Coverage of Maternal, Infant, and Early Childhood Home Visiting Services Wednesday, November 9, 2016 3:00-4:30pm ET Please call in: 1-877-918-6628 Passcode: 3925405 You have the option to either call-in or listen through computer speakers Sign-In Link: https://hrsa.connectsolutions.com/hrsa-cms_national_webinar/ Supported by the Health Resources and Services Administration through the Alliance for Innovation on Maternal and Child Health: Cooperative Agreement Expanding Access to Care for the Maternal and Child Health Population 1
Agenda I. Welcome, Introductions, and Webinar Logistics Karen VanLandeghem, Senior Program Director, NASHP II. Federal Efforts to Advance Evidence-Based Home Visiting Programs and Services David Willis, MD, Division Director of Home Visiting and Early Childhood Systems, MCHB, HRSA III. Home Visiting Services – Opportunities for Medicaid Coverage Marguerite Schervish, JD, Technical Director, Division of Benefits and Coverage, CMS, CMCS IV. Questions and Discussion V. Medicaid and Home Visiting Learning Network: Summary and Lessons Kay Johnson, President, Johnson Group Consulting VI. State Strategies and Approaches to Covering Home Visiting Services William Camp, MHA, South Carolina Department of Health and Human Services VII. Questions and Discussion VIII. Wrap Up David Willis, MD, MCHB, HRSA Marguerite Schervish, JD, CMS, CMCS Karen VanLandeghem, NASHP 2
Evidenc Ev ence e Ba Based Ho Home Vi Visiti iting: ng: An An Ov Overv rview iew of Ke Key Resour urce ces s and Oppor ortun tunities ities for Medica caid id En Engageme ment nt Federal ral Effor forts ts to Advance nce Evidence nce-Base Based d Home Visiti ting ng Program rams s and Servi vices ces Novem vember ber 9, 2016 16 David vid W. Willis, is, MD Direc rector tor, Home me Vi Visiti iting ng and d Ea Early ly Childhood ldhood Sy Syst stem ems Materna ernal and d Child ld Heal alth th Bure reau au (MCH MCHB) B) Heal alth th Reso sources rces and d Serv rvices ices Administra inistration ion (HRSA) RSA) 3
Th The Fe Federal deral Home me Visiting iting Program gram Legisl islati ative ve Au Authori ority ty and Ap Appropri priati ation on • Afford ordable able Care Act of 2010 $100M FY2010 $250M FY2011 $350M FY2012 $379.6M 6M FY2013* $371.2M 2M FY2014* • Protec tecting ting Acces cess s to Me Medicare care Act of 2014 2014 $400M FY 2015 • Medica care re Acce cess ss and CHIP Reauth uthorizati rization on Act (MACRA) RA) of 2015 2015 $400M FY 2016 $372.4M 4M FY 2017* *Reflects the sequestration reduction. 4
Th The Fe Federal deral Home me Visiting iting Program gram • Suppor ports ts Famili lies es • Evidence based parent support services to address family needs • Partnership between parents and home visitors • Volunt untary ary • For families that ask to be empowered with better knowledge, health and parenting • Evid idenc ence-base based • Built on four decades of rigorous research and evaluation • Includes a rigorous national randomized controlled trial evaluation and local evaluations • Models that meet HHS criteria for evidence of effectiveness 5
The Feder deral al Home me Visiting iting Program gram • Po Positiv tive e Return rn on Inve vest stmen ent t • HV prevents child abuse and neglect, encourage positive parenting and promotes child development and school readiness • Long term reduction of school drop out, teen pregnancy and crime • Local ally ly desig igne ned d and run • Provides states with maximum flexibility to tailor programs to fit needs of different communities • States and territories can choose from the models that meet the HHS criteria for evidence of effectiveness that are eligible for program funding • Programs run by local organizations 6
Th The Fe e Fede deral al Ho Home me Vi Visitin iting g Pr Prog ogram am A t A tiered red-ev evid idenc ence e and place ce-bas based ed strate ategy gy • Pr Program ams s are in all 50 state ates, s, DC and five ve territ ritor orie ies s and 787 counti nties es (2015) 5) • Pr Program ams s have e provid vided ed nearly rly 2.3M M home visi sits ts since ce star art t of progra ram • In 2015, , state ates s reporte rted d servi ving ng 145,56 ,561 1 parents nts and child ldre ren. n. 7
Th The Fe Federal deral Home me Visiting iting Program gram Provide ovide volun luntar tary, y, eviden idence ce-base sed hom ome e visiting siting services rvices to improve mprove • Prenatal, maternal, and newborn health • Child health and development, including the prevention of child injuries and maltreatment • Parenting skills • School readiness and child academic achievement • Family economic self-sufficiency • Referrals for and provision of other community resources and supports 8
Fa Fami milies es Populati ation ons s Served ed in 2015 Priority rity Populati ations ns • Low-income families • 79% of families < 100% federal • Pregnant women under age 21 poverty • Families with a history of child abuse or • 48% of families < 50% federal neglect poverty • Families with a history of substance abuse • 69% did not go to college • Families that have users of tobacco in the • 68% minority home • 27% of newly enrolled pregnant • Families with children w/low student teens achievement • 20% of newly enrolled with history • Families with children w/ DD or disabilities of child abuse and neglect • Families with individuals who are serving • 12% of newly enrolled with history or have served in the Armed Forces, of substance abuse including those with multiple deployments 9
Ev Eviden ence ce-Ba Base sed d Models ls State te Grante ntees es Selection ction of Home Visiting iting Models ls for FY 16 Evidence Based Model Number of States Implementing Healthy Families America 36 Nurse-Family Partnership 39 Parents as Teachers (PAT) 35 Early Head Start 15 Home Instruction for Parents of Preschool Youngsters 6 (HIPPY) Family Spirit 4 Child First 1 Health Access Nurturing Development Services (HANDS) 1 Program SafeCare 2 Family Check-up 1 Family Connects (pilot) 1 10
The Fe Th e Fede deral al Ho Home me Vi Visitin iting g Program m Growt wth Number of Counties with Federal Home Visiting Program Services (2010-2015) Number of Participants 160,000 1,000,000 894,347 Number of Home Visits 145,561 140,000 900,000 800,000 120,000 115,545 746,303 700,000 100,000 600,000 80,000 75,970 500,000 489,363 60,000 400,000 40,000 300,000 34,180 200,000 20,000 174,257 100,000 0 0 2012 2013 2014 2015 2012 2013 2014 2015 11
Th Three ee Ty Types pes of f Measurement asurement • Perfo form rmanc ance e & Resul ults ts Acco count untabi ability ity • Perfo form rmanc ance e reporti rting ng • Eval aluat uatio ion n and Resear earch ch • MIHOPE E and MIHOPE-SS SS • Home me Visiting siting Resea earch rch Netwo work rk (HVRN) N) • Grantee tee-le led d Eval aluat uatio ions ns • Multi ti-site site Implem ementa ntatio tion n Eval aluat uatio ion n of Tribal al Home me Visiting siting • Quali lity ty Improv ovem ement nt • Home Visitin siting g Colla labor borative ative Innov ovati ation on and Improv ovement ent Network ork (HV CoIIN IN) 12
New w Performance formance Measures sures Performance Measures Benchmark Areas I. Maternal and Preterm Birth; Breastfeeding; Depression Screening; Well-Child Newborn Health Visit; Postpartum Care; Tobacco Cessation Referrals II. Child Injuries, Safe Sleep; Child Injury; Child Maltreatment Maltreatment, and Reduction of ED Visits III. School Readiness and Parent-Child Interaction; Early Language and Literacy Activities; Achievement Developmental Screening; Behavioral Concerns IV. Crime or IPV Screening Domestic Violence V. Family Economic Self- Primary Caregiver Education; Continuity of Insurance Coverage Sufficiency VI. Coordination Completed Depression Referrals; Completed Developmental and Referrals Referrals; IPV Referrals 13
The Feder deral al Home me Visiting iting Program gram A A new stan anda dard rd of care • Focusing on improving health care and access for mothers, children and families • Increasing child developmental screening and referral • Increasing Maternal depression screening, referral and support • Monitoring child safety and risks for child abuse and neglect • Providing parenting support and education • Providing at-risk families with linkages to needed community supports 14
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