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


IN THIS ISSUE:

1. Case Tip:  Getting Prior Authorizations Back-dated
2. New Electronic Newsletter for Autism and Asperger's Syndrome
3. Children's Mental Health Resource Kit Available for Download
4. Fighting the Fog from LDOnline
5. Model Consumer Directed Care Program Costs Medicaid No More Than Traditional Agency Care
6. HealthWatch Contacts


1. CASE TIP:  GETTING PRIOR AUTHORIZATIONS BACK-DATED
An important feature of family Medicaid and BadgerCare is backdated eligibility for coverage. *  This means that a person may get Medicaid coverage for a date that falls before his or her Medicaid application was approved.  This "back-date" feature can be very important in securing health coverage.  However, some services that are covered by Medicaid or BadgerCare require prior authorization (PA) before they can be paid for.  If you receive services that require a PA before your Medicaid was approved, you may still get those services covered if they are in a back-date period.   This is referred to as retroactive eligibility for Medicaid.  Here is an example of how this works:  Sally applies for Medicaid on September 21, 2003.  At that time, she requests to have her Medicaid backdated to the first day of the month, September 1, 2003, because she did not have coverage then.  Before Sally found out she was eligible for Medicaid, she had several medical appointments during the month of September.  Medicaid tells Sally in October that she qualifies for retroactive eligibility and her medical care is covered, as she requested, from September 1, 2003 onward.  However, while most of her medical care from September is now being covered, Medicaid won't automatically cover some of her medical appointments because these types of appointments require Prior Authorization from Medicaid. What should she do?  How can Sally get prior authorization for previous medical appointments?
In order to qualify for retroactive prior authorization, Sally's health care provider must complete a PA request. Most health care providers have these forms.  Under "Description of Service," the health care provider should indicate that the service was provided at a time when Medicaid covered Sally.  The health care provider must include the actual date each service was provided.  If the PA is approved by Medicaid, the earliest effective date of the PA will be the date the recipient became eligible for Medicaid, in this case September 1, 2003, not before then.
(*Backdate periods for Family Medicaid includes the month of application and the three previous months.  BadgerCare will only back date to the first day of the month of application.)

2. NEW ELECTRONIC NEWSLETTER FOR AUTISM AND ASPERGER'S SYNDROME
Future Horizons, an organization that provides resources for Autism and Asperger's Syndrome has just started publishing a new monthly newsletter called Autism Spectrum.  For more information, please visit: http://www.autismspectrum.net/DesktopDefault.aspx

3. CHILDREN'S MENTAL HEALTH RESOURCE KIT AVAILABLE FOR DOWNLOAD
The Children's Defense Fund has produced a new resource kit on children's mental health screens and assessments. To read a description and summary of the resource kit go to: http://www.childrensdefense.org/pdf/mentalhealthresourcekit/flier.pdf  

To download the full resource kit go to: http://www.childrensdefense.org/pdf/mentalhealthresourcekit/full.pdf


4. Fighting the Fog from LD Online

Fighting the Fog is an account of what it feels like to have Attention Deficit Hyperactivity Disorder, written by Tom Cradit. Tom grew up without knowing that he had ADHD.  In this article, he discusses how he feels to have finally been diagnosed after so many years of struggle.  To view the article, go to: 
http://www.ldonline.org/article.php?id=542&loc=11


5. MODEL CONSUMER DIRECTED CARE PROGRAM COSTS MEDICAID NO MORE THAT TRADITIONAL AGENCY CARE  

(From the Robert Wood Johnson Foundation)

Arkansas Medicaid enrollees who had the opportunity to direct their own personal care services using a cash allowance were much more likely to actually receive such services than were enrollees who were eligible for services but had to get them in the usual way, from an agency, according to the results of a study published online today by the journal Health Affairs. Furthermore, even those who did obtain care from agencies received only about two-thirds of the hours of care to which they were entitled, the study found.

While this better access to care led to higher overall costs for personal care under the consumer-directed program, these added costs were offset by lower Medicaid costs for nursing homes and other long-term care services. Thus, consumers received significantly more personal care at no greater net costs to Medicaid by the end of the second year.

These findings are from an ongoing evaluation of the Cash & Counseling Demonstration and Evaluation Program, which was jointly supported by U.S. Department of Health and Human Services (HHS) and The Robert Wood Johnson Foundation operating under waivers from the Centers for Medicare and Medicaid Services (CMS). In the program -- currently underway in Arkansas, Florida and New Jersey -- Medicaid enrollees who qualify for personal care are given an allowance and a high degree of flexibility and freedom to choose personal care assistants and decide how to manage their own personal care needs.

Today's study found that due, in part, to a worker shortage, home care agencies in Arkansas delivered only about two-thirds of the personal care services to which consumers were entitled, with some consumers receiving no services at all. In addition, more consumers who hired their own personal care assistants were able to receive services in the evenings and on weekends. This differential in the amount of services received resulted in the consumer-directed care approach costing over $2,000 more than the agency model in both the first and second years after enrollment. By the second year after enrollment, however, these higher personal care expenditures were offset by reductions in expenditures on nursing home and other Medicaid services.

"Arkansas' Cash & Counseling program demonstrates that states can design a consumer-directed care program that better meets the needs of people with disabilities at no greater cost," said Randall Brown, Ph.D., co-author of today's article and senior fellow and project director at Mathematica Policy Research, Inc., which conducted the study. "In fact, it appears that the better the traditional agency model is at providing Medicaid authorized services to people, the greater the likelihood of immediate savings from a 'cash and counseling' alternative. In states where the agency model is not performing well, a cash and counseling alternative would help meet those needs and help minimize the higher long-term care costs that result when needs go unmet."

The results announced today compared eligible Medicaid beneficiaries who volunteered for the study and were then randomly assigned to the Cash & Counseling approach with volunteers who were randomly assigned to the control group. The control group had to rely on traditional agencies to deliver the personal care services for which the participants qualified. Approximately 1.2 million Medicaid recipients nationwide get supportive services.

HHS has taken action to assist more states to develop consumer-directed services along the lines of a "cash and counseling" program. HHS' "Independence Plus" waiver program, introduced last year, established a process for states to obtain authorization to operate such programs. Also, this fall, CMS awarded $5.4 million in "Independence Plus" grants to 12 states to support such efforts.

In addition, President Bush has proposed changes in the Medicaid program that would give states much more flexibility. Under the proposal, states would be able to implement programs of this kind without needing to obtain HHS permission.

The Cash & Counseling programs in Arkansas, Florida and New Jersey are funded by The Robert Wood Johnson Foundation. The independent evaluation of the three programs is funded jointly by the foundation and the HHS Office of the Assistant Secretary for Planning and Evaluation.

Today's study, conducted by Mathematica Policy Research of Princeton, N.J., is available at: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w3.566.  More information on the Cash & Counseling demonstration program is available at www.umd.edu/aging. 

	
6. HEALTHWATCH CONTACTS

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 or Brad Montgomery, 414.449.4777, opwindows@aol.com
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

SUGGESTIONS OR TIPS FOR THE UPDATE?

We need your help to develop content and tips for our CKSN Update. Please let us know about your ideas or success stories.  Email your suggestions 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.

ABC for Health is a Wisconsin-based, nonprofit public interest law firm dedicated to linking children and families, particularly those with special health care needs, to health care benefits and services.  ABC for Health's mission is to provide information, advocacy tools, legal services and expert support needed to obtain, maintain and finance health care coverage and services.

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