July 29, 2006

Dearest Advocates:

Wanted to update you.......Unfortunately, DCH has decided to continue with their proposal regarding making it more difficult for our children to receive therapy. We really need to push this issue with our legislators and the Governor that this WRONG and needs to be changed ASAP!  DCH is stating that each therapy is only allowed 8 units/month or a combined therapy (ST/OT/PT) of 16 units/month without getting a prior authorization (PA). Anything over that amount will require a PA.

Here are somethings to think about and write about to your legislators:

In a recent interview on Fox 5 10:00pm news, Mark Trail, Medicaid Director at DCH, indicated that the state must be “financially responsible” with how it spends its money.  While prior authorization is generally a good mechanism to ensure that services are properly administered, it can have several negative consequences if not administered properly (as anyone knows who ever had an HMO).  Therefore, we need to determine whether the proposal outlined by DCH is “financially responsible” in this circumstance.

The only rational explanation for implementing prior authorization requirements is that DCH believes parents, doctors and therapists are not qualified to determine the level of services necessary to meet a child’s needs.  Even though these caregivers see the child daily, weekly and/or monthly, DCH apparently believes it is in a better position to determine the level of services for a child and believes that by reducing prior authorization levels, it will reduce the number of “unnecessary” therapies. 

In order to be financially responsible, governments must determine whether reducing their programs will save money without causing other undesirable results.  For example, the state could simply stop providing any services of any kind.  It could discontinue police, fire fighters, etc.  Although this would save the tax payers money, this would not be a “responsible” decision as it would have serious negative consequences.  Similarly, the state can’t just look at the cost of the program when making changes, it must look at all of the circumstances.  It must determine whether the change will achieve cost savings without reducing the necessary level of care.  Therefore, in order t o make sure these prior authorization level changes are responsible, we must ask ourselves these questions:

1. What will the total costs be for increasing the number of prior authorization reviews?
2. What savings does DCH expect to see as a result of reducing what it believes to be “unnecessary” therapies?
3. Are the savings greater than the cost to implement the changes?
4. Are the pre-authorization levels set appropriately?
5. Are there any other non-monetary factors that must be considered?

I hope the above helps you with writing your letters to your legislators and the Governor!

Here is the actual banner message sent out to providers/therapists yesterday for fyi:

Please get involved and write your letters. Therapy needs to viewed as an investment in our children's future!

UNITED... WE WILL MAKE A DIFFERENCE!

Sincerely,

Heidi