Health Care Agency Disputes Child Care Allegations in DOJ Letter

By: Florida Agency for Health Care Administration Release Email
By: Florida Agency for Health Care Administration Release Email

Tallahassee, Florida- September 10, 2012

“Floridians are being misled by the unfounded allegations in last week’s Department of Justice letter about the availability of medical services for Medicaid eligible children, the funding of medical services for these children and the choices Florida provides to parents for the care of children with medically complex conditions. It is important for Floridians know the facts.”

Facts about Types and Availability of Services:

Florida Medicaid has a comprehensive medical service package that can accommodate any family who chooses to have their child at home.
There is no waiting list for medical services available through the Medicaid state plan for children who are Medicaid eligible. They can receive every conceivable medical service in their home, including private duty nursing, personal care assistance, home health aide services, and occupational, physical and speech therapy whenever medically necessary, in unlimited amounts and/or duration up to 24 hours per day, 7 days per week.
For those services that require prior authorization, AHCA or its designee periodically evaluates whether the child’s medical or social circumstances have changed. If so, services may be increased or decreased depending on the change.
Waivers can provide desirable non-medical services to children, such as home modifications, help with household chores, and respite. These are items and services that Medicaid cannot pay for as a matter of federal law – they can only be obtained through special waiver programs. Almost any child meets the financial eligibility for these services. There are waiting lists for these non-medical services.

Facts about Service Level Determination and Parent Choice

An interdisciplinary team called the Children's Multidisciplinary Assessment Team (CMAT) makes a recommendation regarding the types of care and types of services that may be beneficial for each child given their unique medical needs; the parent makes the ultimate decision about where the child will receive medical services. The CMAT includes the family, the child’s doctor and any other representative the family chooses. The CMAT also representatives from Children's Medical Services (Department of Health), Medicaid program (Agency for Health Care Administration), and may include Community Based Care (Department of Children and Families). CMAT reassessments for children in skilled nursing facilities are done at least annually, if not more often. At each reassessment, input is received from the family, the treating physicians, and all other interested parties in order to determine the least restrictive level of care appropriate for the child. Reassessm ents can be requested at any time, and often a change in medical circumstance such as removal of a tracheotomy tube or discontinuation of ventilator support will prompt a reassessment. Parents are entitled to ask for a reassessment at any time and are an important part of the assessment process.
AHCA uses a professional, federally-approved, quality control system to ensure every child receives the appropriate level of care. For some services, a quality improvement organization makes the determination about what frequency and duration of services are medically necessary. There is an appeals process should the parent disagree with the amount of care determination, and the state honors every appeal.

In 2011, Medicaid authorized for 1648 children to receive private duty nursing, 416 of these children were approved to receive an average of 12 hours or more a day of private duty nursing at home. During the same period, Medicaid authorized personal care services to help with activities of daily living such as assistance with eating, bathing, toileting and dressing for 2023 children. Hundreds of other families have made the choice to keep their child with complex medical needs at home with supportive services through the Florida Medicaid program.
Every nursing home is required to provide an enriching life for each resident whether a child or adult. Additional requirements exist for children that require the implementation of educational programs and activities based on the needs, abilities and individual preferences of each child.
Skilled nursing facilities are strictly regulated to ensure that the appropriate services are provided for children. Florida Medicaid has paid an enhanced per diem rate for children’s nursing home services for more than 20 years to help ensure quality services are provided for children for whom their parents decide a nursing home is the best choice. These facilities are designed to serve persons with complex medical needs; they provide a safe, secure and pleasant environment for the children in their care. Nursing homes that specialize in services to children provide specific programs customized to the needs of kids and although there are separate living environments for adults and children, some also provide enriching intergenerational programs.

Facts about Financing of Services for Medically Complex Children

The “15% cut” referenced in media stories was not a permanent cut, nor was it an annualized one and it did not impact children’s medical services. The cut was to shore up a budget shortfall, and only applied to waiver services. It did not affect Medicaid reimbursement rates for medical services to children. The cut was also temporary, for 90 days, and so annualized it was less than a 4% cut. The quick work of the Legislature and Governor’s Office resulted in the proposed 90-day cut lasting only a week or so. It annualized to around a 0.3% non-recurring, temporary rate cut.

AHCA: It is inappropriate to imply the $35.7 million from the Money Follows the Person Rebalancing Demonstration grant would have been able to assist the medically complex children in question; it would not have because of the federal stipulations regarding use.

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