Case Study: State of Missouri, Department of Social Services, Division of Youth Services

State of Missouri, Department of Social Services, Division of Youth Services (DYS)

Medicaid Residential Rehabilitation Review March 2004 – June 2009

For years, the Missouri Department of Social Services had been receiving Medicaid reimbursement for providing Rehabilitative Services to foster care children under the Children’s Division (CD), but received no reimbursement for similar services provided to juvenile justice committed youth in the care of DYS because of limitations in its Medicaid State Plan. Beginning in 2001, the federal Centers for Medicare and Medicaid Services (CMS) had been increasingly restricting states’ ability to expand Medicaid programs for children in state custody, so the prospects for DYS to do so were uncertain.

PCG Human Services assisted Missouri to develop and submit amendments to Missouri’s Medicaid State Plan Attachments 3.1A and 4.19B to include “Rehabilitative Behavioral Health Treatment Services for Youth.” The amendments defined the allowable components of the service, provider qualifications, and the population receiving the service, along with the payment rate development methodology. After submission of the state plan in 2004, PCG Human Services spent the next three years assisting DSS to respond to questions from CMS before approval. To ensure that the Medicaid program was implemented with the highest possible level of federal compliance, PCG Human Services also reviewed treatment provider documentation supporting services, conducted a time study and cost analysis to develop Medicaid reimbursement, and developed new Medicaid billing procedures and systems.

In 2008, CMS approved the State Plan Amendment for “Rehabilitative Behavioral Health Treatment Services for Youth” retroactive to 2004. In the first Medicaid claim for DYS services, PCG helped DSS achieve $14.7 million in Federal Financial Participation (FFP) for retroactive service reimbursements between October 2007 and August 2008.