Katie Beckett Waiver - New Eligibility Criteria Clarification
http://www.lgtinc.org/articles/71/1/Katie-Beckett-Waiver---New-Eligibility-Criteria-Clarification
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 03/6/2006
March 6, 2006
Dearest Advocates:
As you are aware, on Friday the Dept. of Community Health (DCH) issued out the "new" eligibility criteria for the Katie Beckett Waiver under Intermediate Care Facility / MR (which is how the majority of the families are determined eligible for the Katie Beckett Waiver).
I have some clarification from DCH to your concerns based on the hundreds of e-mails I received over the weekend. Please understand that I will not be able to respond to everyone individually but I'm trying very hard to help everyone with information during this difficult time......
1. Question: If a fair hearing has been schedule, is there going to be any attempt by DCH's legal counsel to review those cases under the new criteria prior to the hearing so maybe some of these families will not have to go through the hearing process and be reinstated?
1. Answer: We have re-reviewed all cases that were pending an appeal. Those children who are approved under the revised criteria have either received approval letters or will receive the approval letters. Families whose denials were upheld will not lose their appeal rights.
2. Question: How is this going to be implemented? Immediately?
2. Answer: The criteria go into effect immediately. Those in process will be reviewed using the new criteria. Those in some stage of appeal will be reviewed using these criteria.
3. Question: How will this criteria impact those children that have cancer, CF, and high medical costs but don't have the MR?
3. Answer: This criteria applies only to the level of care for ICF-MR.
4. Question: Are the other two criteria being re-written as well?
4. Answer: The skilled nursing care criteria will have some revisions, and should be released soon.
5. Question: How will these criteria be implemented for babies and young children? Many children are not given a formal IQ test until they are 8 yrs old in school. Who will be determining if a child is two standard deviations from the norm (therapists, developmental pediatrician, etc)?
5. Answer: The criteria are inclusive, not exclusive. The standard deviation measure appeals to standardized tests administered by the treating professionals. If there is not standardized test available for a particular age or disorder then the medical reviewers will have to use their professional judgment to assess.
I realize this is a very stressful situation for many families and I'm trying very hard to help everyone but please be patient.........I hope this information is helpful.
I will forward additional information as it's available for distribution.
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
(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.