Kathryn Shea, LCSW
The Florida Center for Early
Childhood, Inc.
President/CEO
Sarasota, FL
Celeste Putnam
FSU Center for Prevention & Early
Intervention Policy
Director of Early Childhood
Integration of Care
Tallahassee, FL
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Florida Legislature created the Statewide
Medicaid Managed Care Reform.
Implementation is underway now – May
through October
Families will receive a series of notification
letters starting 90 days before
implementation by Region.
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Managed Medical Assistance (MMA) Plans will
provide all the state plan services to the vast
majority of Medicaid recipients
The MMA health plans will be operated by
Health Maintenance Organizations and
Provider Service Networks
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Health Plans were selected
through a competitive process
The number of plans per
Agency for Health Care
Administration (AHCA) Region
were specified in Legislation
Plans will be integrated- will
provide both behavioral health
and physical health services
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Medipass will end as the health plans roll out
and will terminate in October 2014
Behavioral Health Prepaid Mental Health Plans
will end as the health plans roll out (Value
Options, Megellan)
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Medicaid selected several specialty plans for
populations with special health care needs
Sunshine State Health Plan will be available
for children in the child welfare system
(voluntary)
Magellan Complete Care will be available for
persons with severe mental illness (voluntary)
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Children’s Medical Services (CMS) will provide
integrated health care services to children
through a managed care network.
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Children must have special healthcare needs
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Enrollment is voluntary
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Regions 2, 3, & 4
Regions 5, 6, & 7
Regions 10 &
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Regions 1, 7, & 9
5/1/2014
6/1/2014
7/1/2014
8/1/2014
Implementation Date
Regions:
Standard Plans
Amerigroup
Better Health
Coventry
First Coast Advantage
Humana
Integral
Molina
Preferred
Prestige
SFCCN
Simply
Sunshine State
United Healthcare
Staywell
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5
6
X
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X
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10
11
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X
X
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9
X
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X
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X
X
X
X
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X
X
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X
X
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X
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X
X
X
X
Specialty Plans
Magellan Complete Care
(Serious Mental
Illness)
Sunshine State
(Child Welfare)
X
X
X
X
X
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Young children and their families are eligible
for health care services.
Eligibility
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Pregnant women – 191% of poverty
Infants under age 1- 206% of poverty
Children ages 1-5 – 140% of poverty
Children ages 6-19 – 133% of poverty
Child Welfare out of home and up to age 26
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
Critical Changes in 2001 Handbook:
◦ In-Depth Assessment – Early Childhood Best
Practice
“2. Be exhibiting symptoms of an emotional or
behavioral nature that are atypical for the child’s age
and development. For children 0 through 3 years of
age, Medicaid encourages use of the Diagnostic
Classification of Mental Health and Development
Disorders of Infancy and Early Childhood (DC: 0–3) for
assistance in determining the infant or child’s ICD-9CM diagnosis.”
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Critical Changes in 2001 Handbook:
◦ Individual AND FAMILY Therapy (family added)
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Individual and family therapy services include
the provision of insight oriented, cognitive
behavioral, or supportive therapy to an
individual or family.
Individual and family therapy may involve the
recipient, the recipient’s family (without the
recipient present), or a combination of therapy
with the recipient and the recipient’s family.
Allows for providing and billing dyadic therapy
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New Revised Handbooks (3) – 2014
Significant Changes
◦ No specific “Services for 0-5 Section”
◦ No mention of encouraging
use of DC: 0-3R
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Significant Changes:
◦ No ICD-9CM/ICD-10 codes excluded
◦ Two new Provider titles: Bachelor’s Level Infant
◦ Mental Health Practitioner and Infant Mental
Health Aides
◦ Does designate that assessments/services for
recipients under the age of 6 years must be
provided by the approved professionals “who
have training and experience in infant, toddler,
and early childhood development and the
observation and assessment of young children.”
*Seeking clarification from AHCA in some areas.
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General Medicaid Rules ~
Rule #1 – KNOW THE HANDBOOK!!!!!!!
The ultimate “reimburse-ability” of a service
by Medicaid will depend upon the quality
and content of the documentation. If an
activity is not documented in the record,
from a legal point of view, the activity did
not take place.
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Rule #2: Remember who the “client” is!
◦ Unless you are treating the parent for a specific
mental health disorder, the infant/child is the
“identified client”. The chart is opened under the
child’s name.
◦ All documentation must focus on the child’s
diagnosis, course of treatment, and discharge
planning.
◦ Treatment goals are focused on the child’s
improvement with the parent providing the
mechanism/vehicle for child’s improvement.
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General Medicaid Rules~
◦ All entries must be typed or handwritten
using only black ink
◦ Entries must be individualized to each child
◦ All entries must be legible and kept in
chronological order
◦ All entries must be dated and legibly signed
by the therapist who rendered the service
using full name, credentials, and professional
title
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General Medicaid Rules~
◦ Person(s) referenced in the documentation
should be identified at least once on each
Progress Note Page (i.e. Harry [cousin of
client])
◦ Errors in notes – If an entry is erroneous or
incorrect, clearly draw one line through the
error; write “error” to the side in parentheses;
enter the correction; add signature, title, and
the date; if an explanation seems appropriate,
do not hesitate to clarify why the correction is
needed.
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General Medicaid Rules~
◦ Entries should be made in the record at the
time the service is rendered
◦ Document that the services provided
correspond to the billing in the type of
service, amount of service (length of time the
activity took), the service date and entry date.
◦ Assure the activities are documented
with detail sufficient to support
the “amount of service” billed
to Medicaid.
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General Medicaid Rules~
◦ Activities claimed for reimbursement must be
meaningful and appropriate for the needs of
each individual. A continued need for therapy
services must be substantiated. (Medically
necessary)
◦ Completion/updates of Assessments,
Treatment Plans, reviews, reports,
correspondence, etc. should be referenced in
the Progress Notes. Documentation should
clearly identify where the information can be
located (what section of record)
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General Medicaid Rules~
◦ Therapy services should be documented in
progress notes beginning with the date a new
referral is received and initial assessment
conducted. Include who made the referral,
the reason(s) for the referral, etc.
◦ Be certain all appropriate releases of
information, authorization for assessment
and services is obtained and updated as
required.
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General Medicaid Rules~
◦ Each progress note entry must describe:
 Who the service was with (mother/infant)
 The kind or type of contact (family therapy)
 Where the contact took place (home/office)
 Intervention or specific service rendered (CPP)
 Purpose of contact (Treatment Goal #1)
 Outcome of contact (Progress made as seen
by…..)
 Continued need for services (services continue
to be medically necessary because…)
 Any follow up needed (referrals, contact with
treating physician, etc.)
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Medicaid Made Easy ~
Simplify all you can
◦ Create check lists for each file of what/when due
◦ Create forms that makes it easier for the workers,
but gives Medicaid the information it needs
◦ Conduct internal trainings frequently (quarterly
minimum). The more the workers hear the same
information, the more it sinks in. Take advantage
of all Medicaid trainings, Webinars, etc. Contact
Medicaid for in-house training if needed.
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Medicaid Made Easy ~
Simplify all you can
◦ Conduct peer reviews of charts to ensure quality
and accountability
◦ Document all internal trainings, use sign-in
sheets, document all peer reviews, charts
reviewed, outcomes, etc.
◦ Make sure all department reviews/audits are
incorporated into overall agency Continuous
Quality Improvement (CQI) Plan
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Tips for minimizing audit risk
◦ Must continually document in
assessment, treatment planning,
treatment plan reviews, progress
notes the medical necessity for
services
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From Medicaid:
There is adequate evidence to indicate that
the child is at risk for a more intensive,
restrictive and costly mental health
placement; and
◦ There is adequate evidence to indicate the
child’s condition cannot be improved with
less intensive services or interventions
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◦ Adequate evidence should include:
 Narrative describing the risk
factors/behaviors for
child/parent/relationship (not just a
check list!)
 History of infant/child functional
impairment in sensory/ behavior/social
emotional development (poor
attachment, at risk for expulsion, etc.)
 Tools that support impaired functioning
(ASQ-SE, TABS, CBCL, PSI, Maternal
Depression screening, DECA, etc.)
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Adequate evidence should include
(cont’d):
 Failed interventions (parenting
classes, PBS, ECMH consultation, etc.)
 Risk to child without immediate
treatment interventions (more
intensive, costly services, etc.)
 Child and parents willingness/ability
to benefit from services
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It’s not about quantity of
writing….
It’s about quality of writing
and incorporating all aspects of
service provision
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The ONLY code Medicaid cares about is the
ICD Code; not DSM or DC:0-3R!!!
The DSM 5 DOES NOT automatically
crosswalk to the same ICD-9-CM codes, nor
will they to the ICD-10 codes.
IDC-10 implementation now postponed
another year!
Florida crosswalk created in 2001 to
“crosswalk” the DC:0-3R codes to ICD-9-CM
codes. Updated in 2010. Can be found on
www.thefloridacenter.org – “Resources” page.
Continue to use Crosswalk to bill to ICD-9CM Codes
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Department of Children and Families (DCF)
Substance Abuse and Mental Health
◦ General Revenue
◦ Block Grant
◦ Special category 100-800 funds
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DCF Child Welfare
◦ Title IV E Waiver
◦ Child Abuse Prevention and Treatment Act
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Title V Children’s Medical Services
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Child Care and Development Block Grant
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IDEA Part C Early Steps
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Home Visiting Programs – Healthy Start and
MIECHV
Federally Qualified Health Care Centers
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KATHRYN SHEA, LCSW
PRESIDENT & CEO
The Florida Center for Early
Childhood
Email:
kathryn.shea@thefloridacenter.
org
www.thefloridacenter.org
(941) 371-8820 ext. 1043
CELESTE PUTNAM
FSU Center for Prevention and
Early Intervention Policy
cputnam@cpeip.fsu.edu
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