IV. Priority Recommendations (continued)
Issues and Solutions related to Mental Health
MA1. Study the adequacy of rates and take action to address identified problems, providing for routine rate review and adjustments
Providers have raised questions about the adequacy of Part C EI provider payment rates in Medicaid to ensure quality and sustainability of the system. Given a recent increase in rates, a study of current rates can help to identify problems and areas for action. In addition, a process for routine review and adjustment of rates is warranted. Study the adequacy of rates to cover the cost of EI services, including the impact of recent rate increases, and take action to address identified problems; and provide for routine rate review and adjustment.
Issue
Solution
Administrative Additional funding needed
Type
MA2. Use Medicaid data to address variations in utilization and spending for Early Intervention services
Pennsylvania is making substantial investments of Medicaid funding into Part C EI. Due to lack of publicly available data, however, there is limited understanding about Medicaid spending and utilization patterns for infants and toddlers in the Part C EI system. Use Medicaid data to understand and address variations in utilization and spending for EI services, including monitoring the impact of changes in Medicaid administrative claims by counties.
Issue
Solution
Administrative Some new funding needed
Type
MA4. Leverage Medicaid MCO contracts and quality/performance initiatives to stimulate pediatric primary care developmental screening and referrals
The state and Medicaid providers have set a priority on developmental screening in pediatric primary care. However, providers and families report continued gaps in screening and referrals to Part C EI. Missed opportunities exist to use MCO contracts and other mechanisms to improve developmental screening and referrals. Leverage Medicaid MCO contracts and quality/performance initiatives to stimulate both pediatric primary care developmental screening (based on national recommendations) and referrals to Part C EI, including data-driven quality improvement, training, and performance incentives.
Issue
Solution
Administrative Minimal additional funding needed
Type
June 2022
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