Hearing and Vision Services for Children: Efforts to Ensure Broad Implementation Through Medicaid

Transcription

1 Public Health Law Series Webinar Hearing and Vision Services for Children: Efforts to Ensure Broad Implementation Through Medicaid May 14, 2015

2 How to Use Webex Audio: If you can hear us through your computer, you do not need to use your phone. Just adjust your computer speakers as needed. Support: If you need technical assistance, call Webex Technical Support at Submitting Questions: All participants are muted. Type a question into the Q & A panel for our panelists to answer. Submit your questions at any time during webinar. Recording: This webinar is being recorded. If you arrive late, miss details or would like to share it, we will send you a link to this recording after the session has ended. Public Health Law Series Webinar: 2 Hearing and Vision Services for Children

3 Public Health Law Series Webinar Hearing and Vision Services for Children: Efforts to Ensure Broad Implementation Through Medicaid May 14th, 2015

4 Presenter Introduction Jane Perkins, J.D., M.P.H. Senior Attorney, Network for Public Health Law Southeastern Region and Legal Director, National Health Law Program (NHeLP) J.D., University of North Carolina, Chapel Hill M.P.H., University of California, Berkeley Research interests/areas of expertise: Publicly-Funded Health Insurance Programs Health Access and Health Care for Vulnerable Populations Early Intervention Services for Medicaid-Eligible Children Disability and Civil Rights Public Health Law Series Webinar: Hearing and Vision Services for Children 4

5 Presenter Introduction Sarah Somers, J.D., M.P.H. Attorney, Network for Public Health Law Southeastern Region and Managing Attorney, National Health Law Program (NHeLP) J.D., University of Michigan M.P.H., University of North Carolina School of Health Policy and Management Research interests/areas of expertise: Patient Protection and Affordable Care Act Americans with Disabilities Act Medicaid and Disability Issues Litigation and Litigation Support Public Health Law Series Webinar: Hearing and Vision Services for Children 5

6 Hearing and Vision Services for Children: Efforts to Ensure Broad Implementation Through Medicaid Sarah Somers, JD, MPH Jane Perkins, JD, MPH Southeastern Region, Network for Public Health Law National Health Law Program May 14, 2015

7 The Network for Public Health Law The Network for Public Health Law provides legal assistance, resources and opportunities to build connections for local, tribal, state and federal officials; public health practitioners; attorneys; policy-makers; and advocates. Organizations and individuals committed to improving public health can join the Network.

8 National Health Law Program (NHeLP) The National Health Law Program protects and advances the health rights of low income and underserved individuals. For over 45 years, NHeLP has advocated, educated and litigated at the federal and state levels.

9 Overview to the session Medicaid and EPSDT Vision and hearing problems among children and youth Screening, diagnostic, & treatment requirements Exemplary practices

10 Medicaid: Publicly funded health insurance for people with lower incomes

11 Medicaid: Who s eligible? Children & pregnant women People with disabilities People over age 65 Caretaker relatives Expansion

12 Medicaid: What s covered? For adults: Mandatory services, e.g. physician, nurse practitioner, hospital, FQHC, home health* Optional services, e.g. prescribed drugs, dental, prosthetics, rehabilitative For children: Early & Periodic, Screening, Diagnostic & Treatment (EPSDT)

13 Policy reasons for EPSDT: Low-income children are more likely to have: Vision, hearing and speech problems Untreated tooth decay Elevated lead blood levels Sickle cell disease Behavioral Health problems Anemia Asthma Transportation barriers And more...

14 EPSDT Requirements - Mandatory medical, vision, hearing, and dental screening Medical Screens Health and developmental history Unclothed physical exam Immunizations Lab tests, including lead blood tests Health education

15 EPSDT Requirements Medical, vision, hearing, dental screening Additional Required Screens Vision, including eyeglasses Hearing, including hearing aids Dental, including relief of pain, restoration of teeth and maintenance of dental health

16 EPSDT Requirements Treatment All services that could be covered under state Medicaid plan (mandatory and optional) All Medicaid-covered services necessary to correct or ameliorate physical and mental illnesses and conditions, even if the service is not covered under the state plan.

17 EPSDT Requirements Outreach and informing Effective and aggressive Oral and written Translated Targeted (e.g. pregnant teens, non-users) Transportation and appointment assistance (prior to screen due date) Coordination with other entities

18 Medicaid service delivery Fee for service Capitated, risk based managed care Primary care case management

19 Medicaid Managed Care 74% of Medicaid population All states but AK, WY High enrollment (>95%): HI, ID, MO, OR, SC,TN, VT SOURCES: Kaiser Family Foundation ( CMS (

20 60%

21 Barriers to vision and hearing service delivery [statistics?]

22 Vision problems 25 %

23 Hearing problems Cause of Hearing Loss in Children with Moderate or Worse Sensorineural Hearing Loss in Both Ears 1% 23% 56% Genetic Acquired Unknown Other 20% Source: Saral Mehra et al., The Epidemiology of Hearing Impairment in the United States: Newborns, Children, and Adolescents, 140 OTOLARYNGOLOGY HEAD AND NECK SURGERY 462, 466 (2009).

24 Vision standards & recommendations

25 Hearing standards & recommendations

26 Vision & Hearing Legal Requirements Laws & policies: NHeLP, Issue Brief Vision Services for Children on Medicaid: A Review of EPSDT Services (May 2015) NHeLP, Issue Brief Hearing Services for Children on Medicaid: A Review of EPSDT Services (October 2014) Medicaid Managed care contract provisions: Network for PHL & NHeLP, Survey of Medicaid Managed Care Contracts (May 2015)

27 Vision Periodicity 1/3 states AAP, Bright Futures State laws & policies Wisconsin Comprehensive periodic schedule, with emphasis on ages 0-5 Managed care contracts Michigan AAP periodicity schedule plus additional screens required by court order, foster care, or medical necessity

28 Vision Content of the screen 60% PCPs do not perform adequate vision screening 1/3 states No discussion State laws & policies Kentucky & Wisconsin Identify conditions and testing methods DC Visual acuity charts Managed care contracts Illinois Incorporates Handbook for Providers listing detailed specifications for vision testing

29 Vision Referral & follow-up 40-67% screening children who do not receive follow-up State laws & policies Illinois -- Quantitative & qualitative referral guidelines Managed care contracts Florida Vision screening and objective testing with referral and follow up as appropriate

30 Vision Monitoring & performance State laws & policies Maine, Minnesota -- Standardized reporting forms Ohio On-line tracking Managed care contracts Kansas Provides detailed specifications for monitoring and tracking screening provided

31 Hearing Periodicity 1/3 states AAP, Bright Futures State laws & policies Rhode Island Clear, easy to follow

32 Hearing Content of the screen 1/3 states No discussion State laws & policies Virginia For subjective screening, refers providers to AAP document Managed care contracts Utah incorporate provider manual, which explains content of the screen, into contract

33 Hearing Referral & follow-up State laws & policies Massachusetts Providers who discover child did not receive or pass newborn hearing screening must ensure screened or referred for evaluation Alabama Requires providers to follow-up on referred cases and document if child saw specialist Managed care contracts Florida Hearing screening and objective testing with referral and follow up as appropriate

34 Hearing Monitoring & performance State laws & policies Hawaii Providers must submit a tracking form to state after each screening Managed care contracts Kansas MCO must submit encounter data each month indicating EPSDT screenings performed, referrals made DC MCO must report each month on number and percent of eligible children who received vision and hearing screening

35 Forthcoming Publication Model Medicaid Managed Care Contract Provisions: EPSDT Vision and Hearing Services (May 2015)

36 Contact information Network for Public Health Law National Health Law Program Jane Perkins, (919) (x101) Sarah Somers, (919) (x102)

37 Q&A Please type your questions in the Q&A panel. Public Health Law Series Webinar: Hearing and Vision Services for Children 37

38 Thank you for attending Please join us for our next Series webinar on: Public Health Issues Related to Individual Debt Thursday, June 18th at 1p.m. (ET) Learn more and register at: networkforphl.org/webinars Public Health Law Series Webinar: Shared-Use Hearing and Agreements Vision Services to Support for Children Public Health 38