Comments Needed

Melissa Stone, Director of DDS, is in charge of the new rules for therapy, and she has agreed to meet with the Medicaid Saves Lives founder. We are still setting up the date and time, but please comment with your concerns and comments so that she can be sure to relay them!

Here are some concerns listed by other parents and concerned citizens:

M. Johnson:
1. Who will be deciding what services my child is qualified for and how much time she needs to achieve her goals?
2. What type of time delay will there be with determining the above?
3. What tools will these individuals be using to determine if she is qualified? To what lengths will they go to, to see she gets the services she needs??
4. If extra time is requested beyond the cap of 90 minutes, what is the process to get that extension, on the parents, the therapist, and the school where she attends?
5. I do feel that many services are abused and that something does need to be done, but with that said, what amount will truly be saved by going through this process and possibly contracting out to a third party?

K. Brunen:
In addition there is already what seems to be an eternity for 1) evaluations to be done, 2) then get sent to Ped, 3) referral to be sent back to facility and then 4) scheduled for therapy. This past summer we had a speech eval done and it was over a month for all of that to happen prior to beginning treatment. That’s extremely valuable time. I’m also very concerned on how and who will be determining who gets the extension. As a PT in an Ortho clinic most of my life when pre-autos we’re required for additional therapy, most of the time it was an administrator with very little medical knowledge of specific conditions or functions deciding if further therapy was warranted and justified. This also puts tremendous stress and work on the already over-worked therapists. Their time needs to be spent in therapy with our kids not doing more paperwork fighting to get additional therapy that many of our children desperately need.

Comment below to list your concerns!

Public Meeting 10/5/16

The Arkansas Department of Human Services requests public comment on proposed rules which will establish a limit on the weekly amount of Medicaid funded speech therapy, occupational therapy and physical therapy that may be provided to an eligible beneficiary without prior authorization.

Currently, the Notice of Rule Change says that all therapies billed under the Medicaid State Plan will allow 90 minutes per discipline per week with the appropriate prescription. However, if greater amounts of therapy is required, a prior authorization or extension of benefits process will be utilized.

The public hearing for comments will be held Wednesday, October 5 at 4:30pm at the Central Library East Room (100 Rock Street). Written comments may also be sent to Shelby Maldonado, the DDS Policy Coordinator (Shelby.Maldonado@dhs.arkansas.gov).

Cash | Alma

cashHi! This is Cash. We live in Alma! He was given a postnatal diagnosis for Down syndrome where we also found out he has transient leukemia. Though he is overall very healthy and has not developed full blown leukemia, we do frequent testing with both oncology and hematology. He receives 90 mins/wk of PT, OT, and Speech. We would not be able afford these therapies without secondary coverage from TEFRA.

Wyatt

brewsterThis little guy gets 120mins/week each of PT, OT, and ST and 60min/week of Developmental Therapy. He’s had an adenoidectomy due to 80% blockage of his airways, a frenulotomy, PE tubes, glasses due to farsightedness and strabismus, he’s had an EEG which indicated a tendency for seizures, an MRI, and he takes medication for seizures. He also wears orthotics on his ankles. He is also in the process of diagnostic genetic testing. Absolutely none of that would be possible without Medicaid.

Ava

praterOur daughter was born at 37 1/2 weeks with the cord around her neck. She was diagnosed with Hypoxic Ischemic Encephalopathy which is lack of oxygen to the brain. Her MRI at 5 days old showed severe global brain damage. We were told she may never walk, talk or eat. Over the past 4 years she has also been diagnosed with Microcephaly (a babies head is significantly smaller due to abnormal brain development) Developmental Delays, Seizures, Dysphasia and Apraxia of Speech. We have primary insurance but she has TEFERA as her secondary as the primary doesn’t cover all her therapies. With the help of Medicaid Ava is walking, eating solid food and talking. Today she is Dysphasia free!! However, she does wear AfOs. She is still delayed and desperately needs Medicaid to help her develop. Currently she receives 180 mins of PT, 180 mins of ST and 90 mins of OT. Along with Developmental Therapy. Medicaid has helped Ava get to where she is today. I can’t fathom where she would be without the assistance of Medicaid.

Olive | Mt. Home

olive

Olive is 2.5 and has private health insurance and a few months ago was approved for TERFA Medicaid. 12 days after she was born we were flown down to ACH where we stayed for 21 days battling encephalitis. 3 days into our stay we received a phone call stating that Blue Cross Blue Shield only covers $5,000 of her $12,000 helicopter ride and how would we like to pay for that? We knew nothing about Medicaid. We were naive and assumed that since our child had insurance that would cover what our daughter needed after we met our deductible. Boy, were we wrong. Since then we’ve had another $12,000 helicopter ride! ACH helped us sign up for Medicaid and we were on AR Kids until we were accepted into TEFRA! Olive was eventually diagnosed with Dystonic Spastic Quadriplegia Cerebral Palsy. Since she was 6 months old she’s received 120 minutes of OT, 180 minutes of PT & 180 minutes of ST from a local CMHS facility per week. We maxed out what BCBS covered in February. On top of helicopter rides & therapy there is also equipment that Olive needs to help her progress. Some of which insurance flat out won’t cover, private or Medicaid. My husband and I have spent thousands of dollars out of our pockets on Olive’s care and we are happy we are able to do so as that’s our responsibility as her parents. But without Medicaid we would have been completely bankrupt after her first 8 months of life. In a perfect world insurance companies would cover what a child needs but that doesn’t happen and when your child has a disability such as Cerebral Palsy, Medicaid becomes a necessity.

Tank

tankOur son was born at 37 weeks with a postnatal diagnosis of Down Syndrome. By 4 months of age practitioners informed us that our son had Plagiocephaly, also known as flat head syndrome, which is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. They informed us that a cranial helmet would be potentially 99% effective in correcting the Plagiocephaly. Unfortunately, our primary insurance denied the request for treatment. Thankfully, we had TEFRA and without TEFRA we would not have been able to afford not only one, but two of these helmets. Today our son is 18 months and he is free of a helmet and plagiocephaly. We desperately need medicaid for instances such as this and for daily physical, occupational and speech therapy.

Kennadi, Griffin, & Macy | THE BATESVILLE DAILY GUARD

batesville-daily-guard2

Kennadi Pretty, Griffin Cossey and Macy Bryant are three Independence County children born with special needs whose families, without receiving Medicaid benefits, would not otherwise be able to afford treatments, therapies and other medical expenses for their children. They fear a cut in Medicaid funding will affect these families and many others — as well as a loss of jobs in this area (physicians’ offices, therapy clinics, developmental daycares, dental offices, Arkansas Children’s Hospital and other hospitals in the area).

Their story, “The real faces of Medicaid…” is in today’s Batesville Daily Guard.

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