Fwd: URGENT: Advocacy Needed - DCH Board Meeting July 13, 2006

[Guest guest]

Please share this important information regarding Medicaid with other

families.

Thanks.

July 12, 2006

Dearest Advocates: (PLEASE NOTE: May want to print out this long e-mail)

It has been brought to my attention that the Dept of Community Health (DCH) is going to have a board meeting TOMORROW, July 13th in Blue Ridge, GA where we can express our concerns! (Please note: This is a change of location....The meeting will NOT be at the Twin Towers/Sloppy Floyd Building downtown Atlanta)

If you are a parent or provider/therapist that would be impacted by the proposed prior authorization system DCH is looking to implement in September or if you are having problems getting therapy due to being in a CMO (that is not the case for children that have the disability waivers including Beckett Waiver).....we need you!

Please try to attend to express your concerns as parents and therapists! Many of you have asked....how can I help....Well NOW is your chance. I realize that it is not a convenient location but DCH needs to hear from both parents and providers/therapists concerns.

Here are some quick suggestions if you can attend:

1. Make your speech short and to the point (2-3 minutes). You can type out your entire speech and read it, if you feel more comfortable doing it that way.

2. Prepare a one page summary of your concerns to be handed out to the committee and media. (For parents: include a picture of your child...puts a face to the situation!).

3. Sign up to speak when you arrive.

4. Please contact Deborah Bevelle at (404) 656-4507 or dbevelle@... if you have questions or want additional information about this meeting.

5. General Information: The Thursday, July 13, 2006 Board of Community Health meeting will be held at 12:00 noon in the Community Room, Appalachian Community Bank, 150 Orvin Lance Connector, Blue Ridge, Georgia 30513.

6. Here are directions:

DIRECTIONS TO APPALACHIAN COMMUNITY BANK

Community Room

150 Orvin Lance Connector

Blue Ridge, GA 30513

(706) 258-4000

From Atlanta:

Distance (approx.)

I-75 to I-575 20.4 miles

I-575 becomes Highway 515 around Jasper 70.5 miles

You will travel through Cherokee, Pickens and Gilmer Counties.

Blue Ridge is in Fannin County.

Once arriving in Blue Ridge, go through several intersections.

Landmarks:

-The first intersection is June on right.

-Mcs is on the left of second intersection.

-’s is on the right of third intersection.

After passing KFC on the right, you will start down hill. When you start going uphill you will see the bank on the right. It’s a large red brick building. You will come to a red light and CVS will be on the right and Taco Bell on the left. Take a right on Orvin Lance Connector.

The Appalachian Community Bank (Community Room) is your second right next to CVS.

Distance: Approximately 92.88 miles

Drive Time: Approximately 1 hour, 36 minutes

======================================================

Here is a summary of the situation based on my previous advocacy alerts in the last few weeks...It has been brought to my attention that Dept.of Community Health (DCH) continues to look for ways to reduce their costs (but not necessarily looking at the children's needs, nor the effects on our Medicaid providers).

Recently, DCH announced plans to: implement a "gatekeeper" model for the Aged, Blind and Disabled (ABD) children. The Trialliance (the OT/ST/PT association that are working together to deal with these issues as they come up) met with DCH this week. DCH plans to change the "threshold" of visits for the ABD group of children to a total of 5 units per month for a "single" therapy service. This means each discipline (ST, OT, PT) will be able to bill a total of 5 units each month (currently it is a max of 10 for non-timed codes and 20 for timed codes). If the therapist feels the children need more therapy they can submit a "prior approval" (same process as is in place currently) which will be reviewed by Georgia Medical Care Foundation (GMCF). This would mean that a child will only be allowed approx. 1 PT and OT session / month! and only 2+ ST sessions / month! This is not acceptable! Our families have already been put thru enough due to difficulties with the eligibility criteria, if a child is approved we should not have to fight another battle of Medical Necessity for therapy.

It is my understanding that PT and OT are billed as 1 unit = 15 minutes. Therefore 4 units = 1 hour (this is how I came up with approx. being allowed only 1 hour of PT/OT per month without a prior approval).

The speech coding is more complex: For 92507 speech code, 1 unit =1 visit. For speech you can bill 3 units if you are doing speech, feeding and SI (sensory integration) so then you would only have 1 visit just like PT and OT. The 92507(speech) and the 92526(feeding) codes are just allowed 1 unit=1 session(that is why our rate was cut in half...it used to be 1 unit=30 minutes so you could bill 2 units of 92507...no more). The SI code is timed and 1 unit = 15 minutes. To summarize, speech is all over the board. If you are just seeing a child for speech, you could get 5 sessions. If you bill speech and feeding, 2 sessions, speech and feeding and SI would be 1 session. ST is billed at 1 unit = 30 minutes. Therefore 2 units = 1 hour (therefore you would approx be allowed only 2 hours of ST per month without a prior approval).

DCH said this review would be approved based on "medical necessity" guidelines. DCH also attempted to further limit children who had multiple therapies, however the Trialliance discussed the major problems with this and they said they would reconsider this limitation. The time frame for this implementation is September 1, 2006. (originally DCH had proposed a August 1st implementation)

These proposed therapy requirements will impact both private and hospital therapy for our children. DCH plans on rolling out the changes Sept.1st for private and sometime later this fall for hospital. This will not impact school therapy.

The Trialliance discussed details of how to make the transition easier and specifically informed DCH staff that they were vehemently opposed to this stringent of a program. (AND I CONCUR!)

The bigger issue is that this is unacceptable and something must be done for the therapists and our children! More and more Medicaid providers are not going to accept our children due to the paperwork involved in getting paid by Medicaid. We already have our Pediatricians write the prescriptions for service, therapists submit their progress notes to DCH....WHY do we need another step in the process with paperwork? (especially since one of the items DCH looks for in our application progress for the Beckett Waiver program is if the child has 5 therapy's/week on the DFCS DMA-6A form!)

I'm sorry...but I will not be able to attend due to prior commitments. PLEASE show your support. I hope you find this information helpful.....

UNITED....WE WILL MAKE A DIFFERENCE!

Sincerely, Heidi

--Heidi J. (Proud Mother to - 6 years old with Down syndrome & - 4 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative.