Location

The HealthWatch committee meets regularly in the Harrambee Center in Madison, WI. The street address for the Harrambee Center is:

Harrambee Center
2202 S. Park St.
Room 310
Madison, WI 53713-1916

For a map please click here. For more information on how to get to the Harambee Center, please contact us directly.

Agenda

The agenda for the upcoming HealthWatch meeting is generally posted when the minutes from the last meeting are posted on our website.

Minutes

Listed below are the minutes to the six most recent HealthWatch meetings. Please visit our archive to see older minutes than those below.

Location

The location for the subcommittee meeting changes on a frequent basis. You make check the agenda listing below for the next meeting location. If you have any questions concerning the location or possible locations, please contact us.

Chippewa County

By virtue of its rural location, the obstacles to managed care advocacy in Chippewa County differ substantially from those found in Dane and Milwaukee Counties. Working with the Chippewa Health Watch steering committee, the Chippewa pilot program has identified several deficiencies in care provision and health care advocacy.

At the top of the list is mental health provision. A public forum attended by parents, professionals and HMO representatives raised awareness of several problems in the health care community including: inconsistent billing practices, limited choice of care providers and gaps in access.

Unfortunately, the problems with mental health care in Chippewa County are applicable to health care generally. “Access is a real problem, as is communication,” says Kathy Reetz of the Chippewa County Public Health Department. “Areas served by the HMO managed care contact are limited. This causes problems with access, and these problems are made worse by time limits and limits on care imposed by the HMOs.”

The shortcomings with the many HMO’s care payment systems become apparent when children and people with special health care needs attempt to procure specialized services. “Obtaining referrals to specialists through HMOs can be difficult,” says Reetz. She also is frustrated with the slow pace at which HMOs process requests. “We have to wait two weeks for approval or denial.”

These obstacles seem daunting, but there are glimmers of hope. “We’ve opened good lines of communication with case workers across the county,” says Reetz. This helps clients gain access to services as close to home as possible. “It’s been a collaborative effort,” says Reetz. “We’ve been getting rid of a lot of people’s frustrating and getting them the services they need.”

To date the Chippewa pilot project has been extremely successful. One goal of the project was to provide 100 families with one-on-one assistance in the year 2000, but says Reetz, “we’ve helped 114 families in the first six month of the project alone.”

The biggest obstacle in Reetz’s mind is education. “Neither clients nor physicians are really aware of how a lot of public programs work, or how they are dealt with in a managed care setting,” says Reetz. Unsurprisingly, education is one of Reetz’s biggest goals.

Milwaukee County

As the most urbanized and most diverse county in Wisconsin, Milwaukee county faces a series of unique problems in its attempts to help parents of children with special health care needs.

At one level, the problems in Milwaukee reflect those found in other parts of the state. A major concern noted by Pat Irving of Community Advocates in Milwaukee is the ignorance that managed care professionals have of some children's’ specialized health care needs. “The people who are making the decisions don’t understand what the kids need,” says Irving. Milwaukee advocates, like those in Chippewa, are also are stymied by red tape and bureaucracy. However, Milwaukee advocates run into a different, more vexing problem with HMO advocates in an urban setting.

“It can be hard to get client referrals because everyone is protective of their turf,” says Irving. It is possible that advocates working within HMOs have not yet opened up to the idea that groups like Community Advocates are not their adversaries.

On top of this perceived reluctance, case workers in the county agency are overwhelmed by the sheer volume of cases and as a result are unable to process all the applications. “My understanding is that last quarter, individual caseloads topped 600 cases per worker.” Under that kind of strain, workers aren’t pushing through the most difficult applications.

And while access is less of a problem in the urban setting, limited choice of care providers is. “There can be bad situations,” says Irving. “If you have a child moving from the Neonatal Intensive Care Unit to a managed care setting, that’s scary.

For their part, Community Advocates have identified these problems, and are using their outreach networks to educate parents about how to negotiate the HMO bureaucracy. But, says Irving, “there’s a lot of work to do.”

What is autism? The Autism Society of Wisconsin describes it as “a neurobiological disorder most frequently identified by difficulties and differences in a person’s ability to communicate.” But this clinical definition does not capture the nuances between different children, different types of autism, and the different types of care that they require.

These nuances are troublesome for parents who are often rejected by insurers who either exclude autism from coverage across the board, or exclude it through a number of qualifications. The result is that a group of children and their families are discriminated against when they seek care. In the minds of some advocates this is no different than choosing to deny someone an inhaler because they are diagnosed asthmatic.

However to insurers, the logic is anything but arbitrary. Despite the fact that autism presents a variety of special health care needs, many insurers classify it as a developmental disability and refuse to cover it as a medical problem. In effect this means that insurers will not cover any treatment, such as physical or speech therapy, if it is related to a diagnosis of autism. Also, many insurers will not cover therapies related to autism if the child is diagnosed at an early age as having “autistic tendencies,” even if he or she is not autistic.

Lastly, many insurers deny coverage on the basis of redundancy. Because many school districts and (in Wisconsin) MA provide various types of therapy for autism, insurers claim that there is no need for these same therapies.

The tragedy of all these exclusions is that many children respond well to therapy if caught early enough. If they are denied coverage by their HMOs, parents of autistic children in Wisconsin can apply for the Katie Beckett program. Katie Beckett is an MA program, but does not count income or assets when determining eligibility. Call ABC for Health at 608.261.6939 for more information.

Parent Resources: Autism
Autism Society of Wisconsin http://www.asw4autism.org/
Autism Research Institute http://www.autism.com/ari
Autism Society of America-Madison (608) 276-8358 or jros@chorus.net

GAO: Medicaid Fails to Cover All Children with Special Health Care Needs

In response to a request from four U.S. Senators, the U.S. General Accounting Office (GAO) performed an evaluation of Medicaid’s effectiveness in covering children with special health care needs. GAO’s report indicates that the operational definition of children with special health care needs does not cover all children whose medical condition could be considered exceptional. In addition, many children with special health care needs who are covered under Medicaid due to low income are enrolled in managed care plans that fail to monitor them closely.

This problem is particularly acute because while children with special health care needs make up 7% of MA recipients, they absorb 27% of the payments and closer monitoring of their care would likely lower costs and increase quality of care. The report cited the need for safeguards for such children, but acknowledged that the absence of a homogenous population of children with special health care needs makes the legislation of such safeguards difficult. The title of the report is Medicaid Managed Care: Implementing Safeguards for Children with Special Needs, and can be ordered from GAO by calling 202.512.6000.

SSA Issues Final Rules Regarding False or Misleading Statements

The Social Security Administration (SSA) issued final rules, effective July 10, 2000, concerning penalties for knowingly providing SSA with false or misleading information for the purposes of obtaining or keeping monthly insurance benefits under title II or cash payments under title XVI. Under the rule the first time someone is caught knowingly making a false or misleading statement, they lose their benefits for six months. The second time, they lose benefits for twelve months, and for each subsequent offense they lose benefits for twenty-four months. These penalties apply only to benefits under Title II and Title XVI. Furthermore, only the offender is affected; his or her spouse or children will still be eligible for any benefits they receive. For further information, contact: Gareth Dence, Social Insurance Specialist, Office of Program Benefits, Social Security Administration, 6401 Security Boulevard, Baltimore Maryland, 410.965.9872.

HHS Plans to Increase Emergency Preparedness for CSHCN

The United States Department of Health and Human Services, Maternal and Child Health Bureau, National Highway Traffic Safety Administration, Emergency Medical Services for Children (US DHHS-MCHB-NHTSA EMSC) has advocated a plan to best provide medical information to emergency medical staff when dealing with a child with special health care needs.

The proposed plan involves the use of a passport card or single page form that would contain necessary information about the child. Even though the efficacy of this plan has not been studied, several projects have been implemented in New Mexico, Wisconsin, Ohio, Kentucky and West Virginia. Two methods of handling information have been wallet cards or a single-page two-sided form. Source: Pediatrics, October 1999.

Wisconsin Directory of Services for Women, Children and Families

The Department of Health and Family Services has issued the 2000 edition of the Wisconsin Directory of Services for Women, Children and Families. The DHFS also provides this directory in Spanish. A hard copy is on file at ABC for Health. If you wish to order a copy or have questions, contact: Debbie O’Brien at 608.267.5114 or obriedl@dhfs.state.wi.us and request the Act 309 Directory.

Individualized Education Guide

The U.S. Department of Education’s Office of Special Education and Rehabilitative Services recently published a guide to implementing the requirements of the Individuals with Disabilities Education Act’s Individualized Education Programs (IEP’s). While there are no health benefits directly associated with IEP’s, they do require a physician’s diagnosis of disability. That diagnosis can be a first step to obtaining publicly funded health benefits for children with disabilities. IEP’s are required by federal law, and thus represent an entry into the system for many parents who do not know where to begin. The guide covers both procedure and strategy, as well as frequently asked questions and is available at: http://www.ed.gov/offices/OSERS/OSEP/IEP_Guide/

IDEA Enforcement Weak and Ineffective

A report issued by the National Council on Disability (NCD) in January 2000 called “Back to School on Civil Rights” points that enforcement of Part B, the section that addresses assistance for the education of all children with disabilities, of the Individuals with Disabilities Education Act (IDEA) has been weak and ineffective. Researchers found that each state was in violation of at least one area of IDEA. Problems include the fact that many parents haven’t been educated enough about IDEA’s requirements and monitoring to pursue enforcement. Also, formats of monitoring reports change from one period to the next, making the tracking of changes difficult.

The problems inherent in the system prompted the NCD to compile a list of recommendations to Congress. Among the recommendations are that a federal-level process to handle violations of state or local school districts be implemented with the Justice Department having independent authority to investigate and litigate cases brought under IDEA.

The NCD also sent recommendations to the Department of Education, directing that DOE establish and use national standards to measure states’ progress towards improving academic outcomes of children with disabilities. Another recommendation was that DOE consult with students, parents, and others to develop and implement a number of sanctions that would be triggered by specific indications of a state’s failure to comply with IDEA.

Source: Pacesetter, Spring 2000

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