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Children w/ Health Needs & Managed Care |
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Family Voices is a national grassroots network of families and friends speaking on behalf of children with special health care needs. We would love to add you to our Family Voices mailing list and keep you informed of national and statewide efforts on behalf of our special children. Call Parent to Parent at 655-5290 or 1-800-800-4005 to add your voice to Family Voices.
Children with
Special Health Needs and Managed Care
More than 177 million Americans now receive their health care under managed
care arrangements, though the number of children with special health needs
who do so is not known. While managed care began in the private sector
of health insurance, it is now quite prevalent in the public sector as
well. In Vermont, about half of Medicaid recipients are enrolled in a managed
care system called Primary Care Plus.
In 1997-98 Family Voices conducted a national study with 2,220 families
about the health care experiences of their children with special health
needs. The survey indicated concerns about how children with special health
needs are faring under managed care systems. To collect more information,
Family Voices State Coordinators conducted 17 interviews with managed care
organizations in 10 states between December 1998 and January 2000. The
questions and concerns from the Family Survey informed and enriched the
discussions with managed care organizations.
There were three primary goals as Family Voices Coordinators conducted interviews:
vTo collect and share information about good ideas, interesting policies, and exemplary programs.
vTo initiate constructive relationships between managed care plans and Family Voices leaders around the country.
Family Voices Recommends that:
uthe plans should use standardized definitions to ensure comparable, quality information across plans. Standards required through state Medicaid contracts should be widely known and used. To ensure equity, similar guidelines and practices for both Medicaid and non-Medicaid eligible children should be used whenever possible, for all children served by a plan.
u plans extend their systems of outreach, tracking, and treatment developed for those with high incidence conditions, such as diabetes and asthma, to those with low incidence conditions, since children's special needs are typically low incidence.
u providers must have the time, knowledge and resources to communicate with other service providers and systems. All those providing care for children with special needs should be knowledgeable about other resources and service systems.
u care coordination services provided by managed care plans needs to be linked to other care coordination programs such as those from Title V, Children with Special Health Care Needs Programs or Early Intervention programs, so that families really do receive coordinated care.
u plans should permit specialists to be primary care providers and should allow standing referrals to specialists.
u families of children with special health needs should have clear information about plan benefits, how to access covered services, complaint and appeal procedures, and special features for children with special health needs or their families.
uplans should provide opportunities for families of children with special health needs to advise plans and help shape programs and policies that directly affect families.
| KASA,
Family Voices' Kids as Self Advocates project,
is proud to announce that they have formed their first National Advisory
Board. The Board will help guide the direction of this new and exciting
organization. The ten members reflect a cross section of disability, age,
education, ethnicity, race, geography and ideas.
Janell Wells, age 19, Florida, Co-chair Marlin Thomas, age 24, Illinois Garret Frey, age 21, Iowa Sabourin Lussier, age 19, Rhode Island Peter Graf, age 13, Arizona Maia Wroblewski, age 16, Wisconsin Nate Rennie, age 13, Texas Mitchell Hamilton, age 15, Wisconsin Naomi Ortiz, age 20, Arizona |
The Family Support Committee meets monthly in various locations around the state to review state and federal regulations, laws, and policies with implications and impact on family support programs; to determine positions for VCDR on family support issues and legislation; and to prepare advisory comments to boards and committees relating to family support. If you are interested in becoming part of this vital work please contact Kay Van Woert at 985-5668 or kvanwoert@aol.com© |
The Internal Revenue Service issued a ruling that will allow parents of children with chronic illnesses to deduct some of the costs associated with attending medical conferences related to their children's condition, such as the expenses of admission & transportation. For additional information, look for Internal Revenue Bulletin 2000-19 at http://www.irs.gov/businfo/bullet.html©
Link to More Family Voices Pages
More info on Health Care Finance in VT
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