Innovative Ways to Leverage Funding for Health Care in Schools

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1 Innovative Ways to Leverage Funding for Health Care in Schools NATIONAL ALLIANCE FOR MEDICAID IN EDUCATION (NAME) ANNUAL CONFERENCE October 10, 2013 SESSION OBJECTIVES Learn about strategies used Michigan successfully to fund physical and behavioral health care services in school-based settings. Learn about federal telemedicine regulations and three ways states are using telemedicine to deliver services to children and youth. Learn how to use Medicaid to fund parent mentors for parents of special needs and multi-system children including billable services these parents can provide and the appropriate billing codes. School-Based Health Centers A School-Based Health Center is a partnership created by schools and community health organizations to provide on-site medical, mental health, and/or oral health services that promote the health and educational success of school-aged children. In Michigan, SBHCs are called Child and Adolescent Health Centers (CAHCs). 1

2 SBHCs in Michigan 70 state-funded sites Nearly 30 non-state-funded centers and programs In 30 counties Over 200,000 youth served each year 2:1 Federal match drawn down from state appropriation $11.2 million generated in-kind for SBHC programs SBHC funding in Michigan In Michigan, the 70 state-funded health centers receive $3.5 million from the omnibus school budget which is federally matched by Medicaid 2:1. SBHCs are supported by local, state and federal public health and primary care grants, community foundations, community benefit, donors, and reimbursement from public and private health care insurance. Medicaid Match for MI Purpose: Leverage appropriated state funding with federal Medicaid match to increase the capitated payment. Goal: Improve EPSDT rates in children and youth. Michigan pays managed care plans a per-memberper month fixed payment. Michigan obtained a federal Medicaid waiver from CMS in In return the SBHCs would enroll children and youth in Medicaid or CHIP. 2

3 Funding Flow Chart for Medicaid Match for CAHC & MM MDE CAHC $3,557.3 m GF (School Aid Fund) Baldwin Comm. Schools MM Providers MDCH/DFCH Program & Policy Development Compliance CQI MDCH MSA Medicaid Program (GF matched) Health Plans MPCA Provider contracts Provider payments Fiscal reporting To HP s MDCH MM $500k GF CAHC Providers 2011 What can you do to leverage funding for SBHCs? Initiate a dialogue with your state Medicaid office. Educate managed care providers about the role of SBHCs to improve HEDIS scores. Bring stakeholders to the table. Keep the governor and legislative leaders informed. Ensure that the strategy involves leveraging state and local funds to qualify for federal Medicaid match. Develop reporting and accountability systems. Telemedicine State Policies Implications for School Health Telehealth: the broad definition of technology-enabled healthcare that provides assessment, diagnosis, intervention, consultation, supervision and information (encompasses telemedicine). Telemedicine: the delivery of medical services through a two-way, interactive communication between the patient and a physician or practitioner at a distant site. 3

4 Telemedicine Terms Real Time: Services are delivered live. Store-and-Forward: transfer of data from one site to another using a camera or similar device to record (store) an image is sent (forwarded) via telecommunication to another site. Originating site (spoke site): patient s location at the time of service. Distant Site (hub site): where the physician or other licensed practitioners are located at the time of service. GT : modifier that most States use to designate a CPT code as a telemedicine service. Federal Policies Both Medicaid and Medicare cover telemedicine. Medicaid s Comparability and State wideness requirements do not apply to telemedicine services. Medicaid encourages states to create telemedicine policies that work in their state. CMS does not require states to submit separate Medicaid State Plan Agreements (SPA) for telemedicine reimbursement, if the state reimburses the services the same rate as face-toface services. State Telemedicine Policies 44 States have some Medicaid reimbursement for telemedicine. 16 States require private insurance to cover telemedicine. 7 States allow Medicaid to cover store-and-forward services. 4 States explicitly allows schools or school-based health centers to be originating sites. Most states require both originating site provider and distant site provider have that state s medical license. 4

5 Schools as Originating Sites New Mexico, New York, Oklahoma, and Wisconsin explicitly list schools as an eligible originating site. New Mexico and New York both explicitly list schoolbased health centers as eligible originating sites. New York: allows non-fqhc school-based health centers to be eligible. Oklahoma and Wisconsin: are the only states that explicitly include schools as eligible originating sites. Telemedicine in Schools There is shortage of child psychiatrists. Most states cover telepsychiatry services. 2004, Michigan pilot study conducted to see how patients felt after using telepsychiatry. Most were excited about the use of telepsychiatry, also felt it would be a community asset (Whitten and Kuwahara, 2004). California study found telemedicine increased access to acute and specialty care for children; helped children and families manage chronic conditions; and increased the capacity of school nurses and school-based health centers to meet the healthcare needs of students (Children s Partnerships, 2009). Telemedicine Funding Resources US DOA: Rural Development and US DHHS Distance Learning and Telemedicine Loan and Grant program - range $50,000 to $500,000. USDHHS has Telehealth Network Grant Program administered through the Office for the Advancement of Telehealth (OAT). It provides $250,000 per year over 4 years. 5

6 Peer Parent Support Services P E E R P A R E N T S U P P O R T S E R V I C E S A S S I S T P A R E N T S I N N A V I G A T I N G S Y S T E M S T O A C C E S S F O R M A L S E R V I C E S T H E I R C H I L D A N D F A M I L Y N E E D. P A R E N T P E E R S A D V O C A T E F O R F A M I L I E S A N D E M P O W E R P A R E N T S A N D C H I L D R E N T O A D V O C A T E F O R T H E M S E L V E S A N D O T H E R S. Peer Parent Support Services Efficacy Peer parent support services are found to increase early engagement in appropriate services and to promote engagement and retention in behavioral health and chronic health services (Davis-Groves, S.A., Byers, S., Johnson, K., McDonald, T. 2011). Family and youth peer support providers are integral to teams serving children and youth with behavioral health challenges and their families. They are distinct from traditional mental health service providers in that they operate out of their personal experience and knowledge. Peer Parent Support Partners Personal experiences makes these individuals experts at system navigation. Peer parent support partners can serve as wraparound team cofacilitators Patient Centered Medical Homes (PCMH) care coordinators, and ACA health system navigators. Peer parent support partners are key to Care Management Entities (CME) and Systems of Care (SOC. 6

7 Medicaid Funding Mechanisms Current Medicaid funding sources for family and youth peer support include: the use of state plan amendments (SPA), Medicaid waivers, other service titles/descriptions such as community support, case management, or resource development, and Medicaid administrative match. States can use federal Medicaid matching funds to reimburse community-based programs for administrative activities related to outreach and coordination for people who are potentially eligible for Medicaid or current recipients. Michigan Parent Support Services Family Support and Training Services approved by CMS May 2010 enhancement to 1915 (c) Seriously Emotionally Disturbed Waiver. This family-focused service is provided to families (birth or adoptive parents, siblings, relatives, foster family, and other unpaid caregivers) of children with (SED) for the purpose of assisting the family in caring for a child receiving waiver services. Used in cases where the child is hindered or at risk of being hindered in his ability to achieve goals of: performing activities of daily living, improving functioning across life domain areas, or improving his inclusion and participation in the community or productive activity, or opportunities for independent living. Michigan Parent Support Training Resource Parent or Parent-to-Parent trainings must be provided by a trained parent using the Michigan Department of Community Health (MDCH) - endorsed curriculum (MDCH, 2011). Parents eligible to receive the training must have experience parenting children who have experienced trauma. The peer-parent support partner must complete the MDCH-approved statewide training curriculum and be provided regular supervision and team consultation by the treating professionals. 7

8 Trauma Focus The MDCH Resource Parent program, provides training for parents who wish to become mentors, or Resource Parents, to other adults in their community to share their knowledge and advice to give caregivers the skills to effectively support and provide services for children who have experienced trauma. Parent Support Specialists can be paid for services provided up to two times per day for participating in either parent-toparent supports or Resource Parent programs ($160 per encounter). Parent-to-parent supports may include training, education and support to parents of children with serious emotional disturbance or developmental disabilities (MDCH, 2011). Codes, Coverage and Provider Qualifications Codes Coverage Provider/Staff Qualifications H0038 Peer Support Services-Individual (delivered to the youth) H0038-HR Peer Support Services- Family (with patient present) (delivered to the adult caregiver) H0038-HS Peer Support Services- Family (without patient present) (delivered to the adult caregiver) State Plan Amendment (SPA) A peer support specialist is a person who: Meets all the qualifications of a behavioral health clinical associate (see below); Is competent to provide peer support services by virtue of having experienced behavioral health issues in self or family; and Is supervised by a mental health professional clinician who the behavioral health services provider has determined is competent to supervise peer support services. Additional Examples Codes Coverage Provider/Staff Qualifications S5111 SPA Children s Services Targeted Case Management (TCM)] Waiver for Children with Serious Emotional Disturbance (SEDW) TCM T1017 (modifiers:u1/u4) SEDW: Family training must be done by a psychologist or licensed master s social worker or a Qualified Mental Health Professional. Peer training must be provided by a trained peer. Parent-to-Parent and Resource Parent training must be provided by a trained parent using the MDCH-endorsed curriculum. The parent aide must have satisfactorily completed the one-month (four-week) orientation provided by Children s Services. A parent aide cannot be a case manager of his or her own child. 8

9 Contact for More Information Michele Strasz, Executive Director, Joan Abbey, Consulting Director, Evaluation and Strategic Analytics Unit,