Medicaid Assessment Tool to be Revised
Colorado Springs, CO (PRWEB) August 05, 2013 -- In 2012, Home Health agencies were mandated by the State of Colorado Medicaid regulations to complete and submit the Pediatric Assessment Tool (PAT) on each child that receives Home Health Care services. This Assessment Tool was developed by Colorado Medicaid to determine how many hours of CNA and RN care are medically necessary for the child.
“The mandate came down from the federal government. The states have to justify how they are spending Medicaid money and this is their way of measuring and accounting for Medicaid money that is used for home health care for kids with disabilities,” said Anita Pope, Directory of Nursing for The Independence Center. “It’s a 15 page questionnaire that the nurse fills out about the functionality of the client. Each of questions has a point value assigned to it. You add up the points at the end and there’s a scale on the last page that tells you how many hours of care that child gets a day.”
Upon the roll out of this assessment tool on December 1, 2012, many children with disabilities received a large reduction, some as much as 75%, in their CNA hours. Prior to the PAT, the amount of care was up to the discretion of the home health care nurses, and the patient’s doctor would sign off on the care plan. Now the amount of care a child in need of Home Health Care services requires is calculated with this tool.
“Now it’s judged by this tool and it’s not capturing the true needs of children with disabilities,” Pope said. “Like the young lady we have that has no arms or legs. It has nothing in there to assess that. There’s a question that asks if they have flaccid paralysis, which means that they are paralyzed and can’t move; it’s a yes or no question. There’s no spectrum.”
The IC became an advocate for our clients and caregivers in defense of this controversial assessment tool. Resources were provided to caregivers instructing them of the appeal process, necessary paperwork, and additional resources they may need in order to appeal and request a continuation of benefits.
“When all of this came down, we encouraged all the parents to appeal because they had the right to appeal,” said Pope. “When the State figured out how many hundreds of people were appealing, they put together the review committee. The review committee found that a lot of clients did not get notified that their hours would be cut, and those that did get notified received notifications that were not worded properly. They restored everyone’s hours that did appeal and threw out all the appeals.”
From this point, the State put together a committee of 11 to review and revise the PAT. The head of the committee is an RN who was hired specifically for this purpose. The rest of the committee consists of pediatricians, behavioral analysis doctors, a mother and caregiver of a child with Autism and the IC’s own Home Health Administrator, Katey Castilla.
“It’s a very tedious process, however it is a great group of people working together to make this tool an acceptable means to measure the home health needs of the clients,” said Castilla.
The committee’s goal is to revise the PAT so that it is more encompassing and individualized. Thus far, the committee has had three meetings, each dissecting each question of the assessment tool and evaluating what can be done to improve it.
“That flaccid paralysis (I spoke of earlier) was a yes or no question; now the committee has turned it in to five questions,” said Pope. “We anticipate that the tool will be longer and include more questions that will cover more issues.”
With a revisal committee in place and working hard to improve the PAT, and caregivers receiving their regular hours in the meantime, The IC is confident that positive things are in the future for pediatric Home Health Care service clients and their caregivers.
“I expect more fairness. The whole thing was that it was not inclusive and it was nor a true scientific tool and the right data wasn’t collected because it wasn’t asked for,” Pope said. “I think it is going to be much more accurate. We know there are people that are going to lose some hours, but it won’t be like before.”
The IC will keep everyone up-to-date on the happenings of the revisal committee and other changes that may come from it. To stay informed check out PAT resource page for the most current information: http://www.theindependencecenter.org/home-health/pat-tool-resources.
About the Independence Center:
The IC was founded to assist people with disabilities to make changes in their lives that lead to independence in our community. We empower people with disabilities to live independently, and to enhance options and quality of life. We are a vigorous participant in local efforts to remove barriers for people with disabilities because we believe that people with disabilities should have the same civil rights, options and control over choices in their lives and equal opportunity as people without disabilities. We provide skills training to empower people with disabilities to be well informed advocates and active citizens; to change laws, legislation, systems and attitudes that affect their independence. For more information, please visit us at http://www.theindependencecenter.org.
Amanda Lunday, The Independence Center, 719 471 8181 143, [email protected]
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