FW: Nursing Services/Georgia Medicaid

[Guest guest]

Debbie

Dobbs, MS

Master of Science

Educational Consultant & Child Advocate

Health Care Consulting Services

cell

fax

debbiedobbs@...

CONFIDENTIAL & PRIVELEGED

Information contained in this communication

is confidential and privileged. It is not meant to represent legal or

medical advice, but rather advice given based on my knowledge as the parent of

a child with disabilities, a trained Parent Advocate by the GA Advocacy Office,

a member of the Council of Parent Advocates & Attorneys, by working in the

medical industry for over 20 years, training received from Pete on

Special Education Law and Advocacy, and medical coding and documentation

courses. Please do not forward without my permission.

From: Greer

Gaston-

Sent: Wednesday, December 03, 2008

11:53 AM

To: Amy Lupardus - Occupational

Therapist; April - PLC; Rentz; Barbara Kilbourne; Maddox;

; Thomisee-Love; Cheryl - BCW; Connie - PLC

Chattoga; Debbie Dobbs - North Fulton Autism Support Group; Deborah -

Parent Mentor; Hill; Diane - s - PLC Chatham Co.; Donna Jo

Salhany; Doris Dill - PLC Ben Hill/Irwin Co.; Dottie ; Dr.

Karvanis; Eden Hutchins - Ferry Baptist Church/Respite;

; son; Fran Stalter - Albany Recreation Dept.; Gregg LaVangie -

Miracle League Marietta; Heidi Fernandez; Heidi ; Helen Dulock - Children

w/Special healthcare Needs; Jael McLemore - Parent Mentor; Jane Newman - Parent

Mentor; Jen - Region 3; Hall - Puzzled Parents Support Group;

Jill ; Jo Ellen Hancock-Parent Mentor; Jodi Mazzolini - Parent Mentor;

Joyce Catrett - Attorney; Kimple; Giles; Kolbi Cumbo;

Zimnet; Layla Hogan - Puzzled Parents Support Group; Lipson; Nevitt;

Vaughn - Parent Mentor; Lynn Higgins - PLC; Martha Bush - Parent Mentor;

Shell; Patti ; Bontempo - PLC Gwinnett; ;

Ron Cannon - PLC Twiggs; Ron Cannon - PLC Twiggs Co.; Roslyn Howell - PLC

Co.; Roslyn Howell - PLC Co.; Crain - Parent Mentor; Sharon

- Parent Mentor; Sherri Hardegree - North GA Autism Support Group; Stacey

; Tawanna - PLC Crawford Co.; - PLC/FACES; Terri

Goodridge - Parent Mentor; Reynolds - Parent Mentor

Subject: FW: Nursing

Services/Georgia Medicaid

Please pass along.

Thanks,

Greer

From: Addams

Sent: Wednesday, December 03, 2008

10:34 AM

Subject: Nursing Services/Georgia

Medicaid

Please share the following information with families as appropriate.

Thanks.

Friends,

If your child or any child you know has private duty nursing

services, this message is important to read and/or share.

Without hearing from families about the specific problems we are facing

with getting and then holding on to the nursing services that keep our children

alive and in their own homes, it is hard for advocates to address the

problems. This is your chance to be heard and to make an impact.

Please let me know when you call and what response you get. This

is one more step in getting DCH to be more responsive to the medical needs of

our children...

If you want more information, contact me or a at the GAO.

Thanks,

Pam

Callie's Mom

From: a

<pmillerthegao (DOT) org>

Subject: FW: GAPP prior approvals

To: psmoore91, pmooremadison (DOT) k12.ga.us

Date: Tuesday, December 2, 2008, 3:13 PM

Pam, will you make sure that all providers

and families that you know about receive this email as soon as possible?

Thanks,

a

a

Rafferty

Staff Attorney

The Georgia Advocacy

Office, Inc.

150 E. Ponce de Leon Ave. Suite 430

Decatur, Georgia 30030

1- (voice

or TDD)

Fax

Pmillerthegao (DOT) org

The Georgia Advocacy Office spoke to

Georgia Medicaid management at the Department of Community Health and staff of

the Office of the Inspector General concerning problems with GAPP Prior

Authorizations. We were told that no complaints had been made to DCH by any

providers or families, so the attached letter from GAO to DCH was the first DCH

had heard that there was a problem. DCH says that GMCF is reporting that it is

current on its GAPP caseload and that turnaround time is 14 days.

DCH has identified about 20 kids whose PA¢s

are pending because the LON has not been returned. DCH is changing the policy

that has required the LON to be signed and returned before prior authorization

will be officially given. We are told that gmcf is contacting the nursing

agencies to identify specific children whose services have been or are in

danger of being suspended. DCH will be looking at denied GAPP claims to see

what other problems there may be. Argartha at DCH is over GAPP and

many other program areas. She wants to hear from providers and families

regarding problems with services, prior authorization, and provider payment.

Her direct line is . Her administrative assistant is at

.

If there are other issues, please let us

know. GAO will be reconvening our meeting with DCH on Thursday to discuss the

progress that has been made. It would be helpful to know what the universe of

problems is so that we can ask about the process by which DCH is investigating

and resolving every problem identified.

Promises were made that there would be no

retaliation against any providers or families. If you believe that you may have

been subject to retaliation, please let us know. GAO is the protection and

advocacy system designated in Georgia

in accordance with federal law to protect and advocate the rights of

individuals with disabilities. GAO does not reveal the identities of its

sources unless the source has given express permission to GAO to do so.

Please do not hesitate to call me if you

have any questions.

Best regards,

a

a

Rafferty

Staff Attorney

The Georgia Advocacy

Office, Inc.

150 E. Ponce de Leon Ave. Suite 430

Decatur, Georgia 30030

1- (voice

or TDD)

Fax

Pmillerthegao (DOT) org