CKSN UPDATE for December 1, 2002
 
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IN THIS ISSUE
 
1. Welcome to CKSN Update
 
2. CASE TIP: Prior authorization (PA) and Katie Beckett
 
3. PROGRAM UPDATE: Renewal of PA requests for therapy services provided as part 
of Birth to 3 no longer needed
 
4. PROGRAM UPDATE: Procedure code changes for speech and language pathology 
services
 
5. HEALTHWATCH: Contacts Announced for Regional HealthWatch Committees   
 
 
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1. Welcome to CKSN Update
 
Welcome to the first issue of the CKSN Update. 
 
The Update is the biweekly e-newsletter of Covering Kids with Special Needs 
(CKSN), a statewide project that ABC for Health is implementing with its 
partners, the Regional CSHCN Centers and Family Voices of Wisconsin. Funded by 
the Maternal and Child Health Bureau, this project is designed to: 
 
1) gather information on health care coverage issues facing CSHN;
2)    provide resources and strategies to address these issues; and
3)    promote networking and collaboration between parents and a 
spectrum of service providers across Wisconsin. 
 
Through this project, ABC for Health will provide direct health benefits 
counseling services to families of children with special health needs. Families 
who need assistance in resolving access and coverage issues can contact ABC for 
Health at 1-800-585-4222.
 
The Update will feature ADVOCACY TIPS, CASE STUDIES, and REGULATION/ POLICY 
UPDATES for health care financing programs as well as news from the HEALTHWATCH 
COMMITTEES (see HEALTHWATCH below), including meeting announcements, links to 
meeting minutes, and updates on issue identification activities.
 
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2. CASE TIP: Prior authorization (PA) and Katie Beckett
 
Even before your child’s application for Katie Beckett is approved, you should 
carefully review with your provider the need to submit a PA for certain Medicaid 
covered services. The case study that follows illustrates the importance of 
submitting your PA before you get a notice of eligibility.  
 
A cautionary tale about Prior Authorization and Medicaid eligibility timing.
 
A single mother whose three-year-old son was diagnosed with autism sought 
services from a behavioral therapy provider. She applied for Medicaid for her 
son through the Katie Beckett program, and she immediately began services for 
him even though she had not received notification of an eligibility approval. 
The mother paid out-of-pocket for several months of services before her son was 
approved for Medicaid through Katie Beckett--effective back to the application 
date. 
 
The provider immediately submitted a prior authorization request for the therapy 
services. Even though her son’s Medicaid eligibility ran from the date of the 
application, the prior authorization was only effective for two weeks prior to 
the date it was submitted. Without a timely PA, Medicaid would not pay for a 
majority of the initial services.
 
To avoid this scenario, providers should submit a PA before services 
begin--regardless of the status of the Medicaid application. Once eligibility is 
established the PA may be resubmitted and services covered for the relevant 
applicant’s eligibility period. It is important that the PA be submitted before 
any services begin, regardless of whether the Medicaid eligibility paperwork has 
been received yet.
 
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3. PROGRAM UPDATE: Renewal of PA requests for therapy services provided as part 
of Birth to 3 no longer needed
 
 
Wisconsin Medicaid has a new process which eliminates the need for renewal of 
prior authorization (PA) requests for occupational therapy (OT), physical 
therapy (PT), and speech and language pathology (SLP) services provided to 
Medicaid-eligible children as part of the Birth to 3(B-3) Program.
 
The simplified PA process at a glance:
· Require therapy providers to submit a PA request only once per child, per 
therapy type, per provider for therapy groups and for independent therapy 
providers.
 
· Require rehabilitation agencies to submit a PA request only once per child per 
therapy type.
 
· Grant PA up to the recipient's third birthday.
 
To qualify, children must meet either receive an initial evaluation and 
assessment for B-3 or participate in B-3.
 
This process is effective for PAs granted on and after July 1, 2002.
 
http://www.dhfs.state.wi.us/medicaid/updates/2002/2002-33.htm
 
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4. PROGRAM UPDATE: Procedure code changes for speech and language pathology 
services
 
As of October 1, 2002, Wisconsin Medicaid has adopted a range of procedure codes 
for billing and prior authorization of speech and language pathology services. 
Independent speech-language pathologists, rehabilitation agencies, speech and 
hearing clinics, and therapy groups are required to use these procedure codes.
 
For list of codes:
http://www.dhfs.state.wi.us/medicaid/updates/2002/2002-49.htm
 
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5. HEALTHWATCH:
 
Regional HealthWatch committees with substantial parent involvement will be 
organized and/or expanded across the state to identify issues which are relevant 
to CSHN health care coverage and access; develop advocacy strategies; work 
collaboratively to address issues; and receive training and resource materials 
on selected topics. 
 
Regional HealthWatch contacts are:
 
Northeastern Region: Steve Gerczak, St. Vincent Hospital, Green Bay, 
1.800.236.3030 ext.8154, sgerczak@stvgb.org
 
Northern Region: Deb Blackstone, Family Resource Connection, Rhinelander, 
1.888.266.0028, dblacks@shsmh.org
 
Southern Region: Barbara Katz, ABC for Health, 1.608.261.6939 ext. 207, 
barbk@safetyweb.org
 
Southeastern Region: Pat Erving, Community Advocates, Milwaukee, 1.414.449.4767 
ext. 136
 
Western Region: Rose Marsh, Department of Public Health - Chippewa Falls, 
1.800.400.3678, ext. 2132, rmarsh@co.chippewa.wi.us
 
Please contact the above people if you are interested in getting involved with 
the HealthWatch committee in your region. For a list of counties and their 
corresponding regional centers, please call Wisconsin First Step Hotline at 
1.800.642.7837 or visit their website at 
http://www.mch-hotlines.org/CSHCN/index.html
 
 
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