Let's Get Together, Inc.

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:

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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

June 8, 2007

Dearest Advocates:

Below is a newspaper article today in the Gwinnett Daily Post written by Dave Williams regarding the HB 549 that was VETOED by the Governor 1 � weeks ago. As many of you are aware, this is a very frustrating time for both families and providers since the implementation of a more difficult prior authorization process for therapy in September 2006.

This bill would have allowed for prior authorizations (PA) to occur every 6 months and not 3 months, as well as, increase the number of units of therapy from 8 units to 16 units / month before needing a PA. There is a reason why our children need therapy��We already have to go thru a ton of paperwork just to �prove� that we qualify for Medicaid for our children and now they say we have to �prove� it every 3 months for therapy! This is a waste of taxpayers $$$. Hiring more therapists to �review� the cases instead of paying for the therapy for our children to begin with��is crazy! In addition, our children do not make the type of progress warranted to be reviewed every 3 months like other �general� Medicaid populations. There are many ways to access Medicaid and there are different criteria for those populations. Mr. Trail�s comments below do not make sense. I�m sorry�I usually do not give this much of my personal views on issues, but I strongly disagree with the VETO and the reasoning behind it!

Here is the actual link to the newspaper article:

http://www.gwinnettdailypost.com/index.php?s=&url_channel_id=32&url_article_id=28865&url_subchannel_id=&change_well_id=2

PLEASE take a moment and thank Dave William (dave.williams@gwinnettdailypost.com) for continuing to educate the State on what is truly happening to our children. This same article can also be read in the Albany Herald Newspaper http://www.albanyherald.com/front.html#chil .

We are continuing to work on this issue and will hopefully have more information in the near future on what we all can do to make a difference! Therapy is an INVESTMENT for our children!

Hang in there. UNITED� WE WILL MAKE A DIFFERENCE!

Happy Reading.

Heidi

gwinnettdailypost.com

Parents frustrated with veto of therapy bill

06/08/2007 -

By Dave Williams
Staff Writer
dave.williams@gwinnettdailypost.com

ATLANTA - Advocates for children with disabilities are seeing first-hand just how powerful one governor is compared to 236 state legislators.
As a bill easing restrictions on therapy visits traveled through the General Assembly this year, the 180-member House and 56-member Senate supported it unanimously three times. And the fourth vote on the legislation, in the Senate, was 47-2.

Yet, House Bill 549 was among the casualties last week when Gov. Sonny Perdue vetoed 41 bills in one day. Absent an unlikely attempt by lawmakers to override the governor when they reconvene in January, the measure is dead.
"That's the frustration of this," said Heidi Moore of Alpharetta, a leading advocate for children with disabilities and mother to a 7-year-old boy with Down syndrome.

"The House and Senate saw the need for this. ... Either (Perdue) doesn't understand this bill or it gets down to numbers again."
Moore and other parents began pushing for a legislative remedy to their complaints about therapy services covered under a Medicaid waiver program after the state instituted a policy last September requiring families to seek prior approval every three months.
The bill, sponsored by House Speaker Pro Tempore Mark Burkhalter, R-Alpharetta, would have extended prior approval for therapy visits to six months.
It also would have required the state to cover children for 16 units of physical, speech or occupational therapy per month, up from eight units under the state policy. Four units equals one hour of therapy.
But Perdue, in his veto message, said those changes would have run afoul of the federal agency that oversees Medicaid.

"(The bill) would restrict the state's ability to conduct appropriate prior authorization review as required by federal regulations," the governor wrote.
Mark Trail, Medicaid director for the Georgia Department of Community Health, said the state sent a copy of the bill to the federal Centers for Medicare and Medicaid Services and was told the CMS would not approve it.
Specifically, Trail said the agency objected to a provision allowing children with "chronic" disabilities to seek prior authorizations every six months but forcing kids with "acute" conditions to adhere to a shorter time frame.
"That sets a standard in law that would be unacceptable to the federal government," he said.

Perdue's veto message instructed the DCH to continue looking for ways to streamline the paperwork therapists and parents have to fill out to process prior authorizations.
Trail said the agency already has put in place some changes, including consolidating two of the required forms into a single document and improving the Web site families use to submit prior approval requests.
He said the DCH also has hired 21 therapists to review requests, additional staffing that is expected to speed up the process.
"We have a very high percentage of approvals now, which says to us that the providers know how to submit the forms," he said.

Moore said as long as the process remains cumbersome, more and more therapists will stop taking Medicaid patients.
"We lost a therapist because of it," she said. "Our speech therapist told us she just can't deal with the paperwork."
The ultimate fear, Moore said, is that so many therapists will pull out of the program that families won't be able to get therapy services they can afford. In the long term, that would mean more disabled children growing up to become a huge burden on taxpayers, she said.
"Therapy is an investment in our children," Moore said. "You either pay pennies now or dollars later."

--
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!"

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