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| How Early and Periodic Screening, Diagnosis, and Treatment Helped Create an ABA Benefit and Support Clinicians in Wisconsin |
| Friday, May 22, 2020 |
| 12:00 PM–3:00 PM |
| To Be Determined |
| Area: DDA/AUT; Domain: Service Delivery |
| CE Instructor: Tabitha Ramminger, M.S. |
| TABITHA RAMMINGER (Wisconsin Medicaid) |
| Description: Federal law requires state Medicaid programs to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for Medicaid members under 21 years of age. The purpose of EPSDT is to prevent, diagnose, and treat health problems as early as possible, before they can grow into bigger problems. In Wisconsin, Medicaid has utilized EPSDT authority to create a comprehensive Behavioral Treatment benefit which allows coverage of ABA services for individuals of all ages and diagnoses. This workshop will inform practitioners on EPSDT and how it was utilized to create a the benefit in Wisconsin. The presenters will provide a detailed overview of the prior authorization process, how medical necessity is determined, and common documentation challenges providers experience. Additionally, the presenters will review how prior authorization has been utilized as a tool to improve ABA services in the state of Wisconsin through a customer service approach of high provider engagement, written feedback, and service authorization foreshadowing with the overall intent to support individuals receiving ABA in Wisconsin. |
| Learning Objectives: Understand EPSDT Federal Law for Insurance Coverage Understand Medical Necessity and how it is applied to service determinations Identify common service authorization errors, and how to submit more efficient authorization requests. |
| Activities: Lecture of background and core material Supplemental materials of core material will be handed out along with resource links. Active group discussions. Small breakout groups with activities to develop treatment goals. |
| Audience: Practicing clinicians who bill insurance - preferably those who serve Medicaid recipients in any state |
| Content Area: Practice |
| Instruction Level: Intermediate |
| Keyword(s): EPSDT, Insurance, Medicaid, Prior Authorization |