GETTING YOUTH ON BOARD
SUPREME COURT RULING
"PC PLUS"
WHAT IS A MEDICAL HOME?
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99
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GETTING YOUTH ON BOARD SUPREME COURT RULING "PC PLUS" WHAT IS A MEDICAL HOME? |
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Families know how important it is to learn about laws and systems that provide services to our children with special needs. We also know the value of connecting with other families, but what happens when our children grow up and want to be their own advocates? There are not many places where teens and young adults can go to learn about systems, gain leadership skills, and support one another. This led Family Voices to create KASA (Kids As Self-Advocates). KASA is a "virtual organization" based in the office of Julie Keys, Family Voices staffer in Chicago. Julie and her young friends chat through e-mail and phone, represent youth at national events, and are planning to start a website, hold leadership trainings, sponsor a conference, and prepare one another for the adult world. If you are a teen or know of a teen or young adult with special needs who would like to be a part of this exciting movement, tell them to contact Julie Keys at: 312-642-2745 or email: FamilyVoices_JKeys@msn.com©
Have you heard about the recent Supreme Court Case of Garret Frey vs. Department of Education? Garrett Frey is high school student in Cedar Rapids, Iowa who was paralyzed from the waist down due to a childhood accident, uses a power wheelchair, has a tracheotomy, needs a ventilator, and is catheterized daily. The Cedar Rapids school district said that Garret's severe condition required "medical treatment" by a registered nurse during school hours but they were not obligated to pay for the care. They gave the family a choice of either paying for the nursing care at school or having Garret tutored one hour a day at home. The Freys believed that under the federal IDEA law, their son was entitled to attend school at no expense to them. On March 3, 1999 the Federal Court, in a 7-2 ruling said that IDEA requires schools to provide health supports for students who need them as long as that care is not medical in nature and performed by doctors. The ruling said that "...the district must fund such related services to help guarantee that students like Garret are integrated into public school."
If you have questions about your child’s related services, call Vermont Parent Information Center (VPIC) at 1-800-639-7170 or, for more information, visit the Family Voices’ national website at: www.familyvoices.com©
PRIMARY CARE CASE MANAGEMENT PROGRAM "PC PLUS"
The State of VT is pleased to announce the Primary Care Case Man-agement program called "PC Plus," which began Oct 1, 1999. As many of you know, Kaiser Permanente will be leaving VT, and leaving many of us with Medicaid coverage, enrolled in Access Plus. The Office of VT Health Access will transition Medicaid members who are elderly, blind, or disabled, currently enrolled in Blue First or Access Plus into its new PC Plus program. Health delivery will be similar to a managed care company, because you will need to choose a primary care provider, but will have a bit more flexibility. Their goal is to enhance the continuity of care through the creation of a Medical Home (see following page) and to establish a partnership between state and community providers and maximize dollars spent for medical services.
In the coming months those receiving health care through VT Health Access Plan (VHAP) Access Plus Program will be transitioned into either PC Plus or back into traditional Medicaid; also known as fee-for-service Medicaid. For example, a person enrolled in Access Plus whose physician is NOT a PC Plus physician would go into fee-for-service Medicaid.
Those with Medicaid coverage (this includes Dr. Dynasaur) who are elderly, blind, or disabled must enroll in PC Plus unless exempt from mandatory enrollment in Medicaid Managed Care (those with a Waiver, other health insurance, in the High Tech program, etc.). In addition, others (who are not disabled) with Medicaid and VHAP who are required to enroll in Medicaid Managed Care will have a choice of enrollment in PC Plus or Blue First.
Always remember - IF YOUR CHILD HAS MEDICAID (including Dr. Dynasaur), THEY ARE STILL ENTITLED TO THE SAME EPSDT BENEFITS, regardless of their enrollment in PC Plus, Blue First, or fee for service.
You may receive a letter soon, describing the PC Plus program. Read the letter carefully and call Parent to Parent if you have questions. We're here to help! ©
The American Academy of Pediatrics, in collaboration with the Maternal and Child Health Bureau, have been working with physicians and families for the past eight years to find ways to assure that all children and their families have access to comprehensive, coordinated, family-centered and accessible care, no matter where they live. They have named this concept a Medical Home.
A Medical Home is not a building, house, or hospital, but rather an approach to providing health care services in a coordinated, family-centered manner. Children and families who receive health care through a Medical Home have access to a physician 24 hours a day, 7 days a week, from infancy through adolescence. Ideally, health care is provided in a child's community by compassionate, caring, knowledgeable individuals who value the strengths and input of the family. The family is recognized as the child's principal caregiver and unbiased information is shared so informed decisions can be made regarding their child's care. Physicians and families act as partners to identify and access all the medical and non-medical services needed to help children and their families reach their maximum potential.
Care Coordination within a Medical Home
A critical component of the Medical Home is care coordination. Components of care coordination include coordination of all medical and non-medical care, referrals, resources, and supports including respite care, personal care services, Head Start, WIC, Family Infant and Toddler Project, and family support networks; coordination of information and care amongst specialists; and advocating for successful educational experiences for their child.
Families benefit greatly when they receive accurate information about services and supports available to their child and family. Since most families have access to physicians it is logical that we rely on the medical community for information and coordination with our child's medical and non-medical care. However, we know it takes extra time to talk with a family, make phone calls, and fill out applications, for services--and that time is something physicians often don't have available! Therefore, we must allow physicians (or office staff) to be compensated for the extra time needed to provide a Medical Home to children with special needs. It would be great if they could bill Medicaid for care coordination activities they provide to children and their families they serve.
If you would like more information about either of these legislative issues, please give us a call.
Medical Home Project in VT
In an effort to provide support to practices in implementing a Medical Home, the American Academy of Pediatrics and Maternal and Child Health funded Medical Home Projects nationally. Carl Cooley, M.D., and Jeanne McAllister from the Hood Center at Dartmouth were amongst those funded. Their project, The Medical Home Improvement Project, has been working with two physician practices in Vermont and two in New Hampshire. Doctors Lou DiNicola and Mark Harris have been working with the Medical Home Improvement Project for the past three years. Working with families within their practice they have defined and incorporated the necessary "improvement" to enable them to provide comprehensive, coordinated, family-centered care to children with special needs and their families.
Parent to Parent's Role
Parent to Parent of Vermont is funded by the Rural Medical Home Improvement Project to work with physician practices in Vermont and New Hampshire. Hilde Hyde(see staff) is our Regional Family Support/ Health Care Financing Coordinator. Hilde will be working out of the Wellness Center at Gifford Memorial Medical Center in Randolph, and serving as a support and information resource to families in the region. Hilde will be working closely with the Rural Medical Home Improvement Project (RMHIP) in Orange County. ©
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Vermont Family Voices Pages:
1.
Health Care Concerns, PCCM, Personal Care Services info from
'99 Spring edition
2.
Dr Dynasaur info, Medical Managed Care, Waiver info, Katie Beckett Program
vs Dr. D from '98 Fall edition
3.
PKU- a legislative story from '98 Spring edition
More info on Insurance (Six Ways Booklet)
Vermont Family Voices Links Page contains the latest articles