Scott WalkerGovernor

1 WEST WILSON STREETPO BOX 7851

MADISON WI 53707-7851

Linda SeemeyerSecretary

State of WisconsinTelephone: 608-266-0036

FAX: 608-266-2713TTY: 888-241-9432dhs.wisconsin.govDepartment of Health Services

Children’s Long-Term Support (CLTS) CouncilMeeting Minutes

Wednesday, July 12, 20179:30 am to 3:00 pm

LaQuinta Inn & Suites, Madison

Council Members Present: Liz Hecht (Chair); Naomi Beahm; Patti Becker; Charity Eleson; Dan Idzikowski; Joanne Juhnke; Barbara Katz; Kirsten Menningen; Jo Pelishek; Angela Radloff (for Lynn Green); Lisa Stephan; Sandra Tierney

Council Members participating by phone: Sharon Fleischfresser; Walt Schalick; Melanie Fralick;

Council Members Absent: Nissan Bar-Lev; Cheryl Berg; Jonelle Brom; Pilar Guzman; Wendy Heyn; Darsell Johns; Jeff Muse; Connie Sherd; Melissa Stoltz; Beth Swedeen;

Special Guest Presenters: Pam Appleby (DHS); Robin Cooper (NASDDDS); Mitch Hagopian (DRW); Lori Weaver (Brown County);

WI DHS Council Staff: Curtis Cunningham, Deb Rathermel, Autumn Knudtson, Nancy Bills, Gary Roth (Audio Visual Technician)

Other DHS Staff Attending: Victoria Casola; Terri Enters, Lisa Goldsberry, Jill Groblewski; Andrea Jacobson; Dan Kramarz, Kelsey Mueller, Sam Ninnemann; Kim Pertzborn; Amy Pulda; Emma Schaeffer; Alice Thorsen; Maddie Valent (Remotely); Alyssa Zirk

Public Attendees: Connor Nikolay (WFT); Leila Solati (Ozaukee County); Katy Morgan (Parent)

1. Welcome - Introductions – Updates – Liz Hecht, Chair (Meeting started at 9:35 a.m.) Council members and Department of Health Services (DHS) staff introduced themselves and went

over the agenda. Liz H. requested that the Council Business be taken up later on the agenda. No objections.

She explained that the morning agenda would be to hear from five speakers on EPSDT and the afternoon would be for discussion of committee recommendations to be drafted and forwarded to the Department of Health Services Secretary on this issue. EPSDT/Health Check WI provides services under the card rather than through the waiver.

2. DHS Updates – Deb Rathermel Presented a Department of Health Services (DHS), Division of Medicaid Services update including the

new organizational chart and additional details outlining division-wide changes. The Children’s long term support waiver renewal was approved in the spring and the agency is now working on implementing the rule. The disability determination in the children’s waiver has also been discontinued. Thank you to Sam Ninnemann for her work on this important issue – a fact sheet on this is being developed. Today’s EPSDT discussion is timely. There formerly was a restriction that included a residency requirement (for 6 months) prior to eligibility which is not part of the new waiver program.

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3. National Perspective on EPSDT – Lee James, Policy Analyst NHelP (North Carolina) –Went through his presentation handout: Medicaid’s Early and Periodic Screening, Diagnostic and Treatment Benefit (June 12, 2017) – Presentation attached

4. EPSDT Services for Children – Often an Untapped Resource – Robin Cooper (NASDDDS) – Presentation attached

5. Wisconsin County Experiences with EPSDT – Lori Weaver (Brown County Health and Human Services). No written presentation. From the County perspective, we try to support family’s needs and appeal/ask for assistance

from the State Department of Health Services CSS (Children’s Services Specialist) staff when necessary.

Gave multiple examples where services were needed but not allowed, so appeals were filed.

6. Wisconsin Family Experiences – Mitch Hagopian, Supervising Attorney, Disability Rights Wisconsin (DRW) – Attached copy of his DRW Testimony before the Assembly Committee on Health Regarding Medicaid Prior Authorization Practices and Oversight of Physical, Speech and Occupational Therapists.

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7. Wisconsin State Plan – Pam Appleby, Associate Director, Bureau of Benefits Management, Department of Health Services -- Presentation Attached

ADJOURNED FOR LUNCH at 12:10

8. Liz H. opened the afternoon session MOTION: Liz offered a motion, seconded by Barb K., to approve the April 12, 2017

meeting minutes. No changes, Motion approved unanimously.

9. General Questions/Comments/Observations/Suggestions – Need an independent review process for pediatric prior authorizations up to age 21 and a

separate system for those over age 22. Take into consideration the developmental needs of the children.

Better informational contact system and share knowledge at all levels of the process. What happens in WI is what the law requires – access to EPSDT screening. Awareness on the part of providers and their families. All of these cases should be adjudicated for all children eligible under the Medicaid system. If the total process takes more time than 30 days, it automatically should be approved. The right care for the right child (look at developing language regarding that). Rewrite the definition of medical necessity We need not just an independent review but the right kind of person to do the review.

Expertise for review has to be well-matched to the review area or topic and any quality improvement intervention you need to circle back in a year or two and reassess what we are doing. Is it right or not. Use a metric.

Look at if it’s being requested, is it really needed or is it outside of what is being covered already. Should it be easily expedited or ask more information why it is needed? Is it tied to the presumption on whether or not approval is presumed or not? What is the burden for denial?

We need to train the adjudicator on the burden being more around “is it within what can be provided” and “is it grossly outside of the norm” of what is currently being provided.

Is “experimental” always a reason for denial? Is this the right service for this child, or is it outside of the service definition?

Is there a way to change the dynamic of an underlying presumption that the service provider is somehow benefitting financially?

Core service was service coordination or case management (every family receives help). Kids who meet level of care through the Katie Beckett Program, SSI, Badger Care or Birth to

3 Program – those PAs (include Care4Kids in Foster Care) could be reviewed through an expedited process. Once medical necessity was established the PA review should be reduced.

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Let the State make some assumptions. What would be the “stop gap” or assurance that you are not over-authorizing? Use case managers as intermediaries Is the system at capacity? What are the measures of doing it right and if we see anomalies in

those measures, we can look at options at that point, i.e. relative training. This needs to be written in “easy to read language”, for providers and families to navigate

system. Keep in mind physical and mental health (behavioral health) considerations. Is it necessary that all services under EPSDT be reviewed?

10. Next Steps: Meet and draft a set of recommendations including an overview, and identified issue

recommendations. The following Council members agreed to be a part of this steering committee: Patti Becker; Dan Idzikowski; Sandy Tierney; Liz Hecht; Kirsten Menningen; Joanne Juhnke

Steering Committee put together recommendations for discussion at the October 11th meeting Executive Committee could convene prior to the next meeting to discuss Council should draft recommendations to send to the Department of Health Services

Secretary and to the Bureau of Children’s Services. Ask Pam Appleby for a potential eligibility for EPSDT; getting other services; what is the

population and universe? Use this information to preface the report and recommendations

11. Next Meeting: October 11, 2017, at the Holiday Inn at the American Center, Madison, WI

12. MOTION to adjourn made by Dan I. and seconded by Jo P., passed unanimously. Meeting adjourned at 3:00 p.m.

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