Health Information Center: Featured Articles
Bullet Point Recommendations for Managed Care and Long-Term Supports and Services
By Karen Scallan, Program Director, La Family to Family Health Information Center
Louisiana is investigating the prospect of moving all care under Medicaid for individuals with waiver services, nursing homes and institutional settings for individuals with developmental disabilities into managed care.
There are huge considerations involved in this and as the saying goes, the “devil is in the details.” Below are bullet points from our response to the State’s Request for Information regarding this topic. For a full explanation and details on our recommendations to date, contact Karen Scallan, La Family to Family Health Information Center, 1-800-331-5570 or firstname.lastname@example.org.
- Minimum 2 year planning period before implementation.
- Person-Centered planning based on health, support, emergency needs and self-determination of the individual.
- Consumers and families as active members of oversight and planning of the entire program.
- Surveys and quarterly stakeholder meetings throughout the program for families.
- Managed Care Organization (MCO) required to have internal advisory committees with minimum 25% consumers and advocate representation.
- All methods of involvement (committees, print materials, websites, informational resources, etc.)must be accessible, including culturally and linguistically.
- Ombudsman program established by DHH as integral part of oversight, compliance and safeguard of health and wellbeing of participants.
- Extensive training, information and supports during implementation and for new participants provided in a culturally-competent, conflict-free manner.
- Highly-specialized care coordination with option to provide own care coordination for families currently successfully provide the care coordination for medically complex individuals.
- Opt In system for participation with voluntary enrollment.
- No reduction of service types provided and expansion of the services and providers available, including moderate length inpatient care to provide for behavioral training and mental health.
- Families remain with current providers for at least a year even if they are not providers for the MCO.
- Exemptions to requirements for network providers when continuity of care is essential for consumer health or access to care.
- Care in the LRE including HCBS as a top priority with this built into the system of payments.
- Continue using SIS and LaPlus in face-to-face meetings.
- Truly conflict free case management
- No waivers granted by the state secretary allowing the MCO to have a financial interest in any organization conducting care coordination or case management.
- Medicaid Waiver Self-direction should remain an option.
- All payments to MCOs tied to quality measures.
- MCOs should not determine eligibility; Human Service Authorities/Districts responsible for eligibility.
The way to manage care of individuals with highly complex medical needs is to give them all the medical care they need when they need it so that their conditions do not deteriorate and thus result in more costly hospitalization or worse.
Know Your Rights in Health Care
By Karen Scallan
La Family to Family Health Information Center
When you go to the grocery store and the clerk overcharges you or refuses to serve you, most of us respond by asking for a manager. Why then do we not seek a higher authority when it comes to problems with a health care or other service provider? For whatever reason, this is frequently the case. Patients need to know their rights in the health care system.
Any provider accepting Medicaid, LaCHIP or Medicare or who receives a federal grant–whether they be a therapist, primary care physician, dental provider, hospital or nursing home–is considered a “Federal financial assistance” recipient. As such they are subject to nondiscrimination laws. These laws include Title VI of the Civil Rights Act and Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act.
These entities must not discriminate on the basis of race, color, national origin, disability, age, sex or religion.
Recipients of Federal financial assistance must also take reasonable steps to ensure meaningful access to their programs, services and activities by people who do not speak English or are limited in English proficiency. They may need to provide language assistance services, such as interpreters and translated documents and provide program brochures in languages specific to the languages spoken in their area.
If you feel you or your child has been discriminated against by a medical provider, we recommend you first go up the chain of command in that health care facility. If you do not feel the situation was corrected, you can contact the US Health and Human Services, Office for Civil Rights which has the authority to investigate these types of complaints. Complaints must be filed within 180 days of the discriminatory act unless a waiver is granted by the Department. The Louisiana Family to Family Health Information Center can help you navigate the systems of care and complaint processes. For more information contact The Louisiana Family to Family Health Information Center at 800-331-5570 or U.S. Department of Health and Human Services, Office for Civil Rights, Voice Phone: 214-767-4056; TDD 214-767-8940 or visit http://www.hhs.gov/ocr/office/index.html.
From the Florida Center on Inclusive Communities:
Sexuality & Developmental Disabilities Across the Lifespan
The subject of sexuality can be daunting. Add to the mix a physical or cognitive disability and you may find yourself feeling totally unprepared to deal with the subject matter.
Staff from the Florida Center for Inclusive Communities has collaborated with the Florida Developmental Disabilities Council and University of Albany, Center of Intellectual Disabilities to create an easy to use workbook for families and educators of individuals with developmental disabilities.
We are all sexual beings from the day we are born. Sexuality is the exploration of ourselves our physical bodies, our emotions, our self-worth and image, and our interrelations with others. It is one of the most basic human instincts, and no matter what level our learning abilities, it is a natural part of being human to have the desire to discover what our bodies are all about.
This Instructional Manual and the accompanying Resource Guides are designed to help educators and family members assist individuals with developmental disabilities in their exploration of self and sexuality.
Sexuality Across the Lifespan Workbook for Educators–English
Sexuality Across the Lifespan Workbook for Educators–Spanish
Sexuality Across the Lifespan Workbook for Parents–English
Sexuality Across the Lifespan Workbook for Parents–Spanish
Healthcare.gov is the new government website to help you navigate provisions of the Affordable Care Act (ACA). With this new website, you can find insurance options for you and your family, find quality health care providers, compare providers and learn more about staying healthy.
This interactive website lets you enter basic information to search for insurance options, watch videos with closed captioning that explain provisions of the ACA, learn about pre-existing condition plans, view an interactive time line with implementation dates for all the ACA provisions, and compare hospital, nursing home and dialysis providers to make care decisions. Sections include information for families with children, individuals with disabilities, individuals, employers, young adults and seniors. Information on the ACA Patient’s Bill of Rights is also included.
You can also connect to healthfinder.gov for the latest information on health preventative care for you and your family. Check out Healthcare.gov today!
18-25 Year Olds May Be Able to Continue Health Care Coverage Under Parent Plans Without Waiting
Several large insurance providers have indicated that they will honor some of the provisions of the Affordable Care Act (ACA) early. One of those provisions allow youth ages 18-26 to be on their parent’s health insurance plans now, instead of making the families wait until the first re-enrollment after September 23rd. Each year at open enrollment, your insurance is considered a “new plan.” The ACA provided for all new plans after September 23rd to allow parents to keep coverage on young adult children to age 26.
There are a few catches to the early inclusion on parent’s plans… the employer needs to agree to the early provision of insurance to those youth and larger employers are allowed to insist that the youth take their employer’s insurance instead if they are working and it is available to them.
If your employer agrees, your child may be eligible to stay on your health insurance plan to age 26. Worth checking out!
A list of some larger insurance companies allowing youth to remain on parent health plans early include Cigna, Aetna, United, WellPoint, Humana, Blue Cross/Blue Shield of Louisiana
Learn more by visiting www.HealthCare.gov