Nevada proposes Part C early intervention payment model change; providers warn of disruption
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Summary
A DHS budget item would change how early intervention providers are paid: move from a state-upfront payment model to an insurance-first billing approach with a state supplement for nonbillable services. DHHS said the shift addresses compliance and will free federal match; some providers told lawmakers billing capacity and cash-flow are barriers.
The Division of Aging and Disability Services (ADSD) proposed changing the state's Part C early intervention payment model from a state-upfront payment structure to an insurance-first billing system with state supplements for non-billable services.
ADSD Administrator Dina Schmidt told the committee the existing model pays providers in advance and then requires providers to bill Medicaid or private insurance and return state dollars as appropriate. "That is actually against the Medicaid payment rules," Schmidt said, and ADSD staff said the current approach also conflicts with Office of Special Education (Part C) guidance and leaves the state out of compliance.
Under the proposed change, providers would bill Medicaid and private insurers first and ADSD would pay a supplemental amount for services that are not billable. ADSD said the division already implemented a data and billing system to enable the change and has begun training and outreach.
Several providers and advocates warned the panel that many early-intervention providers are small businesses without administrative capacity or the working capital to wait months for insurance reimbursement. "We receive denials and sometimes we never reach reimbursement," an early-intervention stakeholder said during public comment on related items. Committee members pressed ADSD and DHHS for transition supports, training and a timeline to prevent service interruptions.
ADSD officials said they intend to preserve the nonbillable supplemental payments and to offer technical assistance, but acknowledged enrollment, billing and claim-denial processes will need active support. The department pointed to a December 2023 launch of a billing-ready data system intended to reduce provider burden.
Ending: The subcommittee asked ADSD and Medicaid to provide an implementation timetable and to quantify transition supports so lawmakers can weigh the fiscal and programmatic trade-offs before approving the budget change.