Presentation to the
National Alliance for Medicaid in Education, Inc. Carolyn Ingram, Director, Medical Assistance Division
October 14, 2009
New Mexico
New Mexico
Human Services Department
Highlights for Today’s Discussion
School Health Care Jeopardy
History of School Health in New Mexico
¾ Medicaid School-Based Services
¾ School-Based Health Centers
What’s Up with Health Reform?
¾ Effects on School Health
¾ NASMD’s Role
Future Strategies
¾ Medicaid Leadership Institute
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 - 1988
New Mexico’s Medicaid program added the Medicaid
School-Based Services (MSBS) program to its benefit package under EPSDT - 1994
Covered services include: medical evaluations and
re-evaluations; therapies; nutritional assessments and counseling; nursing; and transportation
Administrative Claiming discontinued due to
inconsistency in the way schools and 3rd party billers
Approach to School-Based Services
Changed in 2003
New Mexico Human Services Department created the
Medicaid School Health Office - 2003
New Mexico reinstated Administrative Claiming - 2004
New Mexico expanded Nursing as a covered service
-2004
43 public school districts, 7 RECs and 3 charter schools
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
$3 million $2.7 million $1.8 million $2.6 million
Total
Reimbursements
School-Based Health Centers -
Reimbursement First Started with Salud!
2000 SBHC/Managed Care Organization (MCO) Pilot Project
¾ $500,000 grant to HSD from the Centers for Health Care
Strategies (CHCS) through the Robert Wood Johnson Foundation
¾ Four year pilot
The goals of the project:
¾ Explore best practices for collaboration between SBHCs &
MCOs
¾ Increase access to care for underserved children and
adolescents
¾ Strengthen the provision of comprehensive and
preventive care
¾ Promote the integration of systems, particularly for
primary and behavioral health
Partnership with MCOs Has Been the Key to
Program Success
Managed Care and SBHCs
¾ Required numerous meetings to get buy-in and agreement to
pay from MCOs
¾ MCOs agreed to a list of reimbursable services
¾ 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
¾ The Medicaid MCOs were the only payer for SBHCs
School Health Summit held at the end of the project
¾ 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
¾ Data also showed a greater behavioral health penetration
rate among students seen by SBHCs
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
¾ His goal was to have one SBHC in each of NM’s 33 counties ¾ Today, there are 83 SBHCs, 44 of them approved to bill
Medicaid for services rendered to Medicaid-enrolled students
¾ 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
2009-2010 New Mexico has a work group studying the
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
National Studies Outlining Benefits of
SBHCs
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
Santa Fe SBHC Parent Survey Results (08-
09 SFY)
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
Item Description
Self-Rating Medical Record Review 1
Medical Record Review 2
(15 SBHC staff) (201 charts) (128 charts) Proportion of students that
complete the SHQ 80% (12 staff) * 94% (189 charts) 98% (126 charts) EPSDT components are
documented 53% (8 staff) † 8% (16 charts) 47% (59 charts)
ICP Comparison of Content Area Specific Assessment (CASA) Self‐Rating and Medical record review Results (5 SBHC Teams)
*most or ¾ of the time
†medical record review “pass” required presence of 13 items
Performance Improved After the First
Record Review
NUTS & BOLTS OF HEALTH CARE
REFORM
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
Bills are Currently Under Discussion
Details vary, but both the Senate and the House bills
include:
¾ Creation of a health insurance exchange ¾ Community rating & guaranteed issue ¾ No pre-existing condition exclusions
¾ Employer participation or contribution mandates (pay or
play)
¾ Mandates for individuals (with exceptions)
¾ Grants and proposals for workforce development ¾ Grandfather current coverage for individuals
¾ Care coordination, medical homes, quality assurance &
disease prevention
Health Reform for Medicaid
Medicaid expansion
¾ Coverage below 133% Federal Poverty Level - (House, SFC) ¾ Coverage below 150% Federal Poverty Level - (Senate HELP)
Changes to SCHIP
¾ SCHIP would go away at the end of current authorization (House)
¾ SCHIP would be maintained at current eligibility level until 2019 – (SFC)
¾ SCHIP would be a “qualifying plan” under the exchange – (Senate HELP)
What Does all this Mean for School Health?
More coverage opportunities
¾ Grant to support operations for SBHC in HR 3200
Education of parents, guardians and students
¾ Significant work will need to be done to enroll people through the exchange and explain options
New possible partnerships
¾ To remain viable, schools must look for other revenue sources ¾ Possible partnership with NASMD
The Future of School-Based Health
Bring together stakeholders with state and local community leaders Assess the needs of school-aged children
¾ Analyze available resources ¾ Show cost-effectiveness
Develop Plan of Action – Look at the Medicaid Leadership Institute
model
¾ What should be done?
¾ Who should do it and how? ¾ Who will pay for it?
Demonstrate savings
¾ Reduce duplication of services
¾ Reduce more expensive care down the line (ER use)
¾ Help meet other goals (keep adolescents in school; improve daily
functioning of high-need children)
Presentation Concluded
Thank You!
Carolyn Ingram, Director Medical Assistance Division NM Human Services Department
