May 2007 Update

Many of you are aware that BCW has been in the process of making changes to their model for several years. In the past few months BCW has held two "stakeholder" meetings, both two day long meetings. I was invited to attend those meetings as a GOTA/Trialliance representative. Both before and during the meetings I was in touch with Debi Hinerfeld, GOTA President, and other OT's across the state for ideas and suggestions.

At the beginning of the first two day meeting there was a great deal of discussion about medicaid, CMO's and rising costs of the program. It became clear that changes had to be made to the program for it to be sustainable.

In light of that we were broken into small groups and asked to review all aspects of the program and make some recommendations. At the end of the first two day meeting some general recommendations were made and the state BCW staff took these to review. We did not have a clear understanding of what, if any, changes would be made.

A smaller group was then invited back to another two day meeting to dicuss more specifics of the program. We were again broken into smaller groups, but with more specific tasks. I was in the "service delivery" group. Our task was to discuss models of delivery and make recommendations that would be financially feasible and would serve the children and families in the program. There were four EI coordinators, a special instructor, two parents, a PTAG representative, BCW staff and others on this group. As you can imagine there was lively discussion over the two day period. As the GOTA/Trialliance representative my position was to support OT's and the children and families we serve. Our position at the meeting was that children should be fully evaluated and if a therapist is needed to meet the needs of the child, then therapy should be recommended. We also felt that if the skills of a therapist are not necessary then other staff, such as special instructors, should be used. We presented that the evaluation phase is crucial to determining "why" a child has a delay and is in the BCW program and therefor what services should be provided. As part of this process, who does the evaluation and how it is done is crucial to determining this and should be the appropriate professional given the delays the child is experiencing. We presented the ethics and challenges providers face with billing for services and what is necessary in order to bill both insurance and medicaid. There was a great deal of discussion about documenting medical necessity so that services would be reimbursable by insurance companies and medicaid. We discussed how the IFSP is written, what is in the IFSP, diagnosis codes and treatment codes used and how all of these relate to the services provided. There was discussion about the current models being used, both traditional and coaching. We discussed the advantages and challenges of both of these and other models. The group felt that a team approach that addresses the individual needs of each child was most effective and feasible. There was also agreement that no one model is effective with every child, so individualization and flexibility are key to success.

There were several other small groups going on at the same time, including groups looking at the "front door" which is how children enter the BCW program, service coordination, and financing. At the end of this two day meeting, BCW staff again took all the recommendations of the different groups back to discuss and make some very tough decisions.

Since then myself, Terrie Millard from PTAG and Jennifer McCullough from GASHA were asked to meet with Paula Forney and Martha Okafor to discuss issues related to therapy in the program. We were asked for evaluation information, which I posted a request for on this listserve. We were also asked about ideas for making the IFSP a more functional document that would reflect medical necessity of services. There was discussion about how the team approach might be implemented using a primary service provider to lead the services for a child and how the IFSP can be a flowing, usable document to meet the needs of BCW documentation, billing to third parties and identifying goals and services for a child. We discussed with them that if therapists are to take on additional roles that these must be well delineated to make clear what services are "direct therapy" and therefor billable to third parties as OT and what are "coordination and documentation" and therefor not billable to third parties as therapy. We also discussed that any additional role, such as coordinating service, providers were asked to take on must be compensated fairly.

I realize this doesn't give you a lot of specifics, but right now we are waiting to hear more from BCW on the specifics. There are a lot of rumors, I would suggest waiting for specific information from the state BCW office before taking any action or making any decisions. GOTA will continue to monitor this and advocate for OT's and the children and families we serve.

If you all want to post specific questions I'll be glad to answer what I can. There is so much information typing this is difficult.