Supporting Children with Disabilities Lessons from the Pandemic: Proceedings of a Workshop (2022) / Chapter Skim
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5 State and Federal Policy
5 State and Federal Policy
Pages 37-48
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From page 37... ...
gave workshop participants an overview of the rights that children with disabilities have under the law. Medicaid plays an outsized role in the care of children with disabilities, and under Medicaid, children are entitled to all "necessary health care, diagnostic services, treatment, and other measures…to correct or ameliorate defects along with physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the state plan." This benefit is referred to as Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
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From page 38... ...
During the pandemic, and the associated declaration of a public health emergency, new flexibilities and approaches to these programs were intro duced. Many of these changes were beneficial to children with disabilities and their families, said Agrawal, including: • Less onerous prior authorization procedures to receive devices or medications; • Paid family caregiving and school aide services; • Fewer redeterminations of eligibility for home- and community based services; • Flexibility, overtime allowances, and increased pay to address workforce shortages in home care; • Virtual education and young adult day programs; and • Coverage for telehealth services.
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From page 39... ...
Policies that expanded the use of telehealth were largely advantageous for children with disabilities, as were administrative flexibilities in the areas of prior authorization rules and expansion of pay to family caregivers. Other changes -- such as relaxed scope-of-practice limitations and out-of-state licensure requirements -- made care easier to access, but also introduced concerns about quality and oversight.
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From page 40... ...
In addition to clarification, it may be necessary to increase Medicaid reimbursement for care coordination, including reimbursement for paraprofessionals like community health workers or promotoras (the Latinx family equivalent of Parents Taking Action)
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From page 41... ...
(e.g., data surveillance, and provisions of info CYSHCN to local CCS agencies) Allow payment parity for synchronous audio- Federal government to coordinate with states Allow reimbursement to pediatric providers only PLUS e-visits and eConsults including for and private health sector a thorough analysis to screen caregivers of CYSHCN some FQHCs/RHCs (or test APMs for clinics)
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From page 42... ...
States could identify and expand Relax or issue flexible guidance on CMS reimbursement for school-based physical rule related to reimbursement of legally and behavioral health services responsible relatives appropriate for TH delivery Funding must be targeted to reduce Extend the enhanced FMAP and continue disparities in access to telehealth, /expand continuous enrollment efforts telehealth equipment and training for that balance need for redetermination families, providers, and schools; expanding broadband coverage, especially in low-income and rural areas; and interpretation services during telehealth visits. Pediatric clinical guidelines should be developed to identify the appropriate use Federal/CMS of telehealth services for specific States and Medicaid Plans Federal and State conditions among CYSHCN.
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From page 43... ...
Finally, said Kuo, there is a need to empower local health authorities so that they can make the most appropriate decisions for their communities and students. Kuo relayed that he saw superintendents "basically beg" for the authority to mandate masks in schools in order to create a safe environment for all; politics and misaligned policies meant that some local authorities' hands were tied.
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From page 44... ...
This could lead to loneliness, and dependence on care provided in devolved institutions." Owuor et al., 2018 Periods of turbulence have historically inspired reinvention to overcome constraints, discord, or assumptions, and to achieve new imperatives, said Shea Tanis (Kansas University Center on Developmental Disabilities; Schiefelbusch Life Span Institute; University of Kansas)
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From page 45... ...
Tanis also encouraged states to move forward with advancing Technology First legislation, which will help harmonize and modernize policies for flexible and agile practices, facilitate cross-agency collaborations to improve access to and use of technologies, and promote user engagement and user-driven training.
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From page 46... ...
Title V agencies have the potential to provide essential leadership by convening stakeholders to talk about the issues facing children with disabilities and their families, said Agrawal. DuPlessis agreed, saying that Title V agencies know these populations better than anyone.
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From page 47... ...
Providers may not feel comfortable writing letters of medical necessity when they are not well-versed on the subject, and may not have the time to learn the ins and outs of prior authorizations. DuPlessis encouraged people to "call up your friendly local medical director" and explain exactly what is needed (e.g., an authorization request with specific language)
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