Re: Medicaid - how can I help?

[Guest guest]

In regard to the proposed Beckett Premiums everyone can continue to contact their legislators and the Governor. Thanks, Heidi Fernandez

[Guest guest]

Would you mind letting people know where they can find the telephone numbers for their Governors or legislators?

In regard to the proposed Beckett Premiums everyone can continue to contact their legislators and the Governor. Thanks, Heidi Fernandez

[Guest guest]

Would you mind letting people know where they can find the telephone numbers for their Governors or legislators?

In regard to the proposed Beckett Premiums everyone can continue to contact their legislators and the Governor. Thanks, Heidi Fernandez

[Guest guest]

Would you mind letting people know where they can find the telephone numbers for their Governors or legislators?

In regard to the proposed Beckett Premiums everyone can continue to contact their legislators and the Governor. Thanks, Heidi Fernandez

[Guest guest]

There have been several posts about who to contact. Please see the most current information.

Thanks, Heidi Fernandez

Dear Advocates- I know there has been some very disturbing news take place today regarding a "banner message" that was sent out to Medicaid Providers from Dept. of Community Health (DCH) regarding a new limit to speech, occupational, and physical therapy.

I wanted to make sure that we got confirmation to what exacting DCH is doing prior to sending out a notice. After discussion with Mr. Mark Trail (DCH-Chief of Medical Assistance Plans) via phone, he did agree to respond to an e-mail clarifying exacting what was meant by the message (SEE BELOW HIS RESPONSE).

He did state that a child CAN RECEIVE ADDITIONAL THERAPY (more than the 20 units/month = 5 hours/month)IF PRIOR AUTHORIZATION OCCURS. He also stated that the therapy rate has NOT been effected.

He did state on the phone that DCH viewed this as a "change in policy" and "not a reduction of services". I don't know if I agree with that BUT THE BIGGER ISSUE IS THAT WE NEED TO MAKE SURE THAT THEY ARE HELD ACCOUNTABLE FOR NO

INTERRUPTION OF THERAPY SERVICES AFTER 4/1/04 DUE TO THIS NEW QUALIFICATION PROCEDURE AND OUR PROVIDERS ARE PAID CORRECTLY FOR SERVICES!

If you have any further questions, you can contact Mark Trail at MTrail@... or Shirlene Adam Hurt at shurt@... (I've been told she is the one that put this together based on a plan in AL).

Also earlier today, I was told that.......These "policy changes to DCH" are not a result of the proposed restoration of the Beckett Waiver funds in either the Supplemental and General Budgets. Two different issues... budget verses policy change.

Thank you again for our wonderful network of advocates. It does help that we are keeping each other aware of these situations and communicating it out to everyone. (I think even DCH was surprise by our knowledge of the subject). We are watching and advocating for our children! Keep up the great work!

If you have any further questions, please let me know.

Sincerely,

Heidi J.

(Mother to -4 years old with Down syndrome and - 2 years old)

"Help The Children Now, So They Can Help Themselves Later ! " ---------------------- Forwarded Message: ---------------------

To: "'heidijmoore@...'"

Cc: Tim Burgess

Subject: RE: Medicaid - Therapy Clarification from DCH

Date: Wed, 10 Mar 2004 18:31:07 -0500

I appreciate the opportunity to clarify the Department's intent on this

matter. As I explained, the DCH has seen an increase in children served by

these services of about 35% since Fiscal Year 2000, yet the cost has

increased over 300%. It is reasonable that the DCH conduct medical review

(prior authorization) when a requirement exists to exceed a normally

expected number of hours of care. Children requiring more than a normal

number of hours will be able to receive that care with prior authorization.

DCH has instructed the vendor that handles this function to expect an

increase in volume. They will be expected to meet the timeliness standards

contained in the contract. The request for prior authorization must come

from the appropriately qualified medical professional providing the service,

as with requests for prior auth in any other program.

The DCH has not proposed reductions in the therapy rates.

I hope this is helpful. I will be happy to answer any other questions you

may have.

Mark Trail, Chief

Medical Assistance Plans

Voice

Fax

Medicaid - Therapy Clarification from DCH

Dear Mark- As we discussed on the phone, many parents and advocates and

therapists are concerned about the "banner" message that was sent out today

from the DCH regarding a new limit of 20 units / month of speech,

occupational and physical therapy starting 4/1/2004.

Could you please clarify a few questions that have come about due this

message being sent out to Medicaid providers ?

A. Please clarify that if a child needs more than the limit of 5 hours (20

units/month), the child can receive more if pre-qualification with DCH

occurs?

How does the DCH plan on handling the excess requests for additional therapy

services? Since this will take effect by 4/1/04, how can we/parents be

assured that there will be no interruption of therapy services after 4/1/04

due to this new qualification procedure?

How will the new qualification for additional therapy services work? Who do

we contact to verify our child will qualify?

B. Please verify that there will be NO reduction in rates to therapy

services provided for our children. The concern has been all along that if

the DCH continues to reduce the reimbursement rate, we will no longer be

able to find providers for those services. We want to make sure that thisis JUST a REDUCTION IN THE NUMBER OF ALLOWED units/month (withoutpre-qualification) and NOT a further REDUCTION IN RATES AS WELL.Thank you in advance for responding to this e-mail. As you can imagine, weare concerned about the communication that has taken place with the DCH andwant answers to our questions. Communication is the key to success inworking through our issues and parents and advocates just want to beinvolved in the process!SincerelyHeidi J. (Mother to -4 years old with Down syndrome and - 2 years old) _____________________________________________________________________________(This is the "banner message" that was issued out to Medicaid Providers today)Dear Medicaid Provider: There are several changes to the Children’s Intervention Services program that are effective 4/1/2004. The time associated with Procedure Code 92507 has been eliminated to reflect the accurate HIPPA definition; therefore, one (1)-unit equals one (1) visit. The allowable units for the fifteen (15) minute procedure codes have changed. The new limit will be 20 units per month or a combination of 20 units per month. Occupational and Physical therapy reevaluations will be limited to 1 per 6 months. Please review Part II, Policies and Procedures, Chapter 1000 in the April 2004 manual for all changes in the maximum allowable units. Also, providers will be notified when to implement the new HIPAA codes via Banner Message. Thank you for participating in the Medicaid program. Sincerely, Department of Community Health