# 65 NOW/COMP Waivers, Disability Study Group and GAPP Updates

[Guest guest]

Dearest Advocates:

As many of you are aware, on Monday the Office of Developmental Disabilities had their 1st family forum night in Gwinnett and on Tuesday had its DD Advocates meeting downtown to discuss families concerns with the implementation of the new NOW/COMP disability waivers in Georgia. I attended both of those meetings. I must say that I was very impressed by the number of families that attended both meetings. Globally, there is a lot of concern with families regarding this transition process which include some of the following issues:

-Prior Authorization (PA) status (your budgets).

-Self direction- Acumen

- Independent contractor vs. vendors.

- SMS costs and using Promed.

- Initial new enrollment packages – access issue.

- Customer service concerns- Not returning phone calls/voice mail being full, etc.

- Not paying their provider invoices in a timely fashion.

-Rate caps and maximum amounts per service categories.

-Communication and training needs for Support Coordinators (SC), families and providers. Including process flow diagrams so everyone understands their responsibilities in the waiver system.

- ABA therapy (not being able to receive enough based on the caps).

- Concerns with weekend respite facilities needing a personal care license if they have more than two individuals in a facility.

- Families globally losing services during this transition.

- Adult Dental services still are not approved.

- Transportation issue to day programs.

- And many more issues…

Office of DD did promise that they are working through the issues. All 12,000 waivers were transferred over to the new system on November 1, 2008. This was the biggest change in disability waivers ever in the State of Georgia. They did say that NSE and CHSS waivers were the ones that were hit the hardest with changes which accounted for approx. 1,400 of the waivers. The Office of DD wanted to rollout this new waiver based on birthdays over a one year time frame but unfortunately the Feds did not agree and they had to implement everyone by November 1st.

Dr. Hall did state that the provider rates are being evaluated and a formal rate analysis study is due for all service categories by October 31, 2009. (Heidi’s comment: I don’t think this is soon enough and we need to work on this issue quickly. Families are losing good providers due to these rate caps/maximums.)

Office of DD did state that they are developing more user friendly manuals to help families understand the process (instead of reading the 250+ page manual now) by January 2009.

Below are meeting minutes taken from a parent on the Tuesday Office of DD advocates meeting that took place at 2 Peachtree. Thanks to Raissa for sending me these notes to help families understand from a parents perspective what happened at this meeting as well. I truly appreciate others getting involved and sending me this information to make my job easier to get out to everyone who were not able to attend.

In addition, below is information regarding Solutions Marketing Group, a disability/health-focused marketing consulting company, looking for research focus group participants in the greater Atlanta area. See below for more information.

Also see below information regarding the GAPP Waivers and Prior Authorization issues with Medicaid. Pam is your parent contact on this issue.

I hope you find this information helpful as we continue to go through this transition process and help all the families impacted.

“UNITED – WE WILL MAKE A DIFFERENCE!”

Sincerely,

Heidi

# # #

Meeting Minutes from the Office of DD Advocates meeting on 12/09/08

Moderator – Dee Dee O’Brien, ARC

Speaker – Steve Hall, Office of Disabilities Director, DHR

Attendees – Disability community including, sen, Director of GCDD, Staff members from GCDD and DHR, Members from Fayette County Exceptional OPS, staff from Parent to Parent of Georgia, other family members and friends of individuals with disabilities.

Purpose – To answer general system questions regarding the implementation of the NOW/COMP Waivers. This session was not about providing individual technical assistance for specific issues, but rather an opportunity to fine tune the process of transitioning from the current MRWP waivers to the NOW/COMP waivers.

Problems with the system

Disappointment over losing a valued Fayette community provider – B & B Services, due to financial ramifications of the lowered value limit of the per unit cost of service.

Frustration over the Acumen process. Specifically cited issues with packet retrieval, understanding how to fill out forms, who to call for technical assistance in the process.

Frustration over lack of training and support from local support coordinators. Time was spent describing what the community should expect from support coordination. At a minimum, support coordination should expect to write the plan, check on the implementation of the plan, figure out the support intensity scales. Dr. Hall addressed that the key to this weak link is to try to increase retention and training for support coordinators...

Frustration over grant in aid current and future availability.

Frustration over slow payment for services and its ramification for businesses deciding to “put clients out on the street”. Dr. Hall said providers may be able to get an assurance letter of payment on a case by case basis.

Potential Solutions

For individual issue escalation and resolution, call Dr. Hall’s office at .

Create an 800 number for consumers to call for help in resolving individual issues. Staff the hotline with a person who can resolve simple issues and generate more Frequently Asked Questions. Provide an escalation process for more complex questions.

Define better market pricing for services. Dr. Hall indicated that a rate survey was being done to fine tune the per unit rate on services.

A web portal (email and document) is posted for frequently asked questions. This web portal is at http://mhddad.dhr.georgia.gov/portal/site/DHR-MHDDAD/menuitem.8d349b4fc181e44b50c8798dd03036a0/?vgnextoid=299d9c1fdddef010VgnVCM100000bf01010aRCRD (Called “What’s New with the waivers?” on the DHR website. Emails should be directed to: NOW-COMP-Questions@.... FAQ is located at http://mhddad.dhr.georgia.gov/DHR-MHDDAD/DHR-MHDDAD_CommonFiles/FAQs%20about%20NOW%20and%20COMP%20Waivers%20%20Nov.21.08.pdf

Dr. Hall spoke of the rollout of Community Guides, but did not elaborate much. Fayette County proposed being a beta test site to help with implementation.

Unbundle gate keeping by DHR with financial intermediaries, and allow self directed users to obtain information/enrollment packets or technical assistance directly from the financial intermediary.

Increase choice in financial intermediaries for self directed options. Right now, the only financial intermediary for self directed support is Acumen. Note that increasing choice will necessitate an additional training component to help consumers choose between plans.

Increase retention and training for support coordinators. Dr. Hall is currently doing a rate survey to begin this process.

Increase options in automation within the process. Dr. Hall has the authority to add an additional IT person to staff to help with this initiative.

Document key operational processes (create a road map) that new users to the NOW/COMP Waivers can utilize. Include proper consumer escalation points (supervisory oversight) when issues arise.

Temporary support coordinator to ‘float’ to areas of need.

Develop a specialized transition coordinator to assist in training of support coordinator and complex issue resolution.

Increase participation in educating legislation to divert more funds to DD through Unlock initiatives.

# # #

Disability Focus Group Participants Wanted

Please direct all inquiries directly to Cheryl Duke, by 5:00pm EST on December 19, 2008, at or cduke@...

The Solutions Marketing Group (www.disability-marketing.com), a disability/health-focused marketing consulting company, is looking for research focus group participants in the greater Atlanta area who have the following disabilities:

Physical or mobility disabilities

Speech disabilities

Blindness/low vision disabilities

Deaf/Hard-of-Hearing disabilities

Additionally, individuals over 60 years old, with and without disabilities

Participants must be between 18 and 75 years of age, be a customer of AT & T residential, Internet, business or wireless service, and has sole or equal responsibility for selecting telecommunications products and services. In return for their time, participants will receive a $60 honorarium.

The focus groups will help AT & T explore preferences, perceptions and what motivates customers with disabilities. The goal is to provide services and products that meet the needs of current and potential customers; and to uncover opportunities to enhance service. The focus groups provide an important opportunity for consumers to share their viewpoints and opinions.

The focus group will take place in Atlanta:

January 13, 2009 at the following times:

Consumers with Speech Disabilities 10:00 am – 12:30 pm

Consumers with Physical Disabilities 2:00 pm – 4:30 pm

Consumers with Hearing Loss and/or Deaf 6:30 pm – 9:00 pm

January 14, 2009 at the following times:

Consumers with Blindness/Low Vision 10:00 am – 12:30 pm

Consumers who are Seniors(age 60-75) 2:00 pm – 4:30 pm

If you are interested in participating in the focus group, please contact Cheryl Duke, by 5:00 pm EST on December 19, 2008, at or cduke@....

# # #

From Pam – GAPP Prior Approvals:

(parent who is very involved with the GAPP Waiver and advocating for our children):

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,PamCallie's Mom

psmoore91@...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 PAs 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 specifi

c 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 design

ated 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

Staff Attorney The Georgia Advocacy Office, Inc. 150 E. Ponce de Leon Ave. Suite 430 Decatur, Georgia 30030 1- (voice or TDD) Fax Pmiller@...

--Heidi J. (Proud Mother to - 8 years old with Down syndrome & - 7 years old) For more information about how Heidi can help you maximize your child's potential, please go to www.heidijmoore.com "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative.