http://www.lgtinc.org en-us http://www.lgtinc.org N/A contact@lgtinc.org Sat, 04 Feb 2012 05:49:40 EST 20 http://www.lgtinc.org/articles/236/1/Advocacy-%26-Medicaid-Information-from-Heidi-Moore May 1, 2007   Dearest Advocates:   A few weeks ago I gave a presentation to the Down Syndrome Association of Atlanta that I thought might be helpful to you.  The presentation has years worth of information in it thanks to many people that have worked with me on my advocacy efforts and trying to better understand the system  in order to help my family and thousands of others.    Please remember: I am just an informed parent and not an attorney. If you need legal advice, please contact an attorney. This information should be used for general information only!    In addition, starting the first of the year, I started a consulting business to help families with the Katie Beckett/Deeming Waiver and MRWP application process (as well as education and other advocacy issues for their child)  based on all the experience I have learned in the last 4 yrs of advocating for families and working with DCH/DHR and other non-profit organizations.  If you are interested in this service, please let me know.      In addition this year,  I started working part-time for B&B Care Services, Inc as their Community Relations Manager. For those that don't know- B&B Care Services, they help to provide services to families under the Mental Retardation Waiver Program (MRWP),Independent Care Waiver Program, Community Care Services Program and the SOURCE Program throughout the State of Georgia. Please let me know if you have any questions regarding this company and how I can help you with getting those services via B&B Care Services, Inc.   I must warn you....this is a very long email and you may want to print it out for future reference.   Hope you find this information helpful!   In addition, if you would like to see my previous advocacy email postings, please go to the following website: http://www.lgtinc.org/authors/41/Heidi-J.-Moore?Page=9   United... We WILL Make a Difference! Sincerely, Heidi ============================================ Medicaid Waivers and AdvocacyYour Child Needs YOU! Heidi J. Moore   Parent Advocate for Children and Adults with Disabilities   Proud Mother to Jacob- 7 yrs old with Down syndrome and Jared - 5 yrs old   The material contained in this presentation 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 qualified legal representative.   Agenda •Medicaid - Waivers and Supports. •Tips and Traps. •Networking and Building Alliances. •Advocacy •General Information - Things you should know!   Medicaid  Medicaid is a federal entitlement program of medical assistance for people of low-income who are: •Age 65 and older; •Blind or have other disabilities; •Children; •Pregnant women; •and families with children.   Medicaid Basics •Funding for Medicaid comes from both state and federal dollars. •Each state's Medicaid program is unique. (must be in compliance with federal guidelines.) Medicaid Eligibility •Individual must meet both "categorical" and "financial" requirements. •In Georgia, the following categories of people are eligible for Medicaid: •Parents and children, •Pregnant women and infants, •Children through age 18, and •The aged, blind and disabled   •In Georgia, SSI recipients are  automatically eligible for Medicaid.   What is the Katie Beckett / Deeming Waiver ? •Category for Medicaid eligibility based on the Tax Equity & Fiscal Responsibility Act (TEFRA) 1982. •State's are allowed to make Medicaid available to a child with a disability if: -18yrs old or younger, AND -Meet federal criteria for childhood disability, AND -Meet institutional Level of Care, AND -Can safely be served at home, AND -Cost does not exceed the applicable institutional cost.   What is the KB Waiver criteria based on? •Federal Regulations established general requirements in 42CFR 435.225. -Requires institutional level of care: nursing home, hospital, or intermediate care facility- mental retardation.   1. Intermediate Care Facility - Mental Retardation - 442CFR440.150 & 42CFR483.440 •Requires 24 hour supervision AND active treatment. 2. Hospital Level of Care - 42CFR440.10 •Georgia uses Interqual. 3. Nursing Home LOC - 42CFR440.155 •DHR Rules 290-5-8 & OCGA 31-7-1(1)(b). •Requires 24 hour nursing care.   Background on Katie Beckett-Deeming Waiver for Georgia •KB Waiver was created to waive income limits of parents to establish eligibility for Medicaid in 1982. •This is an optional Medicaid Program for Georgia. •In 2001, the only national study ever conducted concluded that 20 states enrolled approximately 25,000 children in Medicaid through the KB waiver option. Georgia was the second highest ranked State for KB waivers. •Increase in KB Waiver denials since May 2005. No specific disability has been targeted. •Over 6,200 families had the KB waiver before the new guidelines were implemented on 11/15/04. Over 2,400 children have been denied since that time.   How is the Level of Care determined for the KB Waiver? •Initial application made to DFCS. -Clinical detail is sent to and reviewed by Georgia Medical Care Foundation. -If Level of Care is satisfied, DFCS does cost neutrality assessment. •Georgia Medical Care Foundation does clinical review. -A certified Prospective Review Organization. -Co-Medical Directors and nurse reviewers.   What is the Appeal process for KB Waiver? •An  initial administrative appeal can be requested from GMCF. You have 30 calendar days to supply additional information. •A 2nd appeal can be made by requesting a hearing directly from the DCH. (Fair hearing in front of a judge) •As of 1/17/07, DCH is currently conducting fair hearings for January 2006 requests! DCH has limited any patient liability to 3 months, should the hearing not turn out in the parents favor.   Appealing…..Tips & Traps •Tips for Appealing: -In the original denial letter, the parents have 30 Calendar days to appeal. -Resubmit any Medicaid documents that you feel you may have not filled out properly based on the new eligibility criteria. -Prepare a 24 hour Care Plan going into detail about your child's day. Explain everything you do as a parent that goes beyond a "typical" child's duties as a parent. -Have all your doctors, therapists and any other professional that works with  you child submit a letter explaining why your child needs the waiver. -Contact your local State Senator and Representative and send copies of e-mails to the Governor. -Detailed information on the procedural aspects of a fair hearing and instructional video on representing yourself in a hearing without an attorney can be found at: www.osah.ga.gov/   Tips and Traps •Review the eligibility criteria by going to www.communityhealth.state.ga.us or http://dch.georgia.gov/00/channel_title/0,2094,31446711_31946814,00.html   •All applications have new forms which include the following: -Pediatric DMA6(A). -Care Plan (DMA 706). -Cost-Effectiveness Form (DMA 704 which replaced the Deeming waiver Physicians Referral Form). -3rd Party Liability Health Insurance Info. Questionnaire (DMA 285).   Tips and Traps •Fill out all forms out as a "Provider" NOT as a "Parent". •Always send everything to GA Healthcare Partners / DCH by certified mail / return receipt. •#1 Reason for denials is an administrative denial (lack of paperwork and incomplete package). •Submit ALL the forms and supporting documentation in one application. •Put together a Table and Contents and tab each document. •Question #7 on DMA6(A) "Does guardian think the applicant should be institutionalized? Yes or No".  •Don't date the DMA6(A) until submitting the entire application package. (Form only good for 30 days!) •Include a picture of your child. Make it personal!   Home and Community Based Service Waivers •Section 1915c of the Social Security Act allows the federal government to "waive" (ignore) certain Medicaid rules to enable states to cover home and community-based services as an alternative to institutionalization. •These are called Home and Community Based Service Waivers.   Service Waivers "Waive" Medicaid policies that require institutionalization of an individual before non-medical services can be provided.   •This allows states to offer programs that provide additional services to Medicaid eligible individuals in their home and/or community.               Georgia's Service Waiver Programs •CCSP (Community Care Services Program) •ICWP (Independent Care Waiver Program) •CHSS (Community Habilitation Support Services) •MRWP (Mental Retardation Waiver Program)   Community Care Services ProgramThe Community Care Services Waiver (CCSP) is for the elderly with disabling conditions and people with severe physical disabilities who need in-home support services.             To apply:  CCSP Intake Unit (Atlanta Regional Commission)  (404) 463-3244 www.agewiseconnection.com             Eligibility: Must have a functional impairment. • Require nursing home level of care • Medicaid eligible • Any age             May include cost share which is determined by individual's monthly income Resource limit.  Individual may have up to $2,000 in resources.              Provides Adult Day Health • Personal Support Services • Out of Home respite care • Home delivered meals • Home delivered services, e.g. nursing, PT, OT, ST • Alternative Living Services • Emergency response services   Independent Care Waiver Program The ICWP is for adults between ages 21 and 64, with physical disabilities or traumatic brain injury.   •Individuals must be able to direct their own care. Must be at risk of nursing home or hospital placement.   •Services include: case management, companion services, including homemaker services, personal support services, environmental modification, skilled nursing, specialized medical equipment and supplies, personal emergency response systems,  counseling, occupational therapy, adult day services, respite care,  physical therapy, and speech therapy.   Community Habilitation Support Services   §        This waiver program was created to serve individuals in institutional settings to facilitate their move back into the community. §        Individuals are not being added to this program. §        Individuals must be Medicaid eligible; have mental retardation since birth or before age 18, or another developmental disability since birth or before age 22, which requires services similar to those needed by people with mental retardation. §        Services are residential supports, day habilitation and supported employment.     Mental Retardation Waiver ProgramThe MRWP provides a wide array of community based services to individuals with developmental disabilities.   To be eligible for an MRWP, an individual must: •be Medicaid eligible; •Have mental retardation or another developmental disability which requires services similar to those needed by people with mental retardation; •Be at risk for going into an institution for people with mental retardation if unable to get the services you need in the community. The MRWP is available to all ages.   MRWP Services •Natural Support Enhancements •Respite Care •Specialized Services •Medical Equipment •Personal Support •Day Support •Day Habilitation •Supported Employment •Home Modifications •Support Coordination •Residential Training and Supervision   Support Coordination •Support coordination is a separate State contract- it does not use an individual's waiver money. •Support Coordination is for those on the Short Term Planning List and for those enrolled in the program. •The regional office contracts for support coordination.   MRWP +The largest service waiver program in Georgia.             +The largest waiting list for services (over 6,000 people statewide)   +Georgia has had this waiver since 1989.   MHDDAD Regional Offices Region 1: (706) 802-5272 or toll-free 1-800-646-7221.   Region 2: (706) 792-7733 or toll-free 1-866-380-4835.   Region 3: (770) 414-3052. Clayton, Cherokee, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry and Rockdale   Region 4: (229) 225-5099.   Region 5: (912) 303-1670 or toll-free 1-800-348-3503.   NOW Waiver will likely replace MRWP on 7/07 •Behavioral support up to $2,460 max a year •Community access •Community Guide services up to $ 2000 max a year •Community living support •Community residential •Dental services for adults up to $ 500 a year •Environmental accessibility adaptations up to $ 10,000 lifetime •Financial support services •Natural support training and individual directed goods and services •Professional therapeutic services up to $ 1800 a year •Respite •Specialized medical equipment and supplies •Support coordination •Transportation up to $ 2800 a year •Vehicle adaptation up to $ 6,240 max lifetime cap   Medicaid Covered Services •GAPP (Georgia Pediatric Program) •SOURCE (Service Options Using Resources in Community Environments)   The above are services (not waivers) covered under Medicaid.   Things to Know…. For those who already have a waiver •Individuals who have a Medicaid waiver are entitled to ALL the necessary services provided in that waiver program. •Waivers can be used anywhere in the state of Georgia but cannot be transferred out-of-state.   For those who are waiting for a waiver. •Parents and family members need to advocate for services.    Networking & Building Alliances •Contact Governor's Council on Developmental Disabilities (GCDD) via e-mail (vmsuber@dhr.state.ga.us) regarding being placed on their "Moving Forward" e-mail update during the legislative session. •Contact your State Senator and Representative's by going to www.vote-smart.org and inputting your zip code.  They need to hear from you about your situation and how it impacts your family. •Contact Governor Perdue:  Georgia.Governor@gov.state.ga.us .   Networking & Building Alliances •Stress when talking to your legislators that the majority of the our families are hardworking, middle class, tax paying, voting citizens that have never asked from anything from the State until they had a child with a disability.   •Atlanta Alliance on Developmental Disabilities (AADD) is also involved in advocating for the disability waiting list. http://www.unlockthewaitinglists.com/   •Work with the media to get the message out and to help educate the general population of our concerns and abilities of our children (given the right resources)!   Networking   •Get Involved! Advocating is the key to success in getting the services we need for our children. Send on e-mail to : heidijmoore@comcast.net if you would like to be placed on my advocacy distribution list. (over 2,500+ members)   •My goal: Make the issues easy to understand and explain to advocates what they can do to influence change in this State.   •Additional information can be found at: -www.kidshealthcarega.org -http://www.lgtinc.org/authors/41/Heidi-J.-Moore   •Effective February 2007, Heidi now provides fee based consultation services for the Medicaid application process for the Katie Beckett Waiver and MRWP and other advocacy issues including education, healthcare and general information.  Please contact her for additional information.   More Helpful Website Information •GCDD guide to waivers :   http://www.openminds.com/indres/111306gawaivers.pdf •Summary of GA Medicaid waivers  :  http://www.unlockthewaitinglists.com/pdf/summaryofwaivers.pdf •Medicaid's Main ICF-MR page:          http://www.cms.hhs.gov/medicaid/icfmr/default.asp •Parent to Parent of GA KB Waiver Information: http://www.parenttoparentofga.org/roadmap/insurance/insurancedeemingcover.htm •Unlock The Waiting Lists website : •http://www.unlockthewaitinglists.com/  •ICF-MR level care and "persons with related conditions":             http://www.healthlaw.org/library.cfm?fa=download&resourceID=61843&appView=folder&print •Great site to find current lawsuits in other states re: disabilities: http://www.healthlaw.org/ •When you see a code w/  "CFR" go here to look it up.  Most healthcare is in title 42.  Medicaid's definitions are listed here.             http://www.gpoaccess.gov/cfr/retrieve.html •An appeals decision re: 24 active care vs. 24 supervision.  This is the court's breakdown of the fed regs and how they interpreted them.           http://www.state.in.us/judiciary/opinions/previous/archive/02280101.nhv.html •Autism Handbook http://www.usd.edu/cd/autism/Autism%20Handbook.pdf                                                                          Update : Strengthening Families of Children with Disabilities (SFCD)- KB Waiver Foundation. •In April 2006, the legislature approved $7.6 million to go towards families that have been denied from the KB waiver. •A foundation was formed to manage this process. (Community Foundation of Greater Atlanta-CFGA) •Eligibility: Families that were denied the Katie Beckett Waiver from Oct 2005 - to date. •One time prepaid debit card will be paid in the amount of $2,600/child expires March 31, 2007. •Funds are being set aside to address the long-term needs of medically fragile children and their families •Currently, DHR is finalizing the Advisory Committee members. •Contacts: Lita Ugarte- Program Officer- CGGA (404) 688-5525 and Brian Dowd with DHR bddowd@dhr.ga.gov 404-657-3592..   Advocacy Issues Therapy Issues- -Starting Sept. 1, 2006, Prior Authorizations are needed for more than 8 units/month for ST, PT, OT. -Starting Nov. 1, 2006, CHOA no longer accepts outpatients for therapy. -HB 549 - Defines "Medically Necessary Services" and being prescribed by Physician not defined by DCH. Also changes process and need for prior authorizations. Currently awaiting Governor's signature!   Other Advocacy Issues:   •Administrative Service Organization (ASO) coming in 2007 for all disability waivers. •SB 10 Voucher program for children with IEP's. Waiting Governor's signature. •Get involved and monitor your child's Medicaid card. -www.ghp.georgia.gov and request a password from GA Health Partnership to be able to track Medicaid charges to your child's account. -This is very important in order to verify and report problems. You can report a complaint via the website as well. -Only through education, accountability and communication are we going to be able to make a difference in the process.   Be Prepared, Advocate, and Win…… YOUR Child Depends on YOU! --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "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. Heidi J. Moore Tue, 01 May 2007 00:00:00 EDT http://www.lgtinc.org/articles/230/1/URGENT--HB-549--Therapy-Needs-YOUR-Support-TODAY%21 April 18, 2007   Dearest Advocates:   URGENT- I realize I have issued out a number of advocacy emails in the last few days but this is crunch time in the legislator. We either have our voices heard NOW or NEVER!   PLEASE read below this important advocacy alert that needs your attention TODAY regarding advocating for your child's therapy in Georgia!   House Bill 549 has passed through the House of Representatives and went through the Senate Appropriations Committee.  TODAY- April 18, 2007 at 5:00 the Rules committee votes on this bill and we need all advocates to contact the members of the rules committee to ask them to support this bill. If it passes on Wed. then it will go to the senate floor on Thursday.    Basically, House Bill 549 will help alleviate many of the issues with the prior approval process for therapy in the Medicaid system.  It streamlines the paperwork, defines medical necessity, changes the prior approval process to every six months instead of three and allows 16 units of therapy per discipline before the prior approval process kicks in.     THIS IS BIG NEWS AND CAN HELP ALL OUR CHILDREN WITH THERAPY……Now and in the future!   PLEASE CALL TODAY THE FOLLOWING Senators letting them know of your support of HB 549:   Don Balfour-Chairman 404-656-0095 Dan Moody 404-463-8055 Eric Johnson 404-656-5109 Tommy Williams 404-656-0089 Jack Hill 404-656-5038 Renee Unterman 404-463-1368 David Adelman 404-463-1376 Gloria Butler 404-656-0075 George Hooks 404-656-0065 Ross Tolleson 404-656-0081 David Shafer 404-651-7738 Chip Pearson 404-656-9221   In addition, please contact your own Senator (www.vote-smart.org  and inputting your zip code).   YOUR CHILD's THERAPY MAY DEPEND ON IT!   In addition, please thank Senator Dan Moody for being willing to sponsor the Bill in the Senate at the last minute! Also- Thanks to Donna for working on helping make this possible Bill a reality for our children!   Thanks in advance for your support in this urgent issue.     Sincerely,   Heidi   --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "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. Heidi J. Moore Wed, 18 Apr 2007 00:00:00 EDT http://www.lgtinc.org/articles/229/1/URGENT%3A-Managed-Care--Continued-Advocacy-Needed-By-YOU%21 April 16, 2007   Dearest Advocates:   Please find below additional information regarding our advocacy efforts. MANY thanks to those 25 families/kids/providers/concerned citizens (and even a grandma!) that took time out of their busy schedules to come down to the Capitol today to show a unified voice on this issue.......The Aged, Blind and Disabled populations can NOT be in another managed care model!   The Senate listened and took this proposal OUT of their version of the 2008 Budget!   BUT our advocacy efforts must continue........PLEASE take a moment and call and/or email the below legislators (ESPECIALLY if you are in their District. It means more when you live in their district!!!!!) and the Governor letting them know that managed care does not work in this population of individuals and why.    Please make your stories personal and how it could impact your family. Also thank the Senators for taking it out of their version of the budget and help the our House of Representatives understand better so they will support that final decision with the 08 Budget!   To help you with your phone calls and emails, below are some of the facts to the situation..........   Facts:   Many of our families already have a managed healthcare network! With the Katie Beckett Waiver children alone, 71% of those waivers use Medicaid as SECONDARY INSURANCE and have primary healthcare insurance.  Why would we need to be in ANOTHER managed care situation?   For the other Waivers (including MRWP, SOURCE, ICWP, CCSP, etc) - They are already in a managed care model.     There needs to be a lot more thought and input into this option before adding into the budget at the last minute.  No study data is available at this time. We don't even know how many individuals this could impact!     This plan was not discussed in any public meetings and was NOT recommended by the Appropriation Health Subcommittee and Dept. of Community Health (DCH)!  DCH Commissioner Medows says the plan is premature because the State has less than a year's experience with the current managed care (CMO) model in place.   DCH would have to get a 1115 Waiver from the Federal Medicaid office even if this is approved by the Georgia legislator (which takes time).   Given the complexity and needs of this vulnerable population, many who have private health insurance and hold Medicaid as secondary insurance, the cost of coordinating care would be a financial burden to Medicaid and could actually end up costing the State more taxpayer dollars! Bottom line: Managed care is NOT a good service delivery model for the Age, Blind and Disabled populations and could actually cost the state taxpayers more money.  We need more time to evaluate the options before this radical approach is taken. Please remove this line item from the 2008 Budget! Thanks in advance for your support.   UNITED... WE WILL MAKE A DIFFERENCE!   Our advocacy efforts are paying off...keep up the GREAT WORK!   Sincerely, Heidi  ==================================================== THIS STATEMENT ISSUED BY:  Laura O. Moore Founder and CEO Dream House for Medically Fragile Children, Inc. laura.moore@dreamhouseforkids.net 770-717-7410 Leanne D. Manning Project & Advocacy Coordinator leanne.manning@dreamhouseforkids.org 678-462-7789 Heidi J. Moore heidijmoore@comcast.net 678-357-8200 YOUR VOICE WAS HEARD!!! Dream House Call to Action Update United…We are making a difference!!! Our state leaders heard from you today, your phone calls and emails made the difference and the Senate did not approve the last minute amendment that would implement a managed care program for the Aged, Blind and Disabled Medicaid population in the Atlanta region, which is said to become effective January 1, 2008. We have one more thing to do… The House and Senate Committees will now need to work out their differences on this issue, So we still need to call and email our legislatures, Especially tomorrow, Tuesday, April 17!  Please voice your concern about this rush of putting the aged, disabled and blind into care management.  We would like to have the study data used to validate how many aged, blind and disabled people this change would affect made public and given time to review that data; to learn about how much money this change would actually save or cost, both long and short term; and to be able to participate in timely public response before this change is implemented into legislation. We do not want the state budget balanced upon the health and lives  of children or elderly folks, disabled, or blind people. But what can I do that  will make a difference? 1.      Please call and email your state legislature on Tuesday!! You can find your State Senator and Representative by going to www.vote-smart.org and typing in your zipcode. 2.      Please call Governor Sonny Purdue's office at 404-656-1776, or FAX: 404-657-7332 or email: sperdue@gov.state.ga.us. 3. Contact Lt. Gov. Casey Cagle's office at 404-656-5109 or email him at: http://ltgov.georgia.gov/00/article/0,2086,2199618_2208307_11792200,00.html   4. Contact Senator Jack Hill at 404-656-5038 or jack.hill@senate.ga.gov 5. Contact Senator Tommie Williams at 404-656-0089 or tommie.williams@senate.ga.gov or tommie@tommiewilliams.com 6. Contact Senator Eric Johnson at 404-656-5109 or  eric.johnson@senate.ga.gov or ejohnson56@comcast.net  7. Representative Ben Harbin at 404-463-2247 or  ben.harbin@house.ga.gov 8. Rep. Jerry Keen 404-656-5052 jlkeen@bellsouth.net 9. Rep. Mark Burkhalter 404-656-5072 or  mark.burkhalter@house.ga.gov Dream House for Medically Fragile Children, Inc. provides education, skills training, and assistance with healthcare equipment acquisition and resource referrals, so that kinship, foster, and adoptive families can care for medically fragile children in their own 'dream home'. ###   --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "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. Heidi J. Moore Wed, 18 Apr 2007 00:00:00 EDT http://www.lgtinc.org/articles/228/1/URGENT%3A-Please-Forward%3A-Call-to-Action-for-Monday--April-16-at-10%3A30am April 14, 2007   Dearest Advocates:   URGENT! Please see below a call to action regarding the latest proposal to place the Aged, Blind and Disabled populations to a managed care program.  I realize that this is late notice. Things are moving VERY quickly but we all need to get involved now!    We are asking anyone that can to come to the Capitol this Monday, April 16th at 10:30am and hand deliver your message to the necessary Senators.  The plan at this point is to meet at the front stairs of the Capitol on Washington Street side (where we had our Healthcare for Kids Rally in November) and organize from there. If you have any questions about this call to action, please contact Leanne Manning  at leanne.manning@dreamhouseforkids.org.   If you can't participate on Monday, please make your phone calls and emails!  Senators that need to hear from us including the following:   1. Jack Hill, Chair of Appropriations jack.hill@senate.ga.gov, 404-656-5038   2. Greg Goggans, Vice Chair, appropriations, Health  drgg@alltel.net  or greg.goggans@senate.ga.gov  404-463-5263   3. Tommy Williams, Appropriations, tommie.williams@senate.ga.gov or tommie@tommiewilliams.com 404-656-0089   4. Casey Cagle, Lt. Governor, go to the following website to contact him: http://ltgov.georgia.gov/00/article/0,2086,2199618_2208307_11792200,00.html   or 404- 656-5030   5. Eric Johnson, Senate 1, President Pro-Tem, eric.johnson@senate.ga.gov or ejohnson56@comcast.net 404-656-5109   6. Also please contact your individual State Senator for your own district by going to www.vote-smart.org and typing in your zip code.      7. AND Contact Governor Perdue at sperdue@gov.state.ga.us, or 404-656-1776, Fax:404-657-7332.   Thanks in advance for your support in this matter.   YOUR child's Medicaid may depend on it!  Sincerely, Heidi    --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "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.   -------------- Forwarded Message: -------------- From: "Leanne Manning" Subject: Please Forward: Call to Action for Monday! Date: Sat, 14 Apr 2007 14:38:19 +0000 THIS STATEMENT ISSUED BY:  Laura O. Moore Founder and CEO Dream House for Medically Fragile Children, Inc. laura.moore@dreamhouseforkids.net 770-717-7410 Leanne D. Manning Project & Advocacy Coordinator leanne.manning@dreamhouseforkids.org Heidi J. Moore heidijmoore@comcast.net 678-357-8200 Dream House Call to Action! But what can I do that  will make a difference? Meet us on the Capitol this Monday, April 16 at 10:30am! Our state leaders need to hear from you personally:  Write a letter to our state leaders with your concerns, and let's personally deliver our message! Don't balance the budget upon the health of children or elderly folks, disabled, or blind people. It is very concerning that the House Budget includes a last minute amendment that would implement a managed care program for the Aged, Blind and Disabled Medicaid population in the Atlanta region, which is said to become effective January 1, 2008. There needs to be a lot more thought and input into this option before adding into the budget at the last minute, resulting in: ·       No study data to validate how many aged, blind and disabled people this change would affect. ·       No study data to show how much money this change would actually save. ·       No chance for timely public response; and no options for those affected to learn of the impact of this decision and act in timely response. This last minute item surprised DCH, Medicaid, providers, patients, our top state leaders, and the taxpayers of Georgia, this legislation would implement managed care for the most disabled populations in our state, a model of care that has not proven to be successful across the country.  Instead, the current system which is based on disease management is the most effective for the patient and the payer.  Current state employee health coverage does not provide the same services that PeachCare offers, yet state workers who earn within the income bracket for Peach Care are not allowed to apply for Peach Care. State employees, if they meet the same criteria as non-state employees, should have health care benefits equivalent to those of Peach Care.  How can this be paid for? ·       Not by cutting Peach Care benefits; ·       Not by taking the most disabled and placing them in "managed care" which has a proven failure record for individuals that face complicated or multi-diagnosis'; Don't balance the budget upon the health of children or elderly folks, disabled, or blind people! What kind of message is conveyed by lowering the standards of health care in Georgia? What will happen to people in nursing homes? Would managed care interfere with the implementation of the MRWP/NOW waiver? How will the impact of reduced health care services affect and increase the burden placed upon schools for already overstrained special education services? If a decision is made to 'dump' the most complicated of patients on top of a system that is already ineffective and losing doctors and providers, what kind of care are any of our most vulnerable citizens going to get? Would this change really save 30-40 million dollars by putting elderly, disabled and blind people, individuals in Medicaid waivers like Katie Beckett, Children's Medical Services, into managed care?  Or, would the real cost be the lives and health wasted by lack of coordinated care? Given the complexity and needs of this vulnerable population, many who have private health insurance and hold Medicaid as secondary insurance, the cost of coordinating care would prove to be a financial burden to Medicaid. Problems with the current 'care maintenance' system have resulted in many providers opting out of Medicaid.  These families need home and community based services, requiring a robust provider network with appropriate compensation for their services. Dept. of Community Health and the House and Senate Budget offices have a lot of concerns about the ability to implement this change, and they would need an 1115 waiver to do this.  We have been advised to contact the Senate with these concerns.  The budget will go to the Senate floor by Tuesday, and then it will go to conference committee to work out the differences. Bottom line: Managed care is NOT a good service delivery model for the Age, Blind and Disabled populations and can actually cost the state taxpayers more money.  We need more time to evaluate the options before this radical approach is taken. But what can I do that  will make a difference? Meet us on the Capitol this Monday, April 16 at 10:30am! Our state leaders need to hear from you personally:  Write a letter to our state leaders with your concerns, and let's personally deliver our message! Dream House for Medically Fragile Children, Inc. provides education, skills training, and assistance with healthcare equipment acquisition and resource referrals, so that kinship, foster, and adoptive families can care for medically fragile children in their own 'dream home'. ### Heidi J. Moore Wed, 18 Apr 2007 00:00:00 EDT http://www.lgtinc.org/articles/227/1/Urgent%3A-Advocacy-Needed.-Contact-your-Legislators-TODAY%21 April 13, 2007   Dearest Advocates:   URGENT ALERT! Please Read and write and call TODAY…….   A surprising item showed up in the Fiscal Year 2008 budget when it was passed out of House Appropriations on Thursday, April 12.  It is in the Department of Community Health Budget, and the item reads as follows:  "The Department of Community Health shall implement a managed care program for the Aged, Blind and Disabled Medicaid population in the Atlanta region, effective January 1, 2008."  ($30,000,000)    This means that legislators expect that they can save 30 million dollars by putting this population (individuals in waivers, Katie Beckett, Children's Medical Services) into managed care.  They need an 1115 waiver to do this.  Dept. of Community Health and the House and Senate Budget offices have a lot of concerns about the ability to implement this change.  We have been advised to contact the Senate with these concerns.  The budget will go to the Senate floor Tuesday, and then it will go to conference committee to work out the differences.    What you can do to make a difference by Tuesday -April 17, 2007:   Please Contact the Senate leadership:   1. Jack Hill, Chair of Appropriations jack.hill@senate.ga.gov, 404-656-5038   2. Greg Goggans, Vice Chair, appropriations, Health  drgg@alltel.net  or greg.goggans@senate.ga.gov  404-463-5263   3. Tommy Williams, Appropriations, tommie.williams@senate.ga.gov or tommie@tommiewilliams.com 404-656-0089   4. Casey Cagle, Lt. Governor, go to the following website to contact him: http://ltgov.georgia.gov/00/article/0,2086,2199618_2208307_11792200,00.html   or 404- 656-5030   5. Eric Johnson, Senate 1, President Pro-Tem, eric.johnson@senate.ga.gov or ejohnson56@comcast.net 404-656-5109   6. Also please contact your individual State Senator for your own district by going to www.vote-smart.org and typing in your zip code.      Talking Points:   Many of our families are already in a healthcare network already! With the Katie Beckett Waiver children alone, 72% of those waivers use Medicaid as SECONDARY INSURANCE and already have Primary Healthcare insurance.  Why would we need to be in ANOTHER managed care situation? Managed care will probably NOT save money for individuals that have primary healthcare insurance and use their own provider networks and may end of COSTING MEDICAID MORE MONEY if coordination is not done properly. For the other Waivers (including MRWP, etc)- We are already in a managed care situation.  Our families need home and community based service which managed care companies do NOT do well. We do not want managed care to interfere with the implementation of the MRWP/NOW waiver. There needs to be a lot more thought and input into this option before putting into the budget at the last minute.   BOTTOMLINE: Managed care is NOT a good service delivery option for individuals with disabilities!   I recommend that you first call them. If you feel uncomfortable with that, send them individual emails on this matter.  Please try to not send in a distribution list (it is not as likely to be read).   Also- make your phone call/message or email personal. Explain how this personally impacts your family.   As many of you are aware, the managed care program (CMO- Care Management Organization) has had a ton of difficulties in the general Medicaid population in the last year since implementation and continues to work thru it's issues……Why would we want to be a part of this program given the complexity and needs of our children and many of us already have primarily healthcare insurance with Medicaid as secondary?   The State of Georgia needs to fiscally responsible for our tax dollars and this is NOT going to achieve that. WE ALL NEED TO HELP EDUCATE OUR LEGISLATORS ABOUT THE TRUTH AND NOT WHAT IS BEING LOBBIED BY THE HEALTHCARE INDUSTRY!   I have not been writing as many emails lately due to my health and my son's but I feel that this was too important for all of you to know what is really going on and be apart of the education and change in Georgia.   This is VERY serious…….Please take a moment and contact the above Senators…..YOUR child's Medicaid may depend on it!   Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "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. Heidi J. Moore Wed, 18 Apr 2007 00:00:00 EDT http://www.lgtinc.org/articles/170/1/Healthcare-for-Kids-Rally-Flyer-and-Other-Information--Please-Distribute%21 September 19, 2006   Dearest Advocates:   Please find attached the "official" flyer for our upcoming Healthcare for Kids Rally to be held on November 4th at 9:30am at Georgia State Capitol.    The time has come for us to unite our voices to be heard....HEALTHCARE must be a priority for our children! This rally is being put together for everyone that has been impacted or has a vested interest in the Medicaid system (which includes the following: parents, providers, and concerned tax paying, voting citizens of Georgia....Therefore, everyone is impacted by this issue in the State of GA!)   At the rally, we will be discussing the following issues: + Eligibility + Access to care and provider networks. + Early Periodic Screening Diagnosis & Treatment Federal Requirements. + Burdensome Application, Appeal and Claims Process.   We encourage children to attend and plan on having some entertainment for them as well. It is going to be a family friendly event! We need to put a face to the children being impacted by poor decisions.   The color theme is RED.  Please try to wear red the day of the event.    We recommend that you either car pool with other families or take Marta. There is parking available but it might be easier to come together as a group!    We currently have a wonderful volunteer group of over 40 concerned citizens wanting to make a difference and change in the direction of Medicaid!  I am amazed at how many people are actively wanting to get involved.  If you would like to volunteer (still looking for people the day of the event to help with set-up/clean-up): please send Leanne Manning (leanne_d@bellsouth.net ), my administrative assistant for the Rally, an e-mail with the following information: Name, e-mail, phone numbers, where you live, and if you are a parent, provider,etc.   Also- if you know of a organization and/or person that would like to donate to the Rally, please let us know.  North Metro Miracle League (NMML) has graciously offered to be an administrator of funds for the Rally! Please see the attached flyer for further information. Thanks in advance for your help in this matter.    This is going to be the event of the year for Healthcare in this State....... Let's show our support!   Feel free to distribute this flyer to anyone you think would like to attend and post at therapy clinic's doctor offices,etc. WE need to get the word out about this event. The more people that show up the better........   We are voting citizens and need answers to the healthcare crisis in Georgia!   UNITED... WE WILL MAKE A DIFFERENCE!   Additional information can be found on our website: www.kidshealthcarega.org  Hope to see you there!   Sincerely, Heidi J. Moore Healthcare for Kid's Rally Coordinator   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 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. Heidi J. Moore Tue, 19 Sep 2006 00:00:00 EDT http://www.lgtinc.org/articles/166/1/URGENT%3ASave-That-Date%3A-Children%26%2339%3Bs-Healthcare-Rally%21-11%7B47%7D4%7B47%7D06-at-9%3A30am September 1, 2006   Dearest Advocates:   The time has come for EVERYONE to get involved.......    We are planning a Children's Healthcare Rally at the State Capitol on Saturday, November 4th at 9:30am.  More information will be following but I wanted to make sure you SAVE THAT DATE!   We all need to speak up and have our voices heard for our children and the providers that service them.  This is an election year and we need to make sure the State understands OUR priorities must include healthcare for our children.   The Children's Healthcare Rally will involve some of the following issues:   1. Eligibility Issues for disability waivers (including the Katie Beckett Waiver). 2. Access to a viable provider network (including therapy!) 3. CMO concerns. 4. BCW Concerns. 5. Overall, administrative paperwork problems in the system!   As you can see, we will be advocating for all children with and without disabilities that require healthcare from the State.   The issue is...... all children need healthcare (which includes having service providers to perform those services!).   If you are interesting in getting involved, donating time, or money in helping make this be the most effective rally to get the lawmakers attention....please send me a BRIEF e-mail stating the following:   1. What you think you do to help the cause? 2. Contact information including: name, phone numbers, e-mail address. 3. Where you live? 4. Are you a parent, provider, friend, concerned citizen, etc?   A rally committee is being put together to help make this a successful event.  Thanks in advance for wanting to participate!   Let's show our strength in numbers....OUR VOTE COUNTS!    UNITED... WE WILL MAKE A DIFFERENCE!   Hope to see you there! More detailed information will be following shortly.    Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 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. Heidi J. Moore Fri, 01 Sep 2006 00:00:00 EDT http://www.lgtinc.org/articles/144/1/URGENT%3A-Advocacy-Needed---DCH-Board-Meeting-July-13%2C-2006 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 Katie 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@dch.state.ga.us 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 Walker on right. -McDonalds is on the left of second intersection. -Wendy'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 Katie 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. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 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. Heidi J. Moore Wed, 12 Jul 2006 00:00:00 EDT http://www.lgtinc.org/articles/135/1/People-First-Language May 29, 2006   Dearest Advocates:   It's been brought to my attention that there is a fantastic handout that I think everyone should read regarding how parents/providers/friends/family talk and write about our children with disabilities.     Kathie Snow has put together a wonderful 4 page handout that helps us understand how powerful our words are and how we can help educate the community we live through proper language........   To print out a copy of her handout and educate yourself of the importance of proper language, please go to the following website:   http://ftp.disabilityisnatural.com/documents/PFL0905.pdf   In addition, when I contacted her a few days ago regarding utilizing her handout at one my upcoming presentations, she informed me about her son, Benjamin.   Benjamin recently entered the Film Your Issue competition---an opportunity for 18-26 year-olds to share their passion in a 30 to 60 second film. He wrote, performed in, and directed THUMBS DOWN TO PITY---about the need for films and TV to move beyond the "pity portrayals" of people with disabilities....and his film has made it to the SEMI-FINALS! Now, the general public has a chance to vote on the 35 semifinalists.....Ifyou have a moment, please visit http://www.msnbc.msn.com/id/12721177 ....and if you agree Benjamin's message is an important one, please cast yourvote for THUMBS DOWN TO PITY! The voting ends on June 7th.   Society needs to recognize the impact of their words for individuals with disabilities and as parents, providers and friends....WE need to help continue to help others understand the need for proper language and respect for our children.   I know personally, I don't like it when people refer to my son as having "Downs". This is very degrading and I try to understand that they don't understand but I also take the opportunity to help educate everyone that has contact with my son that he is a person first that happens to have a disability- Down syndrome!  He has touched more lives in his short 6 yrs than most of us will in a life time.  As you can tell, I'm very proud of my little boy and all of his abilities!   Hope you find this information helpful. Have a great Memorial day weekend. Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 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. Heidi J. Moore Fri, 23 Jun 2006 00:00:00 EDT