CKSN Update for February 15, 2002
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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Covering Kids with Special Needs project 
ABC for Health Inc. 

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