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Medical Resources
A friend recently reminded me how difficult it can be when you have a child with significant issues in a hospital.  Remember to you can request a different Nurse or Doctor!  Personalities do clash - and that's ok.  Ask to speak with a Nurse Supervisor, Patient Representative or Hospital Social Worker to resolve your frustrations!  It's about quality care for your child! 
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Reminder: Your Forward card - HMO has Case Managers that are suppose to help you know what benefits you can access!  They are also there to help to access/problem solve what your individual  needs!   If you don't know who your forward card HMO is, call the number on the back of the card!

Remember - Clinics also have people to help you understand benefits.

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Accommodating Patients with Disabilities During COVID-19 Pandemic Today, in response to the first federal complaint challenging discriminatory hospital “no-visitor” policies, the Office for Civil Rights (OCR) at the U.S. Department of Health & Human Services announced a resolution making clear that federal law requires hospitals and the state agencies overseeing them to modify policies to ensure patients with disabilities can safely access the in-person supports needed to benefit from medical care during the COVID-19 pandemic.
https://www.hhs.gov/about/news/2020/06/09/ocr-resolves-complaints-after-state-connecticut-private-hospital-safeguard-rights-persons.html
 
Strict no-visitor policies put in place at hospitals have prevented patients with disabilities from safely receiving support from family members or staff necessary for them to effectively communicate with medical personnel or otherwise receive equal access to medical treatment. No-visitor policies have disproportionately impacted Black people with disabilities, who have higher rates of infection and hospitalization. Accommodations to these policies are required by federal civil rights laws.  
https://www.cdc.gov/mmwr/volumes/69/wr/mm6918e1.htm?s_cid=mm6918e1_w
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Wisconsin Department of Health Services Websites: 
                      Birth to 3   https://www.dhs.wisconsin.gov/birthto3/index.htm 
                      Children's Community Options Program https://www.dhs.wisconsin.gov/ccop/index.htm
                      Children's Long Term Waivers  http://www.dhs.wisconsin.gov/children/clts/index.htm
                                        What Services are Available?
​                                                       https://www.dhs.wisconsin.gov/clts/waiver/family/services.htm
                                       * What types of services are available? 
                                                      https://www.dhs.wisconsin.gov/clts/spcs.pdf
                     Updated Manual: Medicaid Home and Community-Based Services (HCBS) Waiver for the Children’s Long-Term Services 
                     (CLTS) Waiver Program
      https://www.dhs.wisconsin.gov/publications/p02256.pdf

​ 18-01 of the Medicaid Eligibility Handbook Published - http://www.emhandbooks.wisconsin.gov/meh-ebd/meh.htm   
                       Coordinated Services Teams (CST) Initiatives – Children                                                                                                                                                                    https://www.dhs.wisconsin.gov/cst/index.htm
                        Comprehensive Community Services (CCS) Children and Adults                                                                                                                                                      https://www.dhs.wisconsin.gov/ccs/index.htm
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Fact sheet on Children's Programs!
         Visit~  Family Voices of Wisconsin        https://familyvoiceswi.org/
                             
                               Fact sheets               https://familyvoiceswi.org/resource-library/
                                         Children’s Long Term Waivers
                                         Mental Health
                                         Medicaid and Transportation / Medical Appointments
                                         SSI
                                         Mental Health 
                                                Where do I begin/Treatment/Waiting/Paying
                                         Transition - Supported Decision Making
                               In the News grid tab   https://familyvoiceswi.org/newsgrid/
                                        Appealing  a Medicaid Denial
                                         Finding providers
                        ---------------------------------------------
Do you have questions or concerns about your Wisconsin Badger Care or Medicaid SSI. Call 1-800-760-0001 and speak with an Ombudsmen.  Help for:  Grievance
                                         Rights and Responsibilities
                                         Represent enrollee rights
                                         Help with covering services
                                         Denial, Stopped or Reduces Services
                                         Feel you are treated unfairly or disrespectfully
Or write to:  BadgerCare Plus or Medicaid SSI HMO Ombudsmen, PO Box 6470, Madison, WI  53716-4070
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DOA Division of Hearings And Appeals            https://doa.wi.gov/Pages/AboutDOA/HearingsAndAppeals.aspx
​Originally created in 1978, the Division of Hearing and Appeals (DHA) is an quasi-judicial, independent entity created to conduct high quality, impartial, independent, and cost and time efficient hearings that serve customer agencies and the citizens of Wisconsin.
                        819 N 6th St Rm 92, Milwaukee · (414) 227-3818
                        
5005 University Ave Ste 201, Madison · (608) 266-7709
                         
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MetaStar is a quality improvement organization with 45 years of experience working alongside those in the health care system to improve the quality of health care for all patients. Our health care improvement and consulting services address the need for system-wide innovation and consistent, evidence-based approaches across all settings of care. All of our work is guided by our mission, to effect positive change in health and health care.
We work with communities, providers, and insurers to transform care with a vision of optimal health for all. MetaStar is an independent nonprofit based in Madison and represents Wisconsin in the Lake Superior Quality Innovation Network.
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From the  Kaiser Family Foundation   http://kff.org
Health Insurance Marketplace Calculator provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can enter your income, age, and family size to estimate your eligibility for subsidies and how much you could spend on health insurance. You can also use this tool to estimate your eligibility for Medicaid. As eligibility requirements may vary by state, please contact your state’s Medicaid office or Marketplace with enrollment questions.

http://kff.org/interactive/subsidy-calculator/?utm_campaign=KFF%3A+2015+October+Health+Reform+ACA+Open+Enrollment&utm_source=hs_email&utm_medium=email&utm_content=24040652&_hsenc=p2ANqtz-_XnyaqY44up-hhs8ySQNlJRYrxpRifMhO_TgW-waqGUXF_C6aI_7ZaDoOp9e9I5oS5K17OpZ4IDnEaZz2jl_mDhcfXkA&_hsmi=24040652
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Acronym Finder
            Confused by educational and medical jargon?  This web site allows you to enter the acronym or a subject, such as autism, and find  out what the acronyms mean in plain English.   http://www.acronymfinder.com/   
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GRANT
UnitedHealthcare Children's Foundation is a non-profit Section 501(c)(3) charity funded by contributions from UnitedHealth Group, UnitedHealthcare and its employees, as well as the generosity of individuals and corporations.
http://www.uhccf.org/aboutus.html

Purpose:   Children who have medical needs are sometimes not insured comprehensively to provide coverage for all of their medical treatments. There are few places for families who have gaps in their commercial health benefit plan coverage to turn to for funding medically necessary services for their children. Children may go without necessary treatment, or, they receive the care and families assume a large amount of debt. The Foundation understands these needs and is willing to help fill this void. 
http://www.uhccf.org/

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Kathy's House: A Home Away from Home -Kathy's House is a hospital hospitality house - for patients of all ages and their caregivers traveling to Milwaukee area hospitals for medical treatment.  Located near Milwaukee County Zoo.
www.kathyshouse.org www.facebook.com/KathysHouseMilwaukee           414-453-8290            mail@kathy-house.org
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American Cancer Society Hope Lodge in Marshfield cost free lodging during treatment!
Help spread the word about Hope Lodge. Please 
https://www.facebook.com/HopeLodgeMarshfield
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Affordable Care Act -ACA, check out Family Voices of Wisconsin.   http://fvofwi.org/public-policy/affordable-care-act/



Who / What  are your  resources that can help you?

http://www.co.wood.wi.us/Departments/Health/Doc/CYSHCN%20Medical%20Resources%20Fact%20Sheet.pdf
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Northern  Children and Youth with Special Health Care Needs Regional Center  (CYSHCN)
715-261-1906     800-642-7837 specialneedsinfo@co.marathon.wi.us http://northernregionalcenter.org.
   
Medical providers: serving everyone Uninsured or Under- Insured
        Medical Supply Reimbursement rates (Forward Card)
        Medical Information and Resources
        Specialty Medical Support Program
        Medical Insurance Resource

To find your CYSHCN Regional Center:
http://www.dhs.wisconsin.gov/health/children/RegionalCenters/index.htm
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Katie Beckett Program Consultants
Click on an  area of the map, or on the name below, to get information about the Katie  Beckett consultant in your area.

https://www.dhs.wisconsin.gov/kbp/consultants.htm

For  additional assistance to families related to applying for Katie Beckett Medicaid  coverage, contact the Katie Beckett Program Assistant at (608)  266-3236.         (800) 362-3002.
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Katie Beckett Consultant for Wood County - Wisconsin's Katie Beckett Medicaid Program provides health care coverage to eligible children who have disabilities and long-term support needs.
Who do we contact – when?
 Shana Berg
The Parenting Place
1500 Green Bay St.
La Crosse, WI 54601
(608) 397-1897   shana.berg@wisconsin.gov
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Bureau of Children’s Services 
 
See Childrens Services Specialists
Wood Co is Keith Keller for CLTS
608-215-8968  Keith.Keller@wisconsin.gov

CENTRAL OFFICE CONTACTS:
Autumn Knudtson, Chief
Children’s Program Operations and Partner Relations Section
Bureau of Children’s Services
Division of Long Term Care
Phone: 608-267-3257
Email: Autumn.Knudtson@dhs.wisconsin.gov

Susan Larsen, Chief
Policy Initiatives and Program Integrity Section
Bureau of Children’s Services
Division of Long Term Care
Phone: 608-267-9175
Email: Susan.Larsen@dhs.wisconsin.gov 715-292-9677
dennis.liphart@wi.gov
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DHS -  info on children's long term care waivers- http://www.dhs.wisconsin.gov/children/clts/index.htm
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ABC for Health Care    1-800-585-4222  
          32 N BASSETT ST   MADISON, WI 53703
·         608-261-6939       800-585-4222
·         INFO@SAFETYWEB.ORG
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BirthInjuryGuide.org.

Birth Injury Guide is a comprehensive informational website on all types of birth injuries. Our goal is to provide helpful information and guidance to parents if their child was born with a birth injury.

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Tubie Friends www.tubiefriends.com                                                          Taking the fear out of feeding tubes, one Tubie Friend at a time
Find Tubie Friends on Facebook!
              
Communication Clinics  - Brain

UWSP Communicative Disorders Program 

Work:   715-346-3667 (Kaye at front desk) 
Fax:             715-346-4835
Work Address: 2100 Main Street Stevens Point, WI   54481


Waisman  Center
Communication Aids and Systems Clinic (CASC)
1500 Highland Ave.  Room 327 Madison, WI 53705-2280
(608) 262-3039       Fax: (608) 265-9851

Call and ask them to send you an informational packet.  They are unable to give you an  appointment until you fill out the packet and send it back in.  When you  send it in, put a note on it and tell them that you will take any opening that comes up.  Otherwise you may wait up until 16 months.  It's easier to  get in during the winter - driving may suck but it can open up sooner than you  think. 

State of WI Department of Health and Family Services –
Office for the Deaf and hard of hearing
… 715- 842-7693
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Vision therapist  in the Woodruff/Wausau areas...http://www.optometrosts.org/buffington
Kate  Buffington
                                                                                                                                                                                                                    
JEFFREY  BECKER OD VISION REHABILITATION SPECIALIST NEUROSENSORY CENTER OF EASTERN PA 570  763 0054 jbecker@keystonensc.com
www.keystonensc.com

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Family Voices of Wisconsin -
http://www.familyvoicesofwisconsin.com/

Three  new fact sheets are now available on the Family Voices
website at www.fvofwi.org/factsheets.html  These fact
sheets provide easyto understand information on LogistiCare and how to get help with rides or  reimbursement for driving to a Medicaid covered medical appointments. The fact  sheets
include: 

Fact  Sheet #1 - Medicaid and Transportation to Medical
Appointments
 

Fact  Sheet #2 - Mileage Reimbursement for Medicaid Covered
Appointments
 
      
 Fact  Sheet #3 - Medicaid & Help with Lodging and Meals for Medical  Appointments

For more information contact Lynn at Lynn@fvofwi.org or call Family Voices at
608-220-9598
Family Voices Announces the Release of the Bright Futures Family Pocket Guide                
http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html
You  will also find Fact sheets on:    



  • Diapers/Incontinence Supplies and Medicaid: English | Spanish
  • Finding the Right Doctor: English | Spanish
  • Finding and Funding Respite Care for Your Child with Special Needs
  • Insurance Changes that Affect Families: English | Spanish
  • Making the Most of your Doctor's Appointments
  • Medicaid and Transportation to Medical Appointments: English | Spanish
  • Medicaid & Help with Lodging and Meals for Medical Appointments: English | Spanish
  • Mileage Reimbursement for Medicaid Covered Appointments: English | Spanish
  • Outcomes: English | Spanish
  • Personal Care: English | Spanish
  • What is HealthCheck Other Services?
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1/28/13   New Interpretation of FMLA Issued by the  U.S.   Department of Labor's Wage  and Hour Division 
This week, the U.S. Department of Labor's (DOL) Wage and Hour Division issued a new Administrator Interpretation that expands the Family and Medical Leave Act's (FMLA) current
language to include adult children  who are unable to care for themselves because of a mental or physical disability and whose disabilities occurred before or after the age of 18. The previous interpretation of the law was unclear as it applied to adult children with disabilities.

This Interpretation also clarifies FMLA-protected leave for a parent is not dependent on the age of the adult child and the onset of their disability, and broadens the definition of  "disability" to reflect the Americans with Disabilities Act Amendments Act (ADAAA). Ultimately, this Interpretation means that more parents will be able to take FMLA- protected leave from their jobs to care for their adult children with disabilities.
 
Learn more about the FMLA
http://ucp.us1.list-manage.com/track/click?u=2a0f8e7077be7d116c18c3273&id=97eeabff48&e=1f600b3792>and
this new Administrator Interpretation
http://ucp.us1.list-manage.com/track/click?u=2a0f8e7077be7d116c18c3273&id=237b029f2b&e=1f600b3792>
 from UCP's Website
 http://ucp.us1.list-manage.com/track/click?u=2a0f8e7077be7d116c18c3273&id=4a83fa7f55&e=1f600b3792> 
*REFERENCE POINTS* is administered by PACER Center 
http://www.pacer.org/> as a technical assistance activity of the
TATRA Project. The TATRA Project is funded by the
Rehabilitation Services Administration.

Elizabeth Hecht Outreach  Specialist for Public Policy
Waisman Center - UCEDD   608- 263-7148
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Videos

Medicaid Video featuring Wisconsin residents: 
www.imperfectunion.org

Brain Hero | 3-minute video. 
This new video (only 3 minutes long!) comes from the Center for the  Developing Child at Harvard University.

 It depicts how actions  taken by parents, teachers, policymakers, and others can impact child  development and affect life outcomes for both the child and the surrounding community. 

http://developingchild.harvard.edu/resources/multimedia/brain_hero/
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Abstract: State Health Care Financing
Strategies for Children with Intellectual and Developmental
Disabilities


By  Sara S. Bachman, Margaret Comeau, Carol Tobias, Deborah Allen, Susan Epstein,  Kathryn Jantz, and Lynda Honberg Intellectual and  Developmental Disabilities, Vol. 50, No. 3, pp. 181 -  189    June 2012
Citing data from the 2005-2006 National Survey of Children
with Special Health Care Needs
, http://www.childhealthdata.org/) the authors note that about 40% of families  raising children with intellectual and developmental disabilities (IDD) report  that their health insurance is not adequate to meet their children's needs and
34.6% of families experience financial hardship. Title V, Medicaid, the  Children's Health Insurance Programs (CHIP), and state agency supports, which  all vary from state to state, provide some additional services that may help  reduce financial stress. These researchers from the Catalyst Center at  Boston University, the Boston Public Health Commission, and the U.S. Department  of Health and Human Services conducted structured interviews with staff from  state Title V Children with Special Health Care Needs programs, Medicaid program
staff, and family leaders to identify additional strategies to close benefit gaps and  pay for additional  services. They also discussed provisions of the Affordable Care  Act (ACA) that may help reduce variability between states and alleviate the
financial hardship many families experience.

Abstract:
State Insurance Parity  Legislation for Autism Services and Family Financial  Burden By Susan Parish, Kathleen Thomas,  Roderick Rose, Mona Kilany and Robert
McConville
Intellectual and Developmental Disabilities, Vol.
50, No. 3, pp. 190-198
June 2012
Previous  research documents that children with autism spectrum disorders use more health  services than children with other special health care needs. There is also  evidence that Medicaid and families bear the primary financial responsibility
for the cost of these services, as many private health insurers limit or deny  services for children with this diagnosis. Using individual and state level data  from the 2005-2006 National Survey of Children with Special Health Care Needs,  (http://www.childhealthdata.org/) the authors examined the association  between states with autism mandates or parity legislation and family financial  burden. Their preliminary analyses, which support the case of many advocates for
creating autism mandates, found that families living in states with autism  mandates or parity legislation had fewer out-of-pocket costs for their  children's autism services than families living in states without these  requirements for private health
insurers.
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 A Look at State Medicaid Program
Spending, Enrollment and Policy Trends Results from a 50-StateMedicaid Budget
Survey for State Fiscal Years 2012 and 2013
   http://www.kff.org/medicaid/8380.cfm

Information on programs:

Covered Services in Wisconsin's Long-Term Care  Programs 
        
http://www.dhs.wisconsin.gov/publications/P0/p00088o.pdf 
               
Children's Community Options Program: CCOP 

 Power Point from Circles of Life - http://www.circlesoflifeconference.com/.../Childrens...

http://www.dhs.wisconsin.gov/children/index.htm -
Children's Long Term  (CLT) Waivers
               
http://www.dhs.wisconsin.gov/children/clts/waiver/county/csscontacts.pdf
- CLT - waiver  contacts
                  
http://www.dhs.wisconsin.gov/ltcare/adrc/professionals/policyprocedures/opsguide/ch6/OpGuideChildrenAgingintoMLTCIRIS050610.pdf
- Children to adult  LTC
               
http://www.dhs.wisconsin.gov/publications/P0/p00088o.pdf
- covered services LTC programs - FC - Partnership- IRIS-  MA
               
http://www.dhs.wisconsin.gov/publications/p0/p00079.pdf
- bench mark and Badger Care +

BadgerCare Plus Premium and Copayment table beginning on page 12 and the Covered Services table beginning on page 33 of the Benefits and Enrollment Handbook:           
http://www.dhs.wisconsin.gov/em/impubs/pubs/p-00079.pdf

There is also a BadgerCare Plus Core Plan Covered
Services/Copayment table beginning on page  18.
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Medicaid Waiver Manual: http://www.dhs.wisconsin.gov/bdds/waivermanual/app_a.htm. 

7 programs for which the CLTS Functional Screen determines functional eligibility:
       Comprehensive Community Service            
       Community Recovery Services            
       Community Options Program                 
       Family Support Program                                 
       Children's  Waivers                                 
       Katie Beckett Medicaid Program                   
       MH Wrap Around    
                                    
Becky Burns, MSSW, CISWCLTS FS Clinical Advisor / FAX  
608-263-7861   E-Mail: Becky.Burns@wisconsin.gov
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MA Prior Authorization Appeal to:
Martha Maltke - Medicaid Pharmacy Benefit
608-266-9749  
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Have you ever served in the Armed Forces?

If so, you may want to contact your local County Veteran Service Officer to see whether you qualify for additional Wisconsin Veterans Benefits.

• ADAMS
David Guerin
608-339-4221
adamsvso@co.adams.wi.us
• JACKSON
Randy Bjerke
715-284-0225
veterans.services@co.jackson.wi.us
• MONROE
Margaret Garvin
608-269-8726
margaret.garvin@co.monroe.wi.us
• PORTAGE
Michael Clements
715-346-1310
clementm@co.portage.wi.us
• WAUSHARA
William Rosenau
920-787-0446
williamr.parkstreet@co.waushara.wi.us
• WOOD
Rock Larson
715-421-8420
rlarson@co.wood.wi.us


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Community Services Locator: An Online Directory for Finding Community Services for Children and Families, 3rd Edition 
http://www.mchlibrary.info/KnowledgePaths/kp_community.html


The  Maternal and Child Health Library at Georgetown University May 2012
The Maternal and Child Health (MCH) Library
at Georgetown University
has developed a new edition of the
Community Services Locator, an online directory for finding services for children and families in the communities in which they live. Service providers and families can use the locator to find available childcare and early childhood programs; education and special education programs; developmental assessment and
learning services; family support; financial support; and health and wellness care.
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If  you are having  difficulty with obtaining  therapy - you may want to  understand: “Essential Health Benefits” under the
Affordable Care Act.2    and look at habilitative and rehabilitative services  and devices

This is a part of: The Essential health benefits are a set of  health care service categories that must be covered by certain insurance plans,starting in 2014, under the Patient Protection and
Affordable Care Act (the  ASHA Leader, Jan. 18, 2011; Nov. 22,
2011
).
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Health Transition Wisconsin - Supporting Youth to Adult Healthcare                  healthtransitionwi.org  
 
Learn more about youth to adult transition -
*Transition information and resources for youth and families,
                 including youth transition stories
*Transition tools and resources for health care providers, including:
                 practice guidelines and CME opportunities
healthtransitionwi@waisman.wisc.edu
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Enrollment for Health Coalition  -    www.e4healthwi.org  
            
A new, non-partisan, non-aligned, one-stop-shop resource to support and  coordinate trainings, regulatory updates, new sources of materials, meetings and conferences.   New functions will soon be added that will allow for specific groups to have specialized chat rooms-  for Navigators and Certified Application Counselors, Regional Enrollment Network members, and others.
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------------------- 
The Patient at Risk Program is a free, web-accessible
database for Emergency Information Forms
(EIFs) for patients and  families across Wisconsin. The program allows a parent or guardian to create,  store, and manage their child's health information. In the event of an  emergency, providers have fast access to the information about the child's  health which may include:·        
      Health problems or conditions 
  • Current medications
  • Special care instructions including hospital preferences
  • Contact  information for your child's physicians
One key goal of the program is to educate families and caregivers about the EIF,  Emergency Information Form, and it use. Families are strongly encouraged to share their child’s EIF with their local EMS providers as a way to develop an emergency medical care plan.  

To learn  more about the Patient at Risk Program please visit: http://wiaap.org/patient-at-risk.php.  You will be able to review the program support tools for families, emergency responders and medical providers as well as a link to the enrollment database for
families. 
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Financing the Special Health Care Needs of Children and Youth in Foster Care: a Primer
http://hdwg.org/sites/default/files/Foster-Care-Primer.pdf
         
States  are expanding managed care to new geographic areas and to
additional populations and linking payment to performance in an effort to  improve delivery of care to individuals dually eligible for Medicare and  Medicaid.
Forty-four states are implementing care coordination activities.
Some of the care coordination will occur through the Medicaid health home state plan option (section 2703 of the ACA), for individuals with chronic conditions.  
 
• Executive  Summary
• Foster Care: Then and Now Description of the foster care population and their special health care  needs.
• Foster Care Placement Description of the types of
out-of-home placements children may experience.

• Child  Welfare System Synopsis of the funding, federal legislation and key players of the child welfare  system.
 • Comprehensive Health Care for Children in Foster Care Description of important elements in providing comprehensive health  care for children in foster care.
• Federal and State Efforts to Improve the System of Health Care Highlights of steps that federal and state officials have
taken to improve the system of health care for children in foster
care.

• Innovative Models of Health Care Delivery in Foster
Care Summary of three different programs and their models of
providing health care services for children in foster care.

 ---------------------------------
 Video  provides quick answers to the questions you may have about:   
  • When children (younger than 19), including children with special health care needs, can be added to a  parent's private health insurance (hint: know when your open enrollment period occurs);
  • Special circumstances for adding a dependent to a parent's coverage outside of the open enrollment period due to the termination of other health coverage;
  • Whether an insurer can refuse or limit coverage for a child with a pre-existing condition (hint: as of  September 2010, the
    Affordable Care Act (ACA) prohibits private insurance companies from denying or limiting coverage to
    children under age 19 with pre-existing conditions.
    Starting in January 2014, the ACA will also prohibit insurers from denying coverage to adults with pre-existing conditions).
  • If an insurer can increase the premiums for a child with a known  medical condition (yes). 

 Note: As of September 23,  2010, a separate provision of the ACA extended coverage for young adults, ages 19-26, on their parents' private health policies. Some insurers allowed parents to continue coverage for their young adult children with known medical conditions. Young adults with pre-existing conditions who
were denied coverage under their parent's plan prior to 2014 should be able to be  added to their parents' plan starting in January 2014 if they are still younger than  26.

http://www.kaiserhealthnews.org/Multimedia/2012/November/andrews-q-and-a-covering-a-sick-child.aspx
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http://www.childtrends.org/Files/Child_Trends2012_10_01_RB_ChildDisabilities.pdf
         Children with Disabilities: State-Level Data From the
                   A merican Community Survey

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Essential Health Benefits: Balancing State Flexibility with Consumer Protections  By Sara R. Collins
The Commonwealth Fund  Stateline: State Policy & Politics
http://archive.constantcontact.com/fs073/1101483160413/archive/1109075550170.html#Article1

December  20, 2011
The U.S. Department of Health and Human Services (HHS) had
been working toward developing an Essential Health Benefits package that individual and small group health insurers, as well as all health plans in the state exchanges will have to provide as mandated by the Affordable Care Act (ACA). In a change of policy, on December 16, 2011, HHS issued an Essential Health Benefits
Bulletin
that says, rather than creating a one-size-fits-all
essential health benefits package, states will have some flexibility to create a  state-specific benefit plan, as long as each state covers services in the following ten categories:     
  1.  
    • Ambulatory patient services
    • Emergency services
    • Hospitalization
    • Maternity and newborn care
    • Mental health and substance use disorder services, including behavioral health treatment
    • Prescription drugs
    • Rehabilitative and habilitative services and devices
    • Laboratory services
    • Preventive and wellness services and chronic disease management, and
    • Pediatric services, including oral and vision care
States must select one of the following as a benchmark plan, to "fill in" the health services provided in each category: 
  • one of the three largest small group plans in the state by enrollment, or one of the three largest state employee health plans by enrollment, or
  • one of the three largest federal employee health plan options by enrollment, or
  • the largest HMO plan offered in the state's commercial market by enrollment
If a state's benchmark plan does not provide services in one
or more of the 10 categories, states can pick a second plan to complete its  health benefits package.

This will allow insurers to continue covering a state's mandated benefits without the state incurring the cost of those services  which fall outside of the HHS Essential Health Benefits package. See the 2010 list of each state's health insurance mandates. Public input to HHS is welcome about this  process. The deadline for comments is January 31, 2012. Send comments to: EssentialHealthBenefits@cms.hhs.gov
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A tribute to Katie Beckett - well written -!

 
Katie Beckett, Who Inspired Health Reform, Dies at 34 By
DENNIS HEVESI Published: May 22,
2012

 
Katie Beckett, who was 3 years old and
had been hospitalized almost since birth when President Ronald Reagan invoked
her case as an example of irrational federal regulation in 1981 — a crucial
moment in the movement toward government support for home health care — died on
Friday in Cedar Rapids, Iowa, in the hospital where she was born. She was 34,
more than three times the age her doctors had predicted she would
reach. 

 United Press International Katie Beckett, 3, in 1981
leaving a hospital in Cedar Rapids, Iowa, with her parents after a victory over
health care red tape.

The cause was a
digestive disorder not related to the brain inflammation that led to her
lifelong respiratory difficulties, her mother, Julie Beckett, said.


On Monday, the secretary of health and human
services, Kathleen Sebelius, called Ms. Beckett “an inadvertent pioneer in the
civil rights movement for people with disabilities” and the inspiration for
regulations that have allowed more than 500,000 disabled children to live at
home since 1981.

Four months after her birth
at St. Luke’s Hospital in 1978, Katie contracted viral
encephalitis, leaving her partly paralyzed,
unable to swallow and barely able to breathe on her own. Her parents found
themselves in a bureaucratic trap. They wanted to manage her care at home with a
ventilator and began lobbying politicians and bureaucrats. The case led to what
is known as the Katie Beckett Waiver.

Katie
qualified for Supplemental Security Income, a Medicaid program run by the Social Security
Administration. Under the old rules, if she had been taken home, her parents’
incomes would have been counted against her, and she would have lost eligibility
for the aid. Yet her hospital care was costing $12,000 a month, six times as
much as home care would have cost.

President
Reagan heard about Katie from Vice President George Bush, who been told about
her by Thomas Tauke, a Republican congressman from Iowa. At a news conference on
Nov. 10, 1981, Mr. Reagan cited Katie’s case as an example of “hidebound
regulations” that caused “tremendous expense to the taxpayers.” The rules, he
said, forced her to stay in the hospital even though she would be better off at
home.

A day later, the secretary of health and
human services, Richard S. Schweiker, waived the rules to let Katie return home
without the loss of federal support. He also created a review board to handle
similar cases. When she left the hospital a week before Christmas in 1981, Katie
received a rag doll from the Reagans and a note wishing her and her family “the
loveliest holiday ever.”

Ms. Sebelius said
that “thanks to her mother, Julie’s, tireless advocacy, in 1982, Medicaid policy
fundamentally shifted” toward supporting home heath care.


Mary Katherine Beckett was born in Cedar
Rapids on March 9, 1978, to Julie and Mark Beckett. Besides her parents, she is
survived by a stepsister, Chelsea.

Home care
worked for Katie Beckett, her mother said. Although Ms. Beckett required nursing
care an hour a day, five days a week, and 12 hours a day on a ventilator, she
graduated from Mount Mercy University in Cedar Rapids in 2001 with a degree in
English and creative writing. She held several jobs over the years, including
one as a secretary in a homeless shelter.


There were extended hospital stays, but she
had applied to graduate school and was writing a novel. “She wouldn’t let me
read it,” her mother said, “but she loved young-adult romance novels.”


She added: “She lived a fairly normal life.
She wasn’t homebound.”
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