% of all Medicaid expenditures cover prescription drugs. Fifth largest nationwide in Medicaid expenditures. 2.1 million eligibles. Elders, disabled, families, pregnant women, children in families below poverty. Fourth largest Medicaid population in the nation. Providers/ Plans Approximately 80,000 Fee-For-Service providers 19 Medicaid Managed Care plans. 3

5 Medicaid Structure States must submit a Medicaid State Plan to the federal Centers for Medicare and Medicaid Services (CMS). Federal Medicaid laws mandate that certain benefits and certain populations be covered. Medicaid programs vary considerably from state to state, and within states over time because of differences in: optional service coverages. limits on mandatory and optional services. optional eligibility groups. income and asset limits on eligibility. provider reimbursement levels. 4

6 Florida Medicaid Mandatory Services Advanced Registered Nurse Practitioner Services Early & Periodic Screening, Diagnosis and Treatment of Children Family Planning Home Health Care Hospital (Inpatient & Outpatient) Independent Lab Nursing Facility Personal Care Services Physician Services Portable X-ray Services Private Duty Nursing Respiratory, Speech, Occupational Therapy Rural Health Therapeutic Services for Children Transportation Florida Medicaid Mandatory Services for All Eligibles FY Mandatory 40.13% of $14.9Billion 5

7 Adult Dental Services Adult Health Screening Ambulatory Surgical Centers Assistive Care Services Birth Center Services Children s Dental Services Hearing Services Vision Services Chiropractic Services Community Mental Health County Health Department Clinic Services Dialysis Facility Services Durable Medical Equipment Early Intervention Services Healthy Start Services Home and Community-Based Services Hospice Care *States are required to provide any medically necessary care required by child eligibles. Florida Medicaid Optional Services* Intermediate Care Facilities/ Developmentally Disabled Intermediate Nursing Home Care Optometric Services Orthodontic Services Physician Assistant Services Podiatry Services Florida Medicaid Optional Services for All Eligibles FY Optional 59.87% of $14.9 Billion Prescribed Drugs Primary Care Case Management (MediPass) Registered Nurse First Assistant Services School-Based Services State Mental Hospital Services Subacute Inpatient Psychiatric Program for Children Targeted Case Management) 6

8 Key Medicaid Rules Services must be available statewide in the same amount, duration and scope within each eligibility group. Recipient must be Medicaid-eligible on date of service. Service must be a covered service that is medically necessary. Medicaid is payer of last resort. Medicaid state plan benefits must be exhausted before a similar waiver benefit is used. 7

9 What Are Waivers? Allow states to implement services, programs or policies that are not otherwise allowed under federal law. Federal CMS must approve a waiver before a state can implement it. Waivers must be periodically renewed. 3 major kinds of waivers: Research and Demonstration 1915(b) Freedom of choice of providers, managed care 1915(c) Home and community based services 8

10 1915 (c) Home and Community Based Services Waivers Purpose: Allow state Medicaid programs to cover long-term care services in a home or community setting instead of in a nursing home or ICF/DD Provisions waived : Comparability: services may be limited to a targeted group of individuals (e.g., elderly or people with specific diagnosis) State-wideness: services may be limited to particular geographic areas (e.g., county, region) 9

11 1915(c) Home and Community-Based Services Waivers (con t.) State can also limit a 1915(c) waiver by: number of people served dollar amount per person diagnosis or condition age Individuals must meet: Financial eligibility standards Medical eligibility standards (e.g. diagnosis or level of care) 10

12 Florida s 15 HCBS Waivers Adult Cystic Fibrosis Adult Day Health Care Aged/Disabled Adult Alzheimer s Disease Assisted Living for the Elderly Channeling Familial Dysautonomia Model Nursing Home Diversion Project AIDS Care Traumatic Brain Injury/Spinal Cord Injury Waivers for People with Developmental Disabilities Developmental Disabilities (Tier 1) Tier 2 Tier 3 Family and Supported Living (Tier 4) 11

13 Developmental Disabilities Waivers Currently serve about 30,000 beneficiaries (over 8,500 children) Eligibility: Age 3 or older Meet the level of care to reside in an ICF/DD Diagnosis of: Autism, Cerebral Palsy, Spina Bifida, Prader Willi Syndrome, or mental retardation (with an I.Q. of 60-69) There is currently a waitlist of 17,000 for these waivers, making it difficult for a child under age 5 to obtain services unless they enroll under crisis criteria. 12

14 DD Waiver Service Categories Support Coordination Employment and Training Individual and Family Supports Residential Services Environmental and Adaptive Equipment Therapeutic Supports Includes Behavior Analysis and Behavior Assistant Transportation Wellness Management 13

15 Other Services Provided to Medicaid Eligibles with Developmental Disabilities All state plan services are available (e.g., hospital, doctor, prescription drugs, durable medical equipment, home health) Some services are provided only to children (e.g., personal care, private duty nursing, therapies) Medicaid spends $20 million each year on occupational, physical and speech therapy for children diagnosed with autism spectrum disorder or Down Syndrome. 14

16 Children on Medicaid with Diagnosis of Autism Spectrum or Down Syndrome Age Group Autism Spectrum Down Syndrome 0-5 1,438 1,527 2, ,757 1,569 5, ,023 3,050 8,073 Total with Autism Spectrum and/or Down Syndrome 15

17 Physical Therapy Services 16

18 Occupational Therapy Services 17

19 Speech Therapy Services 18

20 Medicaid Waiver Behavioral Services What is Behavioral Analysis A highly specialized treatment that uses data collection and prescriptive, scientific methods to bring about behavior change. An evidence-based practice proven effective in the treatment of autism. Behavior Analysts (BAs) work one-on-one with autistic children, training in functional language and the treatment of atypical behaviors. BAs work directly with caregivers of autistic children to train caregivers in implementing the child s behavior plan. 19

21 Medicaid Waiver Behavioral Services What Does FL Medicaid Pay for Behavior Analysis? Florida Medicaid reimburses Behavior Analysts for services on the three Developmental Disabilities Waiver tiers and the Family/Supported Living Waiver. Florida Medicaid recognizes three levels of Behavior Analysis professionals for reimbursement under those waivers, as well as a paraprofessional level called Behavior Analyst Assistant. On these waivers, the Behavior Analyst meets with the individual typically 2 hours per week, while the Behavior Analyst Assistant meets with the individual for 8-10 hours per week to implement treatment recommendations. 20

22 Medicaid Waiver Behavioral Services How Many Behavior Analysts Practice In Florida? Behavior Analysts are nationally certified through the Certification Board for Behavior Analysis as either a Board Certified Behavior Analyst (BCBA) or a Board Certified Associate Behavior Analyst (BCBA). Florida has 669 Board Certified Behavior Analysts and 752 Board Certified Associate Behavior Analysts. There are 288 providers of Behavior Analysis providers registered as Medicaid DD waiver providers and 121 providers of Behavior Analysis services registered under the Family and Supported Living Waiver. Florida has 10 university-based training programs to certify Behavior Analysts. Additional programs exist throughout the United States and internationally 21

23 Developmental Disabilities Waiver Behavioral Services Provider Rates Service Description Unit Rates Behavior Analyst 15 Minutes $8.27 to $23.58 Behavior Assistant 15 Minutes $3.75 to $5.15 Behavior Assessment One Assessment $ to $

24 For questions about Medicaid services related to developmental disabilities, please contact: Beth Kidder Bureau Chief for Medicaid Services or Leigh Meadows Program Administrator Developmental Disabilities and Special Programs

Maryland Medicaid Program: An Overview. Stacey Davis Planning Administration Department of Health and Mental Hygiene May 22, 2007

Maryland Medicaid Program: An Overview. Stacey Davis Planning Administration Department of Health and Mental Hygiene May 22, 2007 Maryland Medicaid Program: An Overview Stacey Davis Planning Administration Department of Health and Mental Hygiene May 22, 2007 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance

More information

Medicaid 101. The basics of publicly funded healthcare.

Medicaid 101. The basics of publicly funded healthcare. Medicaid 101 The basics of publicly funded healthcare. Medicare Vs Medicaid Medicare: Over 65, or Disabled Federally Managed program Medicaid Resource & Need Based State Federal Partnership Social Security

More information

An Overview of Medicaid in North Carolina *

An Overview of Medicaid in North Carolina * An Overview of Medicaid in North Carolina * Lisa J. Berlin Center for Child and Family Policy Duke University Abstract: In North Carolina, as in other states, Medicaid cost containment is an increasingly

More information

DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW

DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW North Carolina General Assembly Fiscal Research Division February 2005 Overview Purpose of Medicaid Impact of Medicaid - On the State Economy

More information

Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services

Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services Bureau of Medicaid Services October 2012 Developed by: Yolanda Sacipa 1 Learning Objectives Provide guidance about Florida

More information

Statewide Medicaid Managed Care Managed Medical Assistance Program Update

Statewide Medicaid Managed Care Managed Medical Assistance Program Update Statewide Medicaid Managed Care Managed Medical Assistance Program Update Beth Kidder Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration Presented to the KidCare Coordinating

More information

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012 Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint

More information

Resources and Services Directory for Head Injury and Other Conditions

Resources and Services Directory for Head Injury and Other Conditions Resources and Services Directory for Head Injury and Other Conditions Section 2: Accessing and Paying for TBI and Related Services 1000 NE 10 TH ST. OKC, OK 73117 TEL 405.271-3430 OR 800.522.0204 (OK only)

More information

and the uninsured June 2005 Medicaid: An Overview of Spending on Mandatory vs. Optional Populations and Services

and the uninsured June 2005 Medicaid: An Overview of Spending on Mandatory vs. Optional Populations and Services I S S U E kaiser commission on medicaid and the uninsured June 2005 P A P E R Medicaid: An Overview of Spending on vs. Optional Populations and Services Medicaid is a federal-state program that provides

More information

Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders

Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders Common Abbreviations ABA Applied Behavior Analysis AHCA The

More information

Welcome to the Agency for Health Care Administration Training Presentation for Potential Managed Medical Assistance Providers.

Welcome to the Agency for Health Care Administration Training Presentation for Potential Managed Medical Assistance Providers. Welcome to the Agency for Health Care Administration Training Presentation for Potential Managed Medical Assistance Providers. The presentation will begin momentarily. Please dial in to hear audio: 1-888-670-3525

More information

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid

More information

Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon

Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon As of July 2003, 398,874 people were covered under Oregon s Medicaid/SCHIP programs. There were 380,546 enrolled in the Medicaid

More information

oppaga Florida s Medicaid Home and Community-Based Services Waivers

oppaga Florida s Medicaid Home and Community-Based Services Waivers oppaga Florida s Medicaid Home and Community-Based Services Waivers JULY 009 Report No. 09- Office of Program Policy Analysis & Government Accountability an office of the Florida Legislature Florida s

More information

Clarification of Medicaid Coverage of Services to Children with Autism

Clarification of Medicaid Coverage of Services to Children with Autism DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 CMCS Informational Bulletin DATE: July 7, 2014

More information

NC Health Choice. Publication date: September 1999 OVERVIEW. What is it?

NC Health Choice. Publication date: September 1999 OVERVIEW. What is it? NC Health Choice Publication date: September 1999 OVERVIEW What is it? NC Health Choice is a free or reduced cost health insurance program for uninsured children birth through age 18. Who is it for? Children

More information

Elizabeth Dudek Secretary, Agency for Health Care Administration. House Health Care Appropriations Subcommittee January 15, 2013

Elizabeth Dudek Secretary, Agency for Health Care Administration. House Health Care Appropriations Subcommittee January 15, 2013 Florida Medicaid: An Overview Elizabeth Dudek Secretary, Agency for Health Care Administration House Health Care Appropriations Subcommittee January 15, 2013 AHCA Overview The Agency for Health Care Administration

More information

Benefit. Benefits Covered by UnitedHealthcare Community Plan

Benefit. Benefits Covered by UnitedHealthcare Community Plan Benefits Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current member ID card when getting

More information

Table of Contents. Why Are Changes Being Made to Florida s Medicaid Program?... 3. What Is Managed Care?... 3

Table of Contents. Why Are Changes Being Made to Florida s Medicaid Program?... 3. What Is Managed Care?... 3 Table of Contents Why Are Changes Being Made to Florida s Medicaid Program?... 3 What Is Managed Care?... 3 When Will These Changes to Florida Medicaid Occur?... 3 What Is the Goal of the Florida Managed

More information

Florida Medicaid: Mental Health and Substance Abuse Services

Florida Medicaid: Mental Health and Substance Abuse Services Florida Medicaid: Mental Health and Substance Abuse Services Beth Kidder Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration House Children, Families, and Seniors Subcommittee

More information

State Plan for Title XIX Attachment 1.2-B State of Alaska Page11 ORGANIZATION AND FUNCTIONS OF THE DIVISION RESPONSIBLE FOR THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE XIX OF THE SOCIAL SECURITY ACT The

More information

Workshop for Parents and Providers

Workshop for Parents and Providers MEDICAL ASSISTANCE (MEDICAID) in MARYLAND Workshop for Parents and Providers A Partnership between The Parents Place of Maryland and Georgetown University Center for Child and Human Development 1 About

More information

A SUMMARY OF MEDICAID WAIVER PROGRAMS AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS AND THEIR FAMILIES IN NEW YORK STATE JANUARY 2010

A SUMMARY OF MEDICAID WAIVER PROGRAMS AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS AND THEIR FAMILIES IN NEW YORK STATE JANUARY 2010 A SUMMARY OF MEDICAID WAIVER PROGRAMS AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS AND THEIR FAMILIES IN NEW YORK STATE JANUARY 2010 Compiled by Tara Anne Pleat, Esq.* for the Committee on Special Needs

More information

An Overview of Wisconsin s Medical Assistance, BadgerCare, and SeniorCare Programs

An Overview of Wisconsin s Medical Assistance, BadgerCare, and SeniorCare Programs An Overview of Wisconsin s Medical Assistance, BadgerCare, and SeniorCare Programs Prepared by Marlia Moore and Charles Morgan Wisconsin Legislative Fiscal Bureau Medical Assistance W i sconsin s medical

More information

OVERVIEW OF KENTUCKY Outreach MEDICAID AND KCHIP

OVERVIEW OF KENTUCKY Outreach MEDICAID AND KCHIP OVERVIEW OF KENTUCKY Outreach MEDICAID AND KCHIP Lisa Lee Director, Medicaid Division of Provider Operations Program Director, Kentucky Children s Health Insurance Program (KCHIP) September 2011 Background

More information

NC HEALTH CHOICE FOR CHILDREN

NC HEALTH CHOICE FOR CHILDREN CHAPTER 13 NC HEALTH CHOICE FOR CHILDREN What is it? Who is it for? NC Health Choice is a free or reduced-cost health insurance program for uninsured children from birth through age 18. NC Health Choice

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health

More information

issue brief Medicaid: A Key Source of Insurance in New Hampshire

issue brief Medicaid: A Key Source of Insurance in New Hampshire issue brief April 20, 2011 Medicaid: A Key Source of Insurance in New Hampshire As state and federal policymakers come to grips with substantial budget shortfalls both now and into the future one public

More information

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE Table of Contents General Rules and Information... 3 Occupational Therapist, Physical Therapist and Speech Language

More information

130 CMR: DIVISION OF MEDICAL ASSISTANCE MASSHEALTH COVERAGE TYPES TABLE OF CONTENTS

130 CMR: DIVISION OF MEDICAL ASSISTANCE MASSHEALTH COVERAGE TYPES TABLE OF CONTENTS Page 519.000 TABLE OF CONTENTS Section 519.001: Introduction 519.002: MassHealth Standard 519.003: Pickle Amendment Cases 519.004: Disabled Adult Children 519.005: Community Residents 65 Years of Age and

More information

Maryland Medicaid Program

Maryland Medicaid Program Maryland Medicaid Program Maryland s Pharmacy Discount Waiver Tuesday, November 19, 2002 Debbie I. Chang Deputy Secretary for Health Care Financing Maryland Department of Health and Mental Hygiene Overview

More information

MassHealth Eligibility Letter 209 May 1, 2013. Home- and Community-Based Services Waiver-Money Follows the Person

MassHealth Eligibility Letter 209 May 1, 2013. Home- and Community-Based Services Waiver-Money Follows the Person Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Eligibility Letter 209 May 1, 2013 TO: FROM: RE: MassHealth Staff Julian

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). Eligibility for this program will be determined

More information

Overview of the Florida Medicaid Therapy Services Coverage and Limitations Handbook

Overview of the Florida Medicaid Therapy Services Coverage and Limitations Handbook Overview of the Florida Medicaid Therapy Services Coverage and Limitations Handbook 2 Introduction Medicaid reimburses for physical therapy (PT), occupational therapy (OT), respiratory therapy (RT), and

More information

Déjà Vu: Michigan Struggles to Fund Medicaid Program

Déjà Vu: Michigan Struggles to Fund Medicaid Program Michigan League FOR Human Services May 2010 S Déjà Vu: Michigan Struggles to Fund Medicaid Program ix years ago: On February 12, 2004, Governor Granholm released her FY2005 Executive Budget. In it, she

More information

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the

More information

Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado

Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado As of July 2003, 377,123 people were covered under Colorado s Medicaid and SCHIP programs. There were 330,499 enrolled in the

More information

Medicaid Home- and Community-Based Waiver Programs

Medicaid Home- and Community-Based Waiver Programs INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: November 2013 Medicaid Home-

More information

Disability Rights Ohio Frequently Asked Questions about Medicaid: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Disability Rights Ohio Frequently Asked Questions about Medicaid: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) 50 West Broad Street, Suite 1400 Columbus, Ohio 43215-5923 Tel. 614-466-7264 local / 800-282-9181 in Ohio TTY 614-728-2553 / 800-858-3542 in Ohio Fax 800-644-1888 Web: disabilityrightsohio.org Disclaimer:

More information

State of California Health and Human Services Agency Department of Health Care Services

State of California Health and Human Services Agency Department of Health Care Services State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS DIRECTOR EDMUND G. BROWN JR. GOVERNOR DATE: All Plan Letter 14-xxx TO: ALL MEDI-CAL MANAGED CARE HEALTH

More information

130 CMR: DIVISION OF MEDICAL ASSISTANCE

130 CMR: DIVISION OF MEDICAL ASSISTANCE 130 CMR 519.000: MASSHEALTH: COVERAGE TYPES Section 519.001: Introduction 519.002: MassHealth Standard 519.003: Pickle Amendment Cases 519.004: Disabled Adult Children 519.005: Community Residents 65 Years

More information

NJ FamilyCare ABP. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare ABP. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare ABP BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

Medical Policy Original Effective Date: 07-22-09 Revised Date: 01-27-16 Page 1 of 5

Medical Policy Original Effective Date: 07-22-09 Revised Date: 01-27-16 Page 1 of 5 Disclaimer Medical Policy Page 1 of 5 Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans or the plan may have broader or

More information

Understanding Managed Long- Term Care

Understanding Managed Long- Term Care Understanding Managed Long- Term Care Managed Long-Term Care (MLTC) plans are insurance plans that are paid a monthly premium ("capitation") by the New York Medicaid program to approve and provide Medicaid

More information

FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law. What does the Florida Autism Legislation (Senate Bill Number 2654) do?

FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law. What does the Florida Autism Legislation (Senate Bill Number 2654) do? FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law What does the Florida Autism Legislation (Senate Bill Number 2654) do? There are three major components of the Florida Autism Legislation,

More information

Medicaid. Administration

Medicaid. Administration MEDICAID care is reasonable, necessary, and provided in the most appropriate setting. The PROs are composed of groups of practicing physicians. To receive Medicare payments, a hospital must have an agreement

More information

Testimony on the Department of Human Services. Overview of Services Provided to Individuals with Disabilities. Kevin Hancock

Testimony on the Department of Human Services. Overview of Services Provided to Individuals with Disabilities. Kevin Hancock Testimony on the Department of Human Services Overview of Services Provided to Individuals with Disabilities Kevin Hancock Chief of Staff of the Office of Long Term Living Steve Suroviec Deputy Secretary

More information

Occupational therapy Speech-language pathology (SLP)

Occupational therapy Speech-language pathology (SLP) 2009 Medicaid Transformation Program Review Outpatient Therapy Services Description Rehabilitative therapy services are optional Medicaid services which include physical therapy, occupational therapy,

More information

Kansas Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas

Kansas Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas As of July 2003, 262,791 people were covered under Kansas's Medicaid and SCHIP programs. There were 233,481 enrolled in the Medicaid

More information

Connecticut Data as of July 2003

Connecticut Data as of July 2003 Mental Health and Substance Abuse Services in Medicaid and SCHIP in Connecticut As of July 2003, 378,961 people were covered under Connecticut Medicaid/SCHIP programs. There were 364,692 enrolled in the

More information

Department of Social Services. South Dakota Medicaid Division of Medical Services (MS)

Department of Social Services. South Dakota Medicaid Division of Medical Services (MS) Department of Social Services South Dakota Medicaid Division of Medical Services (MS) Overview What is Medicaid? Who We Serve Services Provided Medicaid Budget South Dakota Medicaid: Medicaid is the nation

More information

Social Security, SSI, and Medicaid Basics

Social Security, SSI, and Medicaid Basics Social Security, SSI, and Medicaid Basics T.J. Sutcliffe, The Arc Julie Ward, The Arc Basics Basics Income Maintenance Health Insurance Means Tested Supplemental Security Income (SSI) Title XVI Medicaid

More information

Randall Chun, Legislative Analyst Updated: January 2016. MinnesotaCare

Randall Chun, Legislative Analyst Updated: January 2016. MinnesotaCare INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst is administered by the Minnesota Department of Human

More information

National Training Program

National Training Program National Training Program Module 12 Medicaid and the Children s Health Insurance Program Session Objectives This session will help you Describe eligibility, benefits, and administration of Medicaid Define

More information

Member s responsibility (deductibles, copays, coinsurance and dollar maximums)

Member s responsibility (deductibles, copays, coinsurance and dollar maximums) MICHIGAN CATHOLIC CONFERENCE January 2015 Benefit Summary This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations

More information

Bureau for Children with Medical Handicaps (BCMH) Ohio Department of Health

Bureau for Children with Medical Handicaps (BCMH) Ohio Department of Health Bureau for Children with Medical Handicaps (BCMH) Ohio Department of Health What on earth is BCMH? BCMH Mission The mission of the Bureau for Children with Medical Handicaps is to assure, through the development

More information

STATE AGENCY WAIVER PROGRAMS: COMMUNITY LONG TERM CARE. Jocelin Dawson, SCDHHS Lori Manos, SCDDSN Susan Bolt, SCDHHS

STATE AGENCY WAIVER PROGRAMS: COMMUNITY LONG TERM CARE. Jocelin Dawson, SCDHHS Lori Manos, SCDDSN Susan Bolt, SCDHHS STATE AGENCY WAIVER PROGRAMS: COMMUNITY LONG TERM CARE Jocelin Dawson, SCDHHS Lori Manos, SCDDSN Susan Bolt, SCDHHS Presentation is current as of November 26, 2013 UPDATES ON MEDICAID LONG TERM CARE PROGRAMS

More information

NJ FamilyCare B. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare B. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare B BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

NJ FamilyCare A. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare A. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare A BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT. Ohio Legal Rights Service

Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT. Ohio Legal Rights Service Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT Ohio Legal Rights Service On October 26, 2005, Ohio Legal Rights Service (OLRS) fi led a lawsuit

More information

Appendix 4: SPA and Waiver Options to Enhance Concurrent Care Programs

Appendix 4: SPA and Waiver Options to Enhance Concurrent Care Programs Appendix 4: SPA and Waiver Options to Enhance Concurrent Care Programs Medicaid State Plan Options Each state describes its Medicaid program in the Medicaid State Plan. The State Plan specifies how the

More information

Analysis of the New York State Medicaid Program and Identification of Potential Cost-Containment Opportunities

Analysis of the New York State Medicaid Program and Identification of Potential Cost-Containment Opportunities Analysis of the New York State Medicaid Program and Identification of Potential Cost-Containment Opportunities Prepared for: Citizens Budget Commission Submitted by: The Lewin Group Date: October 22, 2010

More information

Medicaid Reform: More Managed Care Options Available; Differences Limited by Federal and State Requirements

Medicaid Reform: More Managed Care Options Available; Differences Limited by Federal and State Requirements June 2008 Report No. 08-38 Medicaid Reform: More Managed Care Options Available; Differences Limited by Federal and State Requirements at a glance Medicaid Reform Medicaid Reform seeks to provide beneficiaries

More information

Health Insurance Coverage Options Reference Guide

Health Insurance Coverage Options Reference Guide TECHNICAL ASSISTANCE TOOL Health Insurance Coverage Options Reference Guide The Affordable Care Act (ACA) expands access to health insurance coverage for individuals through 400% FPL. Navigators and assisters

More information

Place of Service Codes for Professional Claims Database (updated November 1, 2012)

Place of Service Codes for Professional Claims Database (updated November 1, 2012) Place of Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity

More information

professional billing module

professional billing module professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3

More information

Faces of the Pennsylvania Medicaid Program

Faces of the Pennsylvania Medicaid Program Faces of the Pennsylvania Medicaid Program Judith R. Lave, PhD Monica Costlow, BA, JD Matthew Stevenson, BA, MDA, MPH. Pennsylvania Medicaid Policy Center University of Pittsburgh July 2011 1. Preface

More information

# Slots/Average. Type/Name of Waiver Eligibility Services. Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 1 of 6

# Slots/Average. Type/Name of Waiver Eligibility Services. Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 1 of 6 Elderly or Disabled with Consumer Direction (EDCD) Elderly or Disabled with Consumer Direction (EDCD) Waiver became effective February 1, 2005. It is the combination of two waivers, the Elderly and Disabled

More information

Place of Service Codes for Professional Claims Database (updated August 6, 2015)

Place of Service Codes for Professional Claims Database (updated August 6, 2015) Place of Codes for Professional Claims Database (updated August 6, 2015) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity

More information

APPENDIX 12. Services/Resources Proposed in Developing CHI PACC Models Chart

APPENDIX 12. Services/Resources Proposed in Developing CHI PACC Models Chart APPENDI 12 901 NORTH PITT STREET SUITE 230 ALEANDRIA VIRGINIA 22314 USA 800.2.4.CHILD FA: 703.684.0226 INFO@CHIONLINE.ORG WWW.CHIONLINE.ORG M E M O R A N D U M Date: August 17, 2004 To: From: Subject:

More information

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C Service Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ Division of Developmental Disabilities (DDD) NJ FamilyCare B NJ FamilyCare C NJ FamilyCare D Abortions and related services (covered

More information

POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES. I. Policy Statement

POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES. I. Policy Statement BOARD OF EDUCATION POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES Effective: July 1, 2009 I. Policy Statement The Board of Education recognizes its responsibilities to provide services

More information

SUMMARY OF BADGERCARE PLUS BENEFITS

SUMMARY OF BADGERCARE PLUS BENEFITS SUMMARY OF BADGERCARE PLUS BENEFITS Medical, mental health and substance abuse services Dental emergency NOT Pharmacy, chiropractic and dental services NOT 13 Ambulatory surgery centers Coverage of certain

More information

ASSISTIVE TECHNOLOGY: HOW TO PAY FOR THE DEVICE OR SERVICE THAT YOU NEED

ASSISTIVE TECHNOLOGY: HOW TO PAY FOR THE DEVICE OR SERVICE THAT YOU NEED ASSISTIVE TECHNOLOGY: HOW TO PAY FOR THE DEVICE OR SERVICE THAT YOU NEED COMMUNICATION HEARING MOBILITY LEARNING VISION Prepared by: Disability Rights Network of Pennsylvania www.drnpa.org 1414 N. Cameron

More information

Place of Service Codes for Professional Claims Database (updated November 1, 2012)

Place of Service Codes for Professional Claims Database (updated November 1, 2012) Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where

More information

BIEADL01 LAS/PBS SYSTEM SCHEDULE VIIIB-2 SP 10/15/2009 08:57 PAGE: 1

BIEADL01 LAS/PBS SYSTEM SCHEDULE VIIIB-2 SP 10/15/2009 08:57 PAGE: 1 BIEADL01 LAS/PBS SYSTEM SCHEDULE VIIIB-2 SP 10/15/2009 08:57 PAGE: 1 ----------- SCHEDULE VIIIB - NURSING HOME COUNTY BILLING INCREASE, FUND SHIFT 1 33B2480 GENERAL REVENUE FUND... 66,557,484-1000 NARR

More information

MEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY

MEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL TRANSMITTAL LETTER October 19, 2015 TO: FROM: SUBJECT: CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL CHANGES CHAPTER

More information

Healthy Michigan MEMBER HANDBOOK

Healthy Michigan MEMBER HANDBOOK Healthy Michigan MEMBER HANDBOOK 2015 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?... 3 How Do I Reach Member Services?... 3 Is There A Website?....

More information

Coverage level: Employee/Retiree Only Plan Type: EPO

Coverage level: Employee/Retiree Only Plan Type: EPO This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan documents at www.dbm.maryland.gov/benefits or by calling 410-767-4775

More information

Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses

Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses Contract Number 732HC08B Prepared by Human Systems and Outcomes, Inc. Edited by Celeste

More information

Healthy Michigan MEMBER HANDBOOK

Healthy Michigan MEMBER HANDBOOK Healthy Michigan MEMBER HANDBOOK 2014 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?...3 How Do I Reach Member Services?...3 Is There A Website?....

More information

Benefits and Premiums are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY TBD

Benefits and Premiums are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY TBD Benefits and Premiums are effective January 01, 2017 through December 31, 2017 PLAN FEATURES Annual Deductible PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Network Providers CMS Annual

More information

Randall Chun, Legislative Analyst 651-296-8639 Updated: October 2007. MinnesotaCare

Randall Chun, Legislative Analyst 651-296-8639 Updated: October 2007. MinnesotaCare INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst 651-296-8639 Updated: October 2007 MinnesotaCare

More information

2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County

2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County 2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County Special Needs Plans for Dual Eligible beneficiaries are an HMO plan that limits their membership to people

More information

MAWD or Marketplace?

MAWD or Marketplace? MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage Summary Choosing health insurance coverage that best meets one s needs is important, especially

More information

Kentucky Medicaid Overview September 2003

Kentucky Medicaid Overview September 2003 Kentucky Medicaid Overview September 2003 Kentucky Medicaid provides a broad range of health services to over 660,000 low-income working families, children, and aged, blind, and disabled Kentuckians. During

More information

American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717

American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717 AMENDMENT #4 American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717 This Amendment is duly adopted and effective as of October 1, 2014.

More information

Alabama Autism Task Force Preliminary Recommendations

Alabama Autism Task Force Preliminary Recommendations Alabama Autism Task Force Preliminary Recommendations Having reviewed the findings to date from the Alabama Autism Collaborative Group (AACG), The Alabama Autism Task Force proposes the following changes

More information

AGING STRATEGIC ALIGNMENT PROJECT SOUTH CAROLINA. State Profile for

AGING STRATEGIC ALIGNMENT PROJECT SOUTH CAROLINA. State Profile for State Profile for SOUTH CAROLINA Home- and -based Services for Older Adults and Adults with Physical Disabilities Background South Carolina s 60+ population was 849,263 in 2008 (19.0% of the state s total

More information

uninsured Long-Term Care: Understanding Medicaid s Role for the Elderly and Disabled Ellen O Brien Georgetown University Health Policy Institute

uninsured Long-Term Care: Understanding Medicaid s Role for the Elderly and Disabled Ellen O Brien Georgetown University Health Policy Institute kaiser commission on medicaid and the uninsured Long-Term Care: Understanding Medicaid s Role for the Elderly and Disabled Executive Summary Prepared by Ellen O Brien Georgetown University Health Policy

More information

Section 6087: Self-Directed Personal Assistance Services (PAS) and Cash and Counseling

Section 6087: Self-Directed Personal Assistance Services (PAS) and Cash and Counseling Characteristic Comparability and statewideness Level of care eligibility requirements Section 6087: Self-Directed Personal Assistance Services (PAS) and Cash and Counseling Section 6087 of the DRA (Self-

More information

Healthy PA: Medicaid Expansion. Ann Bacharach PA Health Law Project February 20, 2014

Healthy PA: Medicaid Expansion. Ann Bacharach PA Health Law Project February 20, 2014 Healthy PA: Medicaid Expansion 1 Ann Bacharach PA Health Law Project February 20, 2014 Healthy PA Medicaid Proposal A waiver proposal to: 2 Make substantial changes PA s existing Medical Assistance program

More information

Nationwide Life Insurance Co.: University of Phoenix NJ Coverage Period: 9/24/13-8/23/14

Nationwide Life Insurance Co.: University of Phoenix NJ Coverage Period: 9/24/13-8/23/14 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important

More information

Behavioral Health Benefits. Cortney Shaw Behavioral Health Manager

Behavioral Health Benefits. Cortney Shaw Behavioral Health Manager Behavioral Health Benefits Cortney Shaw Behavioral Health Manager 0 Behavioral Health Services CalOptima s Behavioral Health Services Medi-Cal Duals (Medi-Cal/ Medicare) Orange County Mental Health Plan

More information

Introduction to One Care. MassHealth plus Medicare. www.mass.gov/masshealth/onecare

Introduction to One Care. MassHealth plus Medicare. www.mass.gov/masshealth/onecare Introduction to One Care MassHealth plus Medicare www.mass.gov/masshealth/onecare Overview of One Care Starting in fall 2013, MassHealth and Medicare will join together with health plans in Massachusetts

More information

Summary Table of Benefits Select Medicare Supplement Plan

Summary Table of Benefits Select Medicare Supplement Plan 2016 EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan Summary Table of Benefits Select Medicare Supplement Plan PLAN REIMBURSEMENT METHOD DEDUCTIBLE - Individual Medicare

More information

Florida Medicaid. Nursing Facility Services Coverage Policy

Florida Medicaid. Nursing Facility Services Coverage Policy Florida Medicaid Agency for Health Care Administration May 2016 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible

More information

LEGACY PLAN Medical In-Ntwk Out-of-Ntwk

LEGACY PLAN Medical In-Ntwk Out-of-Ntwk Preventive Services Age, gender and frequency criteria Adult physical/immunizations Well child visits/immunizations Screenings 0 Co-Insurance (after deductible) Out-of-Pocket Maximums Office Visit (copays)

More information

Appendix A. Glossary

Appendix A. Glossary Glossary The following provides brief definitions and descriptions of terms, abbreviations, and acronyms often used in the conjunction with the Medicaid program. AI is an indicator in the CAP block on

More information

What s Medicare? What are the different parts of Medicare?

What s Medicare? What are the different parts of Medicare? Revised June 2014 What s Medicare? Medicare is health insurance for: People 65 or older People under 65 with certain disabilities People of any age with End-Stage Renal Disease (ESRD) (permanent kidney

More information