Therapy Update!!!!
http://www.lgtinc.org/articles/159/1/Therapy-Update!!!!
Heidi J. Moore
Heidi has a BS in Civil Engineering from Purdue. After the birth of her son Jacob, she elected to stay home to ensure his needs were met. Heidi is very involved in many organizations;last year she was appointed by the Governorâs office to be on 3 Medicaid Reform committees, looking at overhauling the entire Medicaid system.Heidi currently has an advocacy distribution list of over 2,500 members to promote awareness of the advocacy issues that affect children and adults w/ disabilities & empower parents. By Heidi J. Moore
Published on 08/10/2006
August 8, 2006
Dearest Advocates:
Our advocacy efforts are paying off. Mark Trail (Director of Medicaid) just released the below statement today stating that Dept. of Community Health (DCH) will NOT be implementing the combined limit of 16 units for all three therapies (PT/OT/ST) that was previously proposed to start Sept. 1, 2006!
We still have issue with the reduction from 20 units/month to 8 units/month for a prior authorization (PA) for all three therapies. DCH needs to implement levels that are more appropriate for each type of program (It is NOT responsible to have the same PA levels for those with and those without disabilities. Based on the proposed standards, most of our children with disabilities will need PA in order to receive their current therapy level.)
We must make sure that we are spending our money wisely, but we must also make sure that those who need services can get them. While the State must look at the big picture, it must also think about the children who could be impacted if there is a disruption of service or lack of service (due to the increase in paperwork and inability to find Medicaid providers to perform the service).
I will meeting with Dept. of Community Health later this week and will give you an update as to what we need to do next regarding advocacy....Keep you posted! Thanks again for everyone getting involved.
UNITED...WE WILL MAKE A DIFFERENCE!
Heidi
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Here is Mark Trail's announcement:
Wanted to let you guys know we are going to change part of the proposed policy. Following several discussion with yourselves, and others, we’ve decided not to implement the cross specialty requirement for the PA. We will proceed as planned however with the 8 unit requirement within specialty, and will retain the current policy that the threshold applies to more than one therapist within the same specialty. We are working on revising the banner m essage and FAQs. Feel free to share with folks if you like.
Plain English: a SLP could use 8 units; a PT could use 8 units; and an OT could use 8 units without requiring PA. Hope that makes sense.
Medical Assistance Plans
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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
(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.