http://www.lgtinc.org en-us http://www.lgtinc.org N/A contact@lgtinc.org Fri, 30 Jul 2010 09:55:13 EDT 20 http://www.lgtinc.org/articles/245/1/UPDATE%3A-Good-Morning-America--CMO%26%2339%3Bs-in-GA-and-Wall-Street-Journal-Article June 27, 2007   Dearest Advocates:   I wanted to give you an update from yesterday's advocacy email.  Thanks to so many of you that forwarded to me additional information that could be sent out to everyone!   If you would like to post your comments on ABC's website regarding the segment Good Morning America aired yesterday entitled "Rocky Transition From Public Medicaid to Private HMO's"…………  Here is the web link:   http://abcnews.go.com/GMA/OnCall/comments?type=story&id=3314626&GMA=true   Let's keep up the pressure on getting something done about the system. Even if you are not affected by the CMO system, please remember that Aged, Blind and Disability populations were almost put into CMO's this legislative session but due to our advocacy efforts was taken out!   We all need to be good stewards of tax-payers $$$- and that's not happening with the CMO program.  Only through communicating what the real issues are and educating those around us………are we going to receive the necessary change needed in the Medicaid system! Please help and get involved!   In addition- for those that did not get a copy of the Wall Street Journals article, it can be found by going to: http://biz.yahoo.com/wallstreet/070625/sb118254994081445264_id.html?.v=1   If you have comments regarding the WSJ's article, they can be sent to the reporter, John Hechinger at john.hechinger@wsj.com    UNITED… WE WILL MAKE A DIFFERENCE!   Sincerely, Heidi ============================================ June 26, 2007   Dearest Advocates:   Today on Good Morning America-ABC National News, they did a story titled "Rocky Transition From Public Medicaid to Private HMO's".  As many of you are aware, this has been a very difficult time for families and providers in the Georgia Medicaid system.  Please take a moment to see the segment at:   http://abcnews.go.com/GMA/OnCall/story?id=3314626&page=1   Also- if you could email ABC news letting them know about your personal struggles with the Medicaid system, that would be great. The more knowledgeable the general public becomes regarding the issues surrounding the Medicaid system…..The Better!  We need to do our part in educating those that don't understand the system (including our legislators and the Governor).  ABC News specifically talked about Georgia's Medicaid system.  I agree we need to be good stewards of taxpayers $$$, but we also have to take care of those that can't take care of themselves!!!!! Including our precious children with disabilities.  ; ; ; ;   Please let our voices be heard….."UNITED… WE WILL MAKE A DIFFERENCE!"   Comments can be submitted to ABC via the following web link (only 500 characters so be brief and to the point): http://abc.go.com/site/contactus.html?cat=Good%20Morning%20America     Education and building awareness of the issues is the key to success in making change in the overall Medicaid system! We as parents and providers must continue to help others understand the need for necessary services.  I do believe our children must be viewed as an INVESTMENT and NOT a Liability in Georgia!   ---------------------------------------------------------------------------------- In addition- the Wall Street Journal had an article on the front page of their newspaper yesterday titled "'Mainstreaming' Trend Tests Classroom Goals". Unfortunately, I was not able to pull the entire story from their website (you have to be a subscriber).  Here is the link for fyi:   http://online.wsj.com/article/SB118254994081445264-search.html?KEYWORDS=inclusion+education&COLLECTION=wsjie/6month   ------------------------------------------------------------------------------------- I hope everyone is having a great summer.   I will be issuing additional information regarding the proposed changes to the Georgia Babies Can't Wait Program and how you can get involved very shortly. Stay Tuned……….   Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how Heidi can help you maximize your child's potential, please go to www.heidijmoore.com "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. For previous advocacy email's, please go to the following website: http://www.lgtinc.org/authors/41/Heidi-J.-Moore. To see how you can advocate for your child go to www.kidshealthcarega.org. Heidi J. Moore Wed, 27 Jun 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/52/1/%0D%0ACalle-Vinas---The-Friendly-Provider I have been blessed to have lived the recent years my life with the assistance of the Independent Care Waiver Program. Some will ask what that is and where they themselves can get and benefit from such a waiver. Email me and I will assist. In many states the Waiver, which pays attendants to help keep individuals out of the grips of institutions, does not exist. Georgia has had it for a while due to the level of activism in this state and the willingness of governing boards to make community based care a part of system. Wanting to give back some of what I was receiving, I served on many advisory boards and public forums, meeting with Department of Medical Assistance staff, to help in creating a better more choice oriented long-term care system for Georgia to restructure itself into. I have mentioned previously about my involvement in long-term care in the nation and how I felt about nursing homes and choice, but up until this time I have never been able to affect it the way I wanted to. This I feel I have achieved by assisting in the evolvement of Calle Vinas, which services the disability community in what I term the right way. I will tell a brief history of my experience with providers in Georgia, without condemning or judging individual companies. Having transferred my waiver among five different providers and interviewing many others, I know the difficulty of finding a provider to service this waiver contract in a kind and helpful manner and not be just consumed on numbers. It is my opinion that even though good providers exist, the majority are run for profit at the expense of both consumer and employees. Though I will not mention names in this article, if asked I will speak truthfully about companies I have had dealings with. I've switched companies because I felt they over step my personal boundaries, or my employees were not getting paid right, or the benefits promised to my employees never materialized. Usually though it's because a provider has gotten so greedy, they look all over for chances to cut people out of time and pay. It is then that one definitely has to switch fast. Never be complacent about switching it is not a hard thing to do. Some providers have even tried to fire staff I've had working for me for years, so they can fill the slot with people they get at the lower end of a pay scale. I've had providers tell me they can't pay for this, or something can't be covered when I know they are billing and getting paid for all the things they say they can't do. They try to dictate how things are going to be since they are your provider and have your okay to service you the way their company sees fit. When I tell a provider that I run my whole show and all they have to do is keep steady with billing and pay, most are okay with that which makes it somewhat easier for me, but I find some can't even do that right. I knew the numbers before I even call to interview providers. I know how big the profit gap will be according to their pay scale and whether benefits are included. I also knew the numbers for some of my friends who were also on the waiver and disgruntled by service delivery. After some time I felt it would take less energy to focus on creating something that could serve the people in the way I felt they should be served, than it would be to find a provider to do business in a humbled and dignified way. Being a board member for the Association for Georgians with Disabilities I met with the others to see if they somehow could support in the creation of a provider system, which would benefit the direct health of the individuals whom they were trying to serve with a banking system. I told them providing care support could help in funding the Association in the many pursuits they intended. Having yet to form fully they thought it best not to deter from their goal of creating a credit union to serve people with disabilities, caretaker's, and immediate family. In this time I met Dominic Ottaviano, who was a friend of my girlfriend's. He was then running a limo service, driving for hire. He had a ten-year history in several business and insurance ventures. His contacts proved necessary in the manifesting of something to help in solving this crisis of service delivery. For weeks Dominic would come by to hang out. Soon long-term care became the focus of conversation. I found myself rambling on about the lack of good providers, the governor's budget, Olmstead vs. LC and EW, the Unlock the Waiting List campaigns, and how it all tied together with a history of genocide and institutional care. I spoke of my affiliation with ADAPT and what they were doing to change the current system. I told him how I wanted to open up my own company and do things for my friends and self, but couldn't because of regulations. I wanted to create something that would benefit all involved leaving no one out. I thought he listened because he wanted to be my friend and not that he was truly hearing what I was saying. But then a month later Dominic meets and gets hired by Jimmy Selth, doing insurance and payroll for a company called Southeastern Administrative Services. SAS turned out to be the missing link in the puzzle of providing good care. A couple weeks later I'm having lunch with Jimmy, his daughter Tracy Simpson, her husband Sandy Simpson, and Dominic to talk a little more in detail about the things I've been ranting and raving about for years. As an advocate and recipient of the waiver I have seen the program through many changes. I had always requested a pilot program for consumer managed-care, knowing there are many individuals like myself who can and do manage individual care. I find that I have more difficulty dealing with providers than I do dealing with disability itself. Things could be better, the reason they have stayed like this for so long is because we are still in the process of developing the structure for care here in Georgia. There is minimal if any competition to insure that providers can't assume a monopoly and dictate how they think servicing the waiver should be. There are no alternatives in many regions to the provider who understands they can do whatever they want because there is no one else to say different. Now with the enforcement of Olmstead across the states and the push for MiCASSA by ADAPT, more providers are needed and competition will grow. This will be healthy for the long-term care industry still in its phoenix stage of dying and rebirthing anew. Long-term care must be redefined. It was important for me that my employees be treated with benefits and security. It affects their attitude and how they take pride in a job, and Boss that does not take advantage or disappreciate their assistance. Employees are a very important part of the dynamic relating between consumers and providers. Employees much of the time are shafted to increase the profit margin. Many providers will change promises almost as soon as the DMA 80 has been signed and approved. It's sort of like their daring one to find a better company and switch knowing there aren't many to switch to. Knowing long-term care to be an area of business that would not disappear anytime soon, they thought it might be a good area to place a little focus. We conversed on the possibility of pooling our resources together to do and create something that would benefit the disability community being served. Explaining the numbers, they were sold on the idea of doing something that not only would allow them to make money, but would also allow them to do a tremendous amount of good where a tremendous amount of good was needed. I explained I would help as long as they were true to their word and the commitment to service. Successful business I said would be in honoring the consumer and their employees. Having been successful elsewhere, they understood the need to respect everyone and do things right in the first place. With Calle Vinas every full-time employee receives health insurance not of their own pay. Long-term workers acquire vacation days. Plus they have worker compensation to safeguard the consumer and company against lawsuits which 1099 providers don't have. If someone gets hurt in a consumer's home and the provider has no worker comp policy, the consumer is liable in lawsuit. I will detail this further in another article as it is very important for waiver consumers to know. I guided their quest to become a provider and now, a year later they have actually started servicing the community. Now that they have, providers providing shoddy care and raping the system, will be forced to step up to a new level and way of approaching long-term care. Otherwise, they will be replaced by Calle Vinas or other good providers who will see a standard reflective of themselves. Because Calle Vinas is statewide in its coverage the least it will do is create an alternative that must be respected and now lived up to.   Zen Garcia Sat, 18 Feb 2006 00:00:00 EST