New Mexico Human Services Department
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1 New Mexico Human Services Department Presentation to the National Alliance for Medicaid in Education, Inc. Carolyn Ingram, Director, Medical Assistance Division October 14,
2 Highlights for Today s Discussion School Health Care Jeopardy History of School Health in New Mexico Medicaid School-Based Services School-Based Health Centers What s Up with Health Reform? Effects on School Health NASMD s Role Future Strategies Medicaid Leadership Institute School Health Leadership 2
3 School-Based Services in New Mexico Have Grown Over Time Congress makes Medicaid funds available to schools for certain health-related services for children and youth with disabilities New Mexico s Medicaid program added the Medicaid School-Based Services (MSBS) program to its benefit package under EPSDT Covered services include: medical evaluations and reevaluations; therapies; nutritional assessments and counseling; nursing; and transportation Administrative Claiming discontinued due to inconsistency in the way schools and 3 rd party billers were billing
4 Approach to School-Based Services Changed in 2003 created the Medicaid School Health Office New Mexico reinstated Administrative Claiming New Mexico expanded Nursing as a covered service public school districts, 7 RECs and 3 charter schools currently participate in the MSBS program 4
5 About $12 Million goes to New Mexico Schools for Services Under the MSBS Program FY06 FY07 FY08 FY09 Unduplicated Students 17,179 16,898 17,011 16,904 Direct Services $10.4 million $11 million $10.6 million $10 million Administrative Claiming Total Reimbursements $3 million $2.7 million $1.8 million $2.6 million $13.4 million $13.7 million $12.4 million $12.6 million 5
6 School-Based Health Centers - Reimbursement First Started with Salud! 2000 SBHC/Managed Care Organization (MCO) Pilot Project $500,000 grant to HSD from the Centers for Health Care Strategies (CHCS) through the Robert Wood Johnson Foundation Four year pilot The goals of the project: Explore best practices for collaboration between SBHCs & MCOs Increase access to care for underserved children and adolescents Strengthen the provision of comprehensive and preventive care Promote the integration of systems, particularly for primary and behavioral health Improve the overall health of students served in SBHCs 6
7 Partnership with MCOs Has Been the Key to Program Success Managed Care and SBHCs Required numerous meetings to get buy-in and agreement to pay from MCOs MCOs agreed to a list of reimbursable services At first, medical providers in the community were against SBHCs; however, they now encourage their patients to use them when they cannot get in to see their PCPs The Medicaid MCOs were the only payer for SBHCs School Health Summit held at the end of the project Project data showed that SBHC providers provided a larger share of EPSDT visits for adolescents, as a percentage of the whole, compared to other providers in the pilot communities Data also showed a greater behavioral health penetration rate among students seen by SBHCs Laid the foundation for SBHC expansion in New Mexico 7
8 School-Based Health Centers Grew Under Richardson s Leadership 2004, Governor Bill Richardson announced his intention to double the number of SBHCs in NM from 34 to 68 His goal was to have one SBHC in each of NM s 33 counties Today, there are 83 SBHCs, 44 of them approved to bill Medicaid for services rendered to Medicaid-enrolled students 21 SBHCs offer summer hours 2007, SBHCs were allowed to credential and bill FFS Medicaid Telehealth services are available to students, specifically when a behavioral health provider would like to consult with a psychiatrist on a specific case New Mexico has a work group studying the feasibility of SBHCs billing private insurance companies 8
9 National Studies Outlining Benefits of SBHCs Reduce inappropriate emergency room use among regular users of SBHCs Reduce Medicaid expenditures related to inpatient, drug and emergency room use Decrease absenteeism and tardiness for students receiving counseling services Reduce hospitalizations and increase school attendance among inner-city school children with asthma 9
10 Santa Fe SBHC Parent Survey Results (08-09 SFY) 89% indicated that the SBHC encourages students to be more responsible for decisions 65% indicated that students miss less school due to the availability of services in the school 90% indicated that the SBHC saved them a trip to the doctor or emergency room 100% indicated that SBHCs are a valuable service to the community 10
11 Envision New Mexico - Measuring Quality Improvement in School Health The EPSDT best practice model sets a high bar for performance, with a total of 13 critical items that must be completed to get a pass on this measure These teams overestimated their compliance with EPSDT requirements, shown in the self-rating Once these performance issues were identified, the teams demonstrated nearly 40% improvement within weeks 11
12 Performance Improved After the First Record Review ICP Comparison of Content Area Specific Assessment (CASA) Self Rating and Medical record review Results (5 SBHC Teams) Item Description Self-Rating Medical Record Medical Record Review 1 Review 2 (15 SBHC staff) (201 charts) (128 charts) Proportion of students that complete the SHQ EPSDT components are documented 80% (12 staff) * 94% (189 charts) 98% (126 charts) 53% (8 staff) 8% (16 charts) 47% (59 charts) *most or ¾ of the time medical record review pass required presence of 13 items 12
13 13
14 NUTS & BOLTS OF HEALTH CARE REFORM 14
15 Three Bills are on Their Way Senate HELP Committee Affordable Health Choices Act Senate Finance Committee America s Healthy Future Act of 2009 (now amended by committee during mark up September 16, 2009) House Tri-Committee America s Affordable Health Choices Act of 2009 (H.B. 3200) 15
16 Bills are Currently Under Discussion Details vary, but both the Senate and the House bills include: Creation of a health insurance exchange Community rating & guaranteed issue No pre-existing condition exclusions Employer participation or contribution mandates (pay or play) Mandates for individuals (with exceptions) Grants and proposals for workforce development Grandfather current coverage for individuals Care coordination, medical homes, quality assurance & disease prevention Benefit coverage requirements 16
17 Health Reform for Medicaid Medicaid expansion Coverage below 133% Federal Poverty Level - (House, SFC) Coverage below 150% Federal Poverty Level - (Senate HELP) Changes to SCHIP SCHIP would go away at the end of current authorization (House) SCHIP would be maintained at current eligibility level until 2019 (SFC) SCHIP would be a qualifying plan under the exchange (Senate HELP) 17
18 What Does all this Mean for School Health? More coverage opportunities Grant to support operations for SBHC in HR 3200 Education of parents, guardians and students Significant work will need to be done to enroll people through the exchange and explain options New possible partnerships To remain viable, schools must look for other revenue sources Possible partnership with NASMD 18
19 The Future of School-Based Health Bring together stakeholders with state and local community leaders Assess the needs of school-aged children Analyze available resources Show cost-effectiveness Develop Plan of Action Look at the Medicaid Leadership Institute model What should be done? Who should do it and how? Who will pay for it? Demonstrate savings Reduce duplication of services Reduce more expensive care down the line (ER use) Help meet other goals (keep adolescents in school; improve daily functioning of high-need children) Redirect savings to expand school services 19
20 Presentation Concluded Thank You! Carolyn Ingram, Director Medical Assistance Division NM Human Services Department 20
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