Thanks to the work of M/CH advocates across the state, the Department of Community Health budget included a tremendous amount of language devoted to our issues, particularly in the area of prevention. Work is yet to be done, however, to assure implementation of new policy.
Steps for Advocates
Federal Abstinence money expended for the purpose of promoting abstinence education shall provide abstinence education to teenagers most likely to engage in high risk behavior as their primary focus, and may include programs that include 9 to 17 year olds. Programs funded must meet all of the following guidelines:
A. Teaches the gains to be realized by abstaining from sexual activity.
B. Teaches abstinence from sexual activity outside of marriage as the expected standard for all school age children.
C. Teaches that abstinence is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other health problems.
D. Teaches that a monogamous relationship in the context of marriage is the expected standard of human sexual activity.
E. Teaches that sexual activity outside of marriage is likely to have harmful consequences.
F. Teaches young people how to avoid sexual advances and how alcohol and drug use increases vulnerability to sexual advances.
G. Teaches the importance of attaining self-sufficiency before engaging in sexual activity.
(2) Coalitions, organizations, and programs that do not provide contraceptives to minors and demonstrate efforts to include parental involvement as a means of reducing the risk of teens becoming pregnant shall be given priority in the allocations of funds.
Many local coalitions feel that these requirements will limit the ability of local coalitions to reach the targeted audience successfully.
1,300,000 allocated to early childhood collaborative secondary prevention. This is new money within the MDCH Budget that will be used in conjunction with money set aside within the Family Independence Agency (2 million) and Department of Education Budgets (2 million) for the purpose of "community based collaborative prevention services." These services will be targeted toward children ages 0-3 that are at high risk for abuse. After 2 years of preventive funding in the FIA and DOE budgets, DCH has begun to contribute to the fund.
Local health departments shall provide preschool hearing and vision screening services and accept referrals for these tests from physicians or from Head Start programs in order to assure all preschool children have appropriate access to hearing and vision screening. Giving Head Start as well as physicians the ability to refer children to local health departments for these tests is a positive step toward health care access for pre-school aged children from low-income households.
This section articulates that health plans have full responsibility for MSS/ISS and EPSDT, and that this responsibility must be stated in consumer materials.
MDCH is charged with developing and implementing a "budget neutral enrollment based incentive program" for qualified health plans, to encourage delivery of MSS/ISS and EPSDT.
The language does not specify exact numbers that health plans must report to be eligible for enrollments.
The language does describe that health plans will refund to the department any unexpended MSS/ISS capitation below the fee for service equivalent MSS/ISS capitation in fiscal year 1996-1997.
Note to Advocates
This language comes close to the policy the Council advocated for during the budget process. We recommended that payments be tied to performance and separated into a shadow capitation rate for prevention services - i.e. "use or lose" the money.
The Legislature stated that the MDCH shall continue to convene a workgroup on EPSDT and MSS/ISS whose responsibility would be to, at least, establish an outreach program to educate providers on EPSDT components, and advise the Department on providing targeted assistance to health plans providing less than 60% of EPSDT and improve access to MSS/ISS.
Listed participants: consumers, advocates, health care providers and health plan representatives.
Note to Advocates:
This workgroup began its work last year, after the urging of many advocates and the Legislature, and made a report to the Legislature this spring. However, no mention of this report has been made and the workgroup was limited in its makeup and assigned tasks. Advocates must remain persistent in calling for real progress from this group, and recommend that Legislators review their work and subsequent MDCH action regularly.
Here, the Department is charged with the following concerning EPSDT and MSS/ISS:
Develop uniform definitions for EPSDT and MSS/ISS screening, services and referrals with a workgroup made up of the MI Association of Health Plans, representatives of qualified health plans, the MI Association of Local Public Health, MI State Medical Society, American Academy of Pediatrics, and MI Osteopathic Association. (The Council has been assured it will also be part of this group)
Explore the feasibility of developing a uniform encounter form for EPSDT services, MSS/ISS referrals, and MSS/ISS screening and services.
Require the evaluation of 100% of pregnant Medicaid women for MSS/ISS screening referral during initial visit.
Report to MDCH and local health department all MSS/ISS screening referrals and Medicaid clients who miss MSS/ISS appointments.
Prohibit qualified health plans from requiring prior authorization for any EPSDT screening and diagnostic service, for MSS/ISS screening referral, or for up to three MSS/ISS service visits.
Coordinate MSS/ISS with WIC, substance abuse, smoking prevention, violence prevention, FIA programs, and other programs focusing on preventing adverse birth outcomes and child abuse and neglect.
Note to Advocates
The Council hopes this language will foster better coordination of services for pregnant women and children, and remove some of the barriers to access. Professionals and advocates should try to partner with the plans as they try to comply with these efforts.
This section calls for an external quality review of qualified health plans, citing 12 maternal and child health data categories. These include:
Note to Advocates:
This review must be completed and delivered to the Legislature by February 1, 2000. This activity can be helpful in improving the Medicaid program. Advocates need to assure that the Legislature remains aware of progress and problems between now and February.
Qualified health plans must contract with local health departments to provide outreach services to Medicaid enrollees for those referred for MSS/ISS or EPSDT services, or those with missed appointments. Local health departments must notify the department of any Medicaid enrollees not participating in a qualified health plans.
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