CKSN UPDATE for June 1, 2003		ABC for Health, Inc.

IN THIS ISSUE:

1. Correction from May 15 Update
2. Case Tip:  Medicaid Denials of Duplicative Therapies
3. Minnesota Statewide Program to Educate Medical Professionals on Screening for Autism Spectrum Disorders
4. Health Insurance Focus for the Spring Packard Foundation Journal
5. HealthWatch Updates


1. CORRECTION FROM MAY 15 UPDATE

RE:  Case Tip #2... The Ombuds number listed in that case tip should only be called if the person is enrolled in a Medicaid/BadgerCare HMO and denied that service by their MA/BC HMO.  If the person is fee-for-service they can contact Recipient Services at 1-800-362-3002.  The moderator apologizes for any inconvenience.

2. CASE TIP:  MEDICAID DENIALS FOR DUPLICATIVE THERAPIES

Parents of children on Medicaid often see prior authorizations for speech therapy denied on the basis that the requested therapy is duplicative of what the school is providing.  Many parents and providers attempt to appeal the denial by demonstrating the differences in the school setting and community settings and how those settings relate to the goals and plan of care for the child.  While this is a good idea, parents and providers may overlook the issue of the adequacy of school services.  Many children only receive a few sessions a week and actually need much more.

Therefore, parents work with the doctor to identify and then prescribe a specific number of therapy hours required by the child (per week).  Then identify the number of hours the school provides.  If the school does not provide the number of hours prescribed a parent should argue that they are entitled to the medically necessary prescribed number of therapy hours.

3. MINNESOTA STATEWIDE PROGRAM TO EDUCATE MEDICAL PROFESSIONALS ON SCREENING FOR AUTISM SPECTRUM DISORDERS

An innovative statewide campaign designed to educate physicians and parents of young children about the early warning signs of autism and other developmental disorders is underway in Minnesota.  The program - Minnesota First Signs - is providing free training, screening kits, and CME credits for physicians, nurse practitioners, and physician assistants in a statewide program that organizers believe can serve as a national model.  The campaign is a collaborative effort of the Minnesota Department of Children, Families and Learning, the Autism Society of Minnesota, the University of Minnesota, the Minnesota Department of Health, and First Signs, Inc., a non-profit organization that is spearheading the effort. The goals of the initiative, which began in May, are to:
a) increase knowledge and awareness of the early warning signs of autism and other developmental disabilities;
b) improve frequency and quality of screening of young children from birth through the early school years;
c) facilitate timely referral of children to local early intervention programs, and
d) lower the age when children with autism and other developmental disabilities are identified.
For more information about the program, go to:
http://www.firstsigns.org/pages/press_center/MN_fact_sheet_042803.html
Additional information for parents and physicians regarding autism and related developmental disorders can be found at http://www.firstsigns.org/index.html
(Source:  Monday Morning in Washington, D.C., Inclusion Research Institute, 2003)

4. HEALTH INSURANCE FOCUS FOR THE SPRING PACKARD FOUNDATION JOURNAL

The spring 2003 issue of The Future of Children, called Health Insurance for Children, contains numerous articles on many aspects of providing health coverage for children.  Topics covered include a historical overview of children's health coverage, why some children are still uninsured, access to health care for special populations of children (including children with special health care needs), reducing health disparities among children, and express lane eligibility.  To access an on-line version of this journal, go to:
http://www.futureofchildren.org/pubs-info2825/pubs-info.htm?doc_id161387
or to:
http://www.futureofchildren.org/homepage2824/index.htm
(Source:  John G. Reiss, jgr@ichp.edu)

5. HEALTHWATCH UPDATES

The Western Regional CSHCN Center held their HealthWatch meeting on May 13, 2003 at the Chippewa County Courthouse.  Sharon Horton from Chippewa County Economic Support presented on the Family Planning Waiver.  Wynne Cook, from the Western Regional Center, presented on the Medical Home.  There were 23 people in attendance, and 10 were parents of children with special health care needs.  The next HealthWatch meeting will be held on July 8.  For more information and to RSVP, please contact Rose Marsh at Chippewa County Public Health, 1-800-400-3678 or by email, rmarsh@co.chippewa.wi.us

The next Southern Regional HealthWatch will be held on Thursday, July 17 from 11:30 - 1:00 pm at the Harambee Center, 2202 South Park Street, Madison.  For more information, and to RSVP, contact Dana McElmury, 608-261-6939, ext.208 or email, danam@safetyweb.org

If you are interested in joining your regional HealthWatch committee, or want more information about their work, please contact the following people:

Southern Region:  Barbara Katz, ABC for Health, Inc., 608.261.6939 ext 207, barbk@safetyweb.org
Southeastern Region:  Brad Holman, Children's Hospital of Wisconsin, 414.266.3189,
bholman@chw.org
Northern Region:  Deb Blackstone, Family Resource Connection, 715.365.8030,
dblacks@shsmh.org
Northeastern Region:  Steve Gerczak, St. Vincent Hospital, 920.433.8154,
sgerczak@stvgb.org
Western Region:  Rose Marsh, Chippewa County Dept of Public Health, 1-800-400-3678, rmarsh@co.chippewa.wi.us



ARE YOU SHARING THE UPDATES WITH FRIENDS OR COLLEAGUES?  

We need your help to better track the distribution of the CKSN update.  Please let us know the names and email contact info of people you forward the email to so we can send them the update directly.  Direct replies to barbk@safetyweb.org 

The CKSN Update is a bi-weekly electronic newsletter of the Covering Kids with Special Needs project that ABC for Health, Inc. is implementing with its partners, the Title V Children with Special Needs Regional Centers and Family Voices - Wisconsin.  If you would like to submit news and information in future CKSN Updates, please send it to the attention of Barbara Katz.  All submissions should be limited to 150 words.

Barbara Katz, moderator
Parent Consultant
ABC for Health, Inc.
608.261.6939 ext. 207
barbk@safetyweb.org