One hour of PT a month?????

[Guest guest]

YIKES! I have been on vacation, sleeping, in a coma or in la-la land or

something!!!!

Our children's' health and well being are once again under attack by DCH.

They are attempting to limit therapies that are prescribed by physicians and

administered by licensed professionals. They plan to limit therapy to 5 units a

month (1 hour and 15 minutes) per discipline. We all know that is ridiculous!!!

Progress cannot be made with such a small amount of intervention!

How can they get away with it? By saying that they are only requiring that

additional therapy be " Prior Approved " . " Prior Approval " is a ridiculously

cumbersome procedure that will force therapists to drop Medicaid patients in

lieu

of patients with private insurance AND it should not be necessary IF a doctor

prescribes something for a child!!!

The federal Medicaid statutes require that states provide complete,

comprehensive health coverage to all children. Georgia is testing the limits of

what

they can get away with - and they are playing with our children's future in an

effort to save DCH dollars. They know that therapists will not be able to keep

up with the prior approval paperwork and they couldn't care less if that means

that our children will not be able to get services.

PARENTS must speak out against these changes! DCH has been forced to do the

right thing before - we must make sure they continue. We are the ones that can

make a difference. We are the ones who have the most at stake - our children's

futures!

Time to send out those emails and make those phone calls - vacation time is

over! Hmmmm . . . I wonder if the timing of this may have to do with our

summertime apathy?

In a message dated 6/28/06 10:08:17 AM, heidijmoore@... writes:

<< DCH plans to change the " threshold " of visits for the ABD group of

children to a total of 5 units per month for a " single " therapy service. This

means

each discipline (ST, OT, PT) will be able to bill a total of 5 units each month

(currently it is a max of 10 for non-timed codes and 20 for timed codes). If

the therapist feels the children need more therapy they can submit a " prior

approval " (same process as is in place currently) which will be reviewed by

Georgia Medical Care Foundation (GMCF). This would mean that a child will only

be

allowed approx. 1 PT and OT session / month! and only 2+ ST sessions / month!

This is not acceptable! Our families have already been put thr ough enough

due to difficulties with the eligibility criteria, if a child is approved we

should not have to fight another battle of Medical Necessity for therapy.

DCH said this review would be approved based on " medical necessity "

guidelines. DCH also attempted to further limit children who had multiple

therapies,

however the Trialliance discussed the major problems with this and they said

they would reconsider this limitation.

The time frame for this implementation is August 1, 2006. >>