Dearest Advocates:

 

Based on a number e-mails I received in the last few days…….

 

Below is the text presentation that I gave at the  FOCUS (Families of Children Under Stress) educational conference held on Feb. 4th regarding the Katie Beckett Waiver program.   I thought everyone could benefit from the below information that I presented. PLEASE note this presentation did not include  the recent changes to the eligibility criteria based on our advocacy effort that I released today!  Also: 

 

 

Happy Reading. Sincerely, Heidi

===============================================================

 

What is the Katie Beckett 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 disabled child 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.

•          

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)

 

Background on Katie Beckett 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 1,600 children have been denied with a projection of 48% by FY 2007.

•         Over 71% of all KB Waiver families have primary healthcare insurance. Therefore, Medicaid is secondary insurance.

•         KB waiver is already a cost reduction program versus the States alternative to institutional care.

•         KB Waiver accounted for $33 million of the 2003 Medicaid expense. This represents less than 1% of the total Medicaid budget.

•         Based on data given by DCH at the Public Hearing for KB waiver held on 1/19/06:

•         GA program has had significant growth: 250% growth in 5 yrs; 2,694 FY2000, 6,299 FY2004.

•         Since 6/1/05:

•         2,761 have applied to renew: 37% approved.

•         461 have applied for 1st time: 33% approved.

•         1274 have request 1st appeal: 10% approved.

•         246 have requested hearings: 67 resolved

Tips and Traps

•         Review the new eligibility criteria by going to www.communityhealth.state.ga.us.

•         All applications after 11/15/04 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).

•         Fill out all forms out as a “Provider” NOT as a “Parent”.

•         Always send everything to GA Healthcare Partners / DCH by certified mail.

•         DCH is currently reviewing applications submitted in September 2005.

•         #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.

Networking & Building Alliances

•         If you are denied, contact Governor’s Council on Developmental Disabilities (GCDD) via e-mail at pnobbie@dhr.state.ga.us. They are keeping track of denials in the state.

•         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.

•         Stress when talking to your legislators that the majority of the KB waiver 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 is also involved and looking for suggestions. http://aaddpolitical.blogspot.com/

•         Work with the media to get the message out and to help educate the general population of our concerns.

•         AJC is currently asking for feedback during this legislative session. http://my.ajc.com/WBRH037AF62C6991AEF773D35A3F10

•         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.

•         My goal: Make the issues easy to understand and explain to advocates what they can do to influence change in this State.

•         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.

•         Financial Responsibility:

•         The first Denial letter allows parents 30 days to provide additional information to support the level of care approval request.  Whether the parents submits additional information or not, the benefits should continue until a Final Denial letter is issued.

•         The Final Denial letter allows parents 30 days to request an appeal.  Benefits are terminated at the end of the month, once the Final Denial letter is served. However, upon request, benefits are reopened retroactively if an appeal is requested.  The benefits continue through the hearing process.

•         When the appeal decision has been rendered and properly served, the benefits can be terminated at the end of the month that the hearing decision was rendered and served.

•         Families could be held liable for coverage provided during the appeal process. If the family is a new applicant, they would receive no coverage during the appeal process.

Appeal Process

•         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/

•         If any parent feels that they have been discriminated against during the fair hearing they can report it to Chief Justice Louis Oakley or Deputy Chief Judge Michael Malihi. Contact information can be found on the above website.

•         List of helpful websites:

•         Medicaid’s Main ICF-MR page: http://www.cms.hhs.gov/medicaid/icfmr/default.asp

•         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

Current Concerns and Solutions to KB Waiver Situation

•         Consistency of review. We need to make sure that “reviewers” are not just looking at the Individual Education Plans (IEP’s) that report the child’s progress, not the delays, as well as, the child’s disability, appeal info. etc.

•         Federal Regulations versus the States interpretation. It is my understanding that the State is currently exceeding the regulations for hospital, nursing home and intermediate care facility levels of care determination for eligibility. “Active treatment” definition also needs to be defined.

•         Qualifications of the medical review team. Making sure all those on the review team have pediatric and clinical experience in disability related issues.

•         Problems with the overall communication process and training of staff. DFACS case workers are not able to help families as they go through the process due to lack of knowledge of the system.  Also having a “live” person available to help answer questions families may have during the documentation and appeal process.

•         Reauthorization Process needs to be modified.  The status of many children does not significantly change from year to year yet our families, doctors, nurses, therapists, etc  have to fill out a stack of paperwork every year that may not be necessary. This adds time and money to the process without adding value.

•         Possible Solutions for those that do not qualify for KB waiver but need support.  Create an Insurance Risk Pool, Buy-in insurance program or a State fund pool to help families with costs not met by their insurance.  May also want to look at a new waiver for those children that do not qualify for KB Waiver but have significant behavioral, health related and developmental delay needs. The State may also need to look at increasing the private insurance’s responsibility for standards of care for children.

•         Overall: Families are asking for a clear and fair review process  for their child’s KB waiver

Other Things to know:

•         Attend Disability Day at the Capitol to be held on February 23, 2006. More info: www.gcdd.org.

•         Medicaid Modernization. The Governor’s office is looking to reform the entire Medicaid population. This recently was announced to be delayed until 2007.

•         Georgia Enhanced Care Program.

•         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.

 --
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.

March 3, 2006

 

Dearest Advocates:

 

As promised, please find below the new eligibility Level of Care criteria for Intermediate Care Facility / MR for Katie Beckett Waiver from the Dept of Community Health. 

 

Please note: I have not had a chance to review these criteria in detail. Therefore, I'm sure we will all have questions that will need to be addressed BUT at least we know what the new rules are right now.

 

If you have concerns about the new criteria, please send me a BRIEF e-mail explaining your concerns and your child's disability and age so I can put together a composite listing to be given to Dept. of Community Health for review and clarification.

=======================================

 

INTERMEDIATE CARE FACILITY (ICF/MR) LEVEL OF CARE

 

Summary:

 

1.        ICF/MR level of care is appropriate for individuals who require the type of active treatment typically provided by a facility whose primary purpose is to furnish health and rehabilitative services to persons with mental retardation or related conditions.

2.        An ICF/MR level of care is generally indicated if one condition of Column A is satisfied in addition to the conditions Column B and Column C being satisfied.  Conditions derived from 42 C.F.R. 440.150, 435.1009, and 483.440(a).

3.        Column B refers to “an aggressive, consistent implementation of a program of specialized and generic training, treatment, health services, and related services.”   These active treatment services, as defined in 42 C.F.R. 483.440, provide aggressive, consistent monitoring, supervision and/or assistance as defined in the plan of care to address the specific medical conditions, developmental and behavioral needs, and/or functional limitations identified in the comprehensive functional assessment.  This comprehensive functional assessment must be age appropriate.

4.        The following conditions meet ICF/MR institutional level of care criteria, as these individuals would be institutionalized regardless of ability to participate in an aggressive program of specialized and generic training, treatment, health services, and related services as outlined in Column B:

·         Those children with an IQ of 50 or below (moderate to profound mental retardation) or

·         Those children who meet the criteria for Autism, Autism-Spectrum, Asperger’s, Pervasive Developmental Disorder, Developmental Delay, Mental Retardation, Down’s Syndrome, and any other Developmental Disability as evidenced by:

                                                               i.       a score on a standardized adaptive functioning tool of 2 standard deviations below the norm in three or more of any of the following behavior domains: self care skills, understanding and use of verbal and nonverbal language learning in communication with others, mobility, self-direction, and age-appropriate ability to live without extraordinary assistance or an overall standard score < 70, or

                                                              ii.      if their age equivalency composite score is less than 50% of their chronological age, and/or

                                                            iii.      the child has a Childhood Autism Rating Scale (CARS) score of above 37, a Gilliam Autism Rating Scale (GARS) of  121 or greater, or any other equivalent standardized assessment tool which indicate severe autism.

 

 

COLUMN A (Diagnosis)	COLUMN B (Plan of Care)	COLUMN C (Functional Need)
1. The individual has mental retardation.                OR   2. The individual has a severe chronic disability attributable to cerebral palsy or epilepsy.                      OR   3. The individual has a condition, other than mental illness, (i.e. Autism, Autism-spectrum, Asperger’s, Pervasive Developmental Disorder, Down’s Syndrome or Developmental Delay) which is found to be closely related to mental retardation because it is likely to last indefinitely, and requires similar treatment and services.   AND   4. The impairment for those conditions outlined above constitutes an impairment of general intellectual functioning, and results in substantial limitations in three or more of the following functional limitations: ·         Self-care skills such as feeding, toileting, dressing and bathing; ·         Understanding and use of verbal and nonverbal language learning in communication with others; ·         Mobility; ·         Self-direction in managing one’s social and personal life and the ability to make decisions necessary to protect one’s self as per age-appropriate ability; and/or ·         Age-appropriate ability to live without extraordinary assistance	On a continuous basis, the individual requires aggressive consistent implementation of a program of specialized and generic training, treatment, health services, and related services which is directed towards— a. The acquisition of the skills necessary for the individual to function with as much self-determination and independence as possible; and b. The prevention of further decline of the current functional status or loss of current optimal functional status. This is evidenced in the Plan of Care by the individual’s participation (at least five (5) days a week) in interventions which are required to correct or ameliorate the conditions/diagnosis; and are compatible with acceptable professional practices in light of the condition(s) at the time of treatment.   Active treatment does not include: interventions that address age-appropriate limitations; or general supervision of children whose age is such that supervision is required by all children of the same age or physical assistance for persons who are unable to physically perform tasks but who understand the process needed to do them	1.  The services have been ordered by a licensed       physician.   AND   2.  The services will be furnished either directly        by, or under the supervision of, appropriately          qualified providers (see definitions):    AND   3. The services, as a practical matter, would have ordinarily been provided in an ICF-MR, in the absence of community services.

 

Revised 3/3/06

 

Hope this information helps.

 

Sincerely,

Heidi

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

March 8, 2006

 

Dearest Advocates:

 

Yesterday I sent the below advocacy e-mail but wanted to clarify and add a few items......

 

1. The Katie Beckett Waiver funding of $7.6 Million was put into the Supplemental 2006 Budget. Therefore, both the House and Senate have agreed to this funding.  Please also take a moment to thank the following Senators, as well as, the below Representatives I gave you yesterday:

 

Senator Tommy Williams tommie@tommiewilliams.com

Senator Jack Hill jhill@legis.state.ga.us

Senator Bill Stephens bstephen@legis.state.ga.us

 

2. The funding for the MRWP and ICW programs is being proposed with the House for the 2007 Budget and therefore will be going to the Senate next for approval.

 

3. Change: Rep. Judy Manning's e-mail address is: judymanning@bellsouth.net

 

Sorry for the confusion....It's very hard to keep track of everything going on (especially, when I'm not down at the Capitol). I rely on my vast network of families, legislators, friends, providers, etc in getting the information out as quickly as possible.

 

In addition, I'm working with a few reporters all over the State right now regarding our advocacy effort and needs for children and adults with disabilities.  Education is the key to success! If you have not already done so, please submit the following information (if you are interested in speaking to the media). I'm specifically looking for the following areas: Savannah, Albany, Athens, Athens, Augusta, Macon, Columbus, and Rome.

 

1. Name.

2. Child's age and disability.

3. Where do you live.

4. Contact info including: phone and email address.

5. Any additional comments you have that may be interesting to the media.

 

Thanks again- This is a very exciting time for Georgia and Disability Awareness and FUNDING!

 

Have a wonderful day,

Heidi

Dearest Advocates:

 

Today, the House Appropriations Committee recommended, as part of a multi-year funding plan, to fund 1,500 new supports to Unlocking the Waiting Lists with 9 months of funding and 152 new Independent Care Waiver slots for the 2007 Budget! This is fantastic news! 

 

In addition, the House has proposed a TOTAL OF $ 7.6 Million for those families that have been denied the Katie Beckett Waiver due to the change in criteria in November 2004! As part of that proposal, a foundation would be established to review, process and issue monies to those families. The funding would be for the remaining 06 budget (April 06-June 06) and the entire 07 Budget (July 06 -June 07). The hopes would be that this foundation would be self sufficient by mid-2007. (Please don't ask me additional questions regarding this funding.....this is all I know at this time. As soon as I have more information, I'll forward to the group).

 

If the above information does not show  you that grass roots advocacy is paying off.......I don't know what does. This is amazing!

 

 

Please take a moment to thank the following Representatives in the House and let them know we appreciate their commitment to children and adults with disabilities:

 

bharbin@legis.state.ga.us, jbrown@legis.state.ga.us, dsheldon@legis.state.ga.us , mickey@legis.state.ga.us, chugley@legis.state.ga.us, jshaw@legis.state.ga.us, subrmyster@aol.com, votebutler@bellsouth.net, repdavidgraves@hotmail.com, judymanning@bellsouth.net, rstephens@legis.state.ga.us, lwalker@nfumc.org, loneal@legis.state.ga.us

 

(I tried to make this as easy as possible for you so all you have to do is cut and paste the above list of legislators into your thank you document)

 

This funding still needs to be approved in the Senate but this is a step in the right direction!

=====================================================

In addition, I know we all have concerns regarding the recently published eligibility criteria for the ICF-MR for Katie Beckett Waiver.  I am currently in the process of preparing a list of concerns to be issued to Dept. of Community Health. If you have specific issues, please email me a BRIEF list of your concerns.

 

Thanks again, Heidi

Dearest Advocates:

 

The new eligibility criteria for Intermediate Care Facility (ICF-MR) Level of Care (which I sent out early March 06) AND the Nursing Facility Level of Care has  been posted to the Dept of Community Health's website:

 

 

Many of you asked about a child that is medically fragile, cystic fibrosis, organ transplant, premature children, hemophilia, sickle cell and Osteogensis Imperfecta, etc.........Your level of care specifics can be found under Nursing Facility Level of Care now.....

=================================================

In addition, if your child received a final notice of denial in the mail that stated that you did not submit additional paperwork (when you did).....Please let me know.

 

Over the weekend a number of families contacted me, regarding this issue and I need to get a list together of parents effected by this "process" breakdown.  If this has happened to you, please submit to me the following information:

1. Name of Child.

2. Medicaid Number.

3. When did you submit your additional information. (if you have a delivery tracking number let me know that too).

4. When did you get a letter stating that you have a final denial based on not submitting additional paperwork (and you did).

 

This is EXACTLY why I say that you need to send ALL information via certified mail/returned signature receipt. You need to have proof that you submitted to them this information. Also- ALWAYS make copies of everything you submit too!

 

======================================================

I hope this information is helpful.

 

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.

Dearest Advocates:

 

I have a few updates for you:

 

1. Below is an e-mail from Dave Blanchard of AADD. It is fantastic news....The House and Senate agreed to 1,500 Medicaid Waiver slots for MRWP and 152 for ICWP!  Please take a moment to thank your legislators and the legislators on the below link........ 

The session is finally over!

In the final budget, the House and Senate agreed to 1,500 Medicaid waiver services for the MRWP and 152 for the ICWP slots! They also included in the DCH's budget a directive for DCH to research a Medicaid Buy-In initiative for Georgia. This real success reflects the many months of hard work and effort from individuals like yourself all across Georgia.

For all the details, go to http://aaddpolitical.blogspot.com/

Now is the time to send a note of thanks to a few of the legislators that helped make this happen - again we have made this very easy for you.

Simply, go to http://www.unlockthewaitinglists.com/actionalert.html and click! Thank you for all you are doing and congratulations!!

Dave Blanchard
http://www.unlockthewaitinglists.com

====================================================

2. I was just informed that Mark Trail will not be attending the Medicaid forum to take place on April 8th in Royston, GA.  Nancy Durden (Acting Director for Recipient and 3rd Party Services from the DCH) will be attending on Mark's behalf.  Just wanted you to have the latest information.

=====================================================

3. Do to your overwhelming thank you's to Rosemary Taylor - Editor of the John's Creek Herald and contributing reporter to the Revue and News newspapers, they plan on having a few your letters that were submitted to her in the next weeks newspaper. Thank you so much for continuing the communication and keeping the issue alive....The more the community understands the issues associated with our families, the better!

=====================================================

4. Many of you have asked if the $7.6 million that was set aside for families that have been denied the Katie Beckett Waiver has been made available yet......It is my understanding at this point they are looking at the best way to have a foundation get up and running quickly so the money will be made available very soon. As soon as I hear of any updates, I will let you know.

======================================================

5. Here is a great summary of some of the issues from this legislative session prepared by Pat Nobbie of Governor's Council on Developmental Disabilities (GCDD) "Moving Forward": (Heidi's Note: I did delete some of the issues due to the length of the email. I thought this would be the issues you would be most interested in)

The legislative session ended last night at midnight, and overall it was a very productive year for people with developmental and physical disabilities in Georgia. Major accomplishments were in the Unlock Budget: 1500 MRWP waiver slots funded for 6 months with important infrastructure funding, 152 ICWP waiver slots for people with physical disabilities and traumatic brain injury, and $7.6 million for families no longer eligible for Katie Beckett access to Medicaid. See below for the budget breakdown!

In the DCH 06 budget:

Add 152 slots to the Independent Care Waiver Program (ICWP) $3,286,957 state $8,535,333 total

***By December 1, 2006, the department shall conduct an analysis of Medicaid Buy-In programs operational in other states and shall recommend a cost-effective Medicaid Buy-In program that would allow working Georgians with disabilities to receive healthcare through Medicaid.***

ITEMS TO WATCH:

Reduce Medicaid costs generated in the Aged, Blind and Disabled populations through the provision of better business practices to ensure that the member receives the right services, at the right time, and the right cost. CC: Reduce Medicaid Benefit costs by implementing an Administrative Services Organization model as a gatekeeper. State: $25,038,336 Total $65,017,751 (Heidi's Note: This is something we are going to have to really watch and see what is recommened)

In the DHR 06 budget:

Annualize the cost of the 925 waiver slots on the MR/DD Waiting List, adults $2,648,987 state $6,878,700 total

Annualize the cost of the 925 waiver slots on the MR/DD Waiting List, children $548,430 state $1,424,123 total

Add 750 slots for consumers on the MR/DD Waiting list (total 1500 slots, 6 months funding, adult share) $9,619,528 state $21,837,981 total

Add 750 slots for consumers on the MR/DD Waiting list (total 1500 slots, 6 months funding, children’s share) $1,970,266 state $4,472,842 total

ITEM TO WATCH:

Recognize efficiencies within the Department of Human Resources through the implementation of an Administrative Services Organization provided by the Department of Community Health. State ($500,519)

Please call or write the legislators on the Appropriations Subcommittees and full committees on Appropriations both House and Senate to THANK them for their commitment to funding for people with disabilities!

·  DHR Fiscal Year 2007 Budget

Olmstead - Fund 1500 MR/DD slots to Unlock the Waiting Lists; Adult services, $9,993472; Child and adolescent services, $2,046,857. State funds: $12,040,329 Total funds: $25,148,408 (Senate: Fund 1550 Services for 6 months, state funds $11,598,794: Senate added 1500 MRWP waiver services at 12 months of funding $24,147,199 state funds) ·  DCH Fiscal Year 2007 Budget Reduce Medicaid benefit costs by implementing am Administrative Services Organization model as a gatekeeper and manager of services. House: $24,847,200 Senate: $26,229,750Total $39,674,223 $35,926,380 Add 152 slots to the Independent Care Waiver Program (ICWP) $3,286,957 state $8,535,333 total (Senate, 10 slots annualized from FY 2006 budget, and 142 new slots) Increase reimbursement for Speech Therapy visits. State, $346,590 Total funds $553,410 (Heidi's Note: This is great news for our Medicaid speech providers!) Provide Dental coverage for Medicaid eligible pregnant women (designated codes) State, $2,500,000 Total funds $6,491,820

====================================================

Have a safe and wonderful Spring Break.  Please note: I will not have access to e-mail next week.  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.

April 10, 2006

 

Dearest Advocates:

 

Hope everyone had a great spring break.  I have a couple of  advocacy updates for everyone. You may want to print this e-mail out to read due to the length................

====================================================

1. I have been informed the Skilled Nursing Level of Care has been changed for the Katie Beckett Waiver. The Dept. of Community health has added under Column B #3 the following language: "The beneficiary must require skilled nursing or skilled rehabiliation services or both on a daily basis".  To see entire Level of Care, please go to the following website:

 

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2. Due to all your wonderful Letters to the Editor of the John's Creek Herald and Revue and News Newspapers regarding the recent Katie Beckett Waiver article, they dedicated an entire section to our families comments.  The editor stated the following: "We received a huge response from readers regarding our 3/29 story on disabled children who've lost their Katie Beckett Medicaid benefits. Above is just a sampling from some of the parents of these children". 

 

Many thanks to: Christy Butch, Paige Couper, Amy Adams, Sherry Brooks and Loretta Mitchell for your comments to Rosemary Taylor (Editor).  Let's keep up the great work at continuing to educate the community of the concerns we face of families with children with special needs.  If you would like to write Rosemary, her e-mail address is: rosemary.taylor@northfulton.com. I know last time I spoke to her, she is interested in possibly doing a follow-up article later this year.

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3. I have had a couple of families contact me over the last two weeks expressing some concerns with the "process" of renewal even after they appealed last years denial and were reinstated.  Just a reminder: If you know that your renewal date is coming up and have NOT received a Medicaid renew application in the mail, PLEASE contact your DFACS worker and let them know. Don't assume, just because you did not receive any paperwork you don't have to submit this year.  A few families were denied AGAIN due to this procedure problem.

 

We as parents need to be proactive with our child's Medicaid and make sure we have the necessary paperwork in on time with the DFACS office.

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4. I will be posting a parents "Letter of Medical Necessity" that their child's Pediatrician submitted on behalf of their appeal.  Happy to say they were reinstated the Katie Beckett Waiver.  Many thanks to Judy D. for submitting this information to help other families.  If you would like to see this example, please go to the following website for more information:

 

If you have a successful letter that may help other parents or tips of how to help families, please submit to my e-mail address: heidijmoore@comcast.net. We can all learn from each other.........

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5. Another article was written by reporter, Lee Shearer of the Athens Banner Herald on Sunday regarding the Katie Beckett Waiver situation. Please take a minute to thank Lee for his on-going coverage of the issues! Lee can be reached at lee.shearer@onlineathens.com.  Communication and education are the key for us continuing our advocacy efforts. Keep up the great work. Many thanks to Jodi C. for letting me know about the article!

 

Here is the article just in case you missed it:

Parents unload on Medicaid programs For disabled children
By Lee Shearer   |   lee.shearer@onlineathens.com   |   Story updated at 8:57 PM
on Sunday, April 9, 2006
ROYSTON - Parents of children with severe and costly disabilities vented their
frustrations with state Medicaid programs designed to help them pay big medical
bills at a meeting at the Royston Baptist Church on Saturday.

Decisions on whether a child is eligible for Medicaid help are sometimes
arbitrary, parents said.

Jodi Cronic, assistant principal at Madison County's Comer Elementary School,
said Medicaid has helped her family pay for overwhelming medical costs over the
past three years for her 12-year-old son, who has complex learning and behavior
problems.

But now, state officials say the family is no longer eligible, she told about 50
people at a meeting of a group called "Connections for Special Parents." The
reason for the denial: Part of her son's problem is considered psychological,
and help for primarily psychological problems is not allowed under the Katie
Beckett waiver, a Medicaid program which has provided financial help to cover
her son's medical bills for three years.

"How fair is that?" she asked. "I think it's discriminatory."

Most Medicaid programs are designed to help low-income people, but the Katie
Beckett waiver helps families with children with unusually severe disabilities,
regardless of family income. It's called a waiver because federal officials have
waived normal rules that limit Medicaid spending to people confined to
institutions, such as nursing homes. Waiver programs like Katie Beckett allow
them to receive treatment in their home or community instead.

Cronic, crying as she spoke to the group, said her family will face medical
costs they can't pay for if a final appeal fails. Her state health insurance has
denied coverage for her son's treatments, and the cost for just part of it, a
one-week stay in a psychiatric hospital last year, was $14,000, she said.

Hundreds of families have been cut off the Katie Beckett waiver since last year,
after the state Department of Community Health, which administers Medicaid,
tightened up eligibility requirements.

Nancy Durden, a state Department of Community Health administrator, reminded the
group that federal regulators, not state ones, make the eligibility rules.
Before tightening the eligibility rules, Georgia had gotten "pretty far outside
the guidelines," she said.

The eligibility rules were not the only target of complaint Saturday.

Workers with a private company the state hired to make eligibility decisions for
Katie Beckett help often are not qualified to make those decisions, said Joshua
Norris, director of legal advocacy for the Georgia Advocacy Office, a nonprofit
corporation that helps disabled and mentally ill people in the state.

And case managers with the state Department of Family and Children Services, who
are supposed to help families negotiate the Medicaid bureaucracy, often don't
know the Medicaid programs well enough to help, some parents said.

"Why can't you tell parents what services are available?" asked one parent,
speaking to DFCS representatives at the meeting.

The director of state Medicaid programs promised more than a year ago to see
that DFCS case managers were trained in Medicaid programs, said Pam Moore, who
works with the parents of disabled children in the Madison County School System.

"They haven't been," she said.

Others said it's hard for people who work with Medicaid full-time to keep up
with frequently changing rules and programs, much less DFCS workers, for whom
Katie Beckett families are a small part of a caseload of hundreds of families.

"The one thing you need to realize is even if you think you understand it
(Medicaid), it will change," said Dottie Adams of the Governor's Council on
Developmental Disabilities.

Georgia could stretch its Medicaid dollars more, Adams said.

The federal government provides generous matching money when states put money
into Medicaid waiver programs, but Georgia doesn't get as much federal Medicaid
money as some other states, she said.

"One of our problems is that it has not been a priority for our legislature,"
she said. "It's a good deal for our state."

But good news came out of this year's legislative session, she said.

Legislators added enough money to the Medicaid budget to take 1,500 people off
waiting lists to receive various kinds of Medicaid services such as in-home
nursing care. There are about 6,000 people on these waiting lists, but there
ought to be more than 14,000, Adams said. Many people who are eligible for state
help don't even bother to sign up because the waits are so long, she said.

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Hope this information helps. Have a great evening.

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.