Source: A Young Person’s Guide to Health Care Transition | NCWD/Youth
A Young-Persons-Guide-to-Health-Care-Transition is about making the transition from pediatric to adult health care. This brief will review topics youth should consider around transitioning to adult health care, living a healthy lifestyle, and paying for health care. Youth need to be a part of conversations about health care. Most youth rely on their parents to handle decisions about their health care and health coverage. Before you know it, you may be expected to make these decisions on your own, if you are not doing so already. This brief will provide some information and help you think about ways you can start planning now for your transition from pediatric to adult health care.
Taking charge of your health care transition goes hand in hand with helping you achieve your career and life goals. Managing your health and wellness as a young person is the first step necessary for going to school, transitioning to work, and living the life you want. To make your dreams and career goals a reality, start learning about your health, health insurance, and health care transition planning at a young age. Make it a habit to manage your health and well-being as a young person, and you will carry this skill throughout your life.
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Got Transition and the American Academy of Pediatrics released a new 2017 Transition Coding and Reimbursement Tipsheet 2017 to support the delivery of recommended transition services in pediatric and adult primary and specialty care settings. The new tip sheet includes a list of updated transition-related CPT codes, including the new code for transition readiness assessment, and current Medicare fees and RVUs for these services. It also includes a new set of seven clinical vignettes with recommended CPT and ICD-10 codes. HERE for the tip sheet.
American Network of Community Options and Resources 2017
2015 Median Annual Cost of Care In:
Home Services*: $45,760
Adult Day Care*: $17,940
*Fall under the community services umbrella.
Intellectual and developmental disabilities (IDD) services are contending with external market disruptions which severely affect workforce retention and recruitment and are causing a public health crisis. Without qualified staff, agencies are limited in how they offer client-driven services, namely assisting individuals with IDD in living where, with whom and how they choose.
IDD services are a unique marriage of the private sector and the public good; providers, who range from small family-operated agencies to multi-state organizations, offer services funded by the government so that individuals with IDD can live full lives in the community instead of institutions. These services are delivered through dedicated staff called direct service professionals (DSPs). DSPs perform a wide range of work, from coaching individuals so they can find jobs to helping medically fragile individuals eat and get ready for the day. Agencies use their business acumen to deliver efficiencies so that services in the community are less costly to the government than institutions, while increasing the quality of outcomes for individuals because they can decide what help they want. However, agencies’ ability to meet this endeavor is severely hampered by a steadily growing workforce crisis.
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Michael López, Kerry Hofer, Erin Bumgarner, and Djaniele Taylor
A changing population According to 2013 U.S. Census data: • 48 percent of children under the age of 18 were members of racial/ethnic groups other than nonHispanic white. • Of this group, Hispanics represented the largest racial/ethnic group (24 percent), followed by nonHispanic blacks (14 percent) and non-Hispanic Asians (5 percent). • Hispanics also are a fast-growing racial/ethnic group, almost tripling as a share of the U.S. population between 1980 (9 percent) and 2013 (24 percent). a Across that culturally and linguistically diverse population, however, there is great variability within any given racial/ethnic group. Understanding the variability within and across racial/ethnic subgroups is an important step any organization must take to ensure its services are culturally responsive to the needs of its targeted population.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html
Produced in collaboration with the National Health Law Program under subcontract to NORC at the University of Chicago www.NORC.org
EPSDT’s goal is to assure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting.
“The Medicaid program’s benefit for children and adolescents is known as Early and Periodic Screening, Diagnostic and Treatment services, or EPSDT. EPSDT provides a comprehensive array of prevention, diagnostic, and treatment services for low-income infants, children and adolescents under age 21, as specified in Section 1905(r) of the Social Security Act (the Act). The EPSDT benefit is more robust than the Medicaid benefit for adults and is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. The goal of EPSDT is to assure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting.”
Source: Ten Ways the Affordable Care Act Helps Older Adults and People with Disabilities
NHeLP Senior Policy Analyst David Machledt provides a succinct examination of the ways the Affordable Care Act is improving the lives of older adults and people with disabilities. For example, the ACA bars health plans from discriminating against those with pre-existing conditions and since its enactment 3.6 million people with pre-existing conditions have gained health care coverage.
This NHeLP fact sheet provides information about health services for children, under age of 21, in schools. Many of the services are provided in schools, and some these services are provided Medicaid and/or the Individuals with Disabilities Education Act, or IDEA.
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Source: Health Services in Schools: Medicaid and Special Education Services
Health services in schools.
- Services provided in schools can play an important role in child and adolescent health care.
- Many services are already provided in schools: through school-based health clinics, school nurses, or through special education programs. This includes services such as mental health services and physical, occupational, and speech therapies.
- Some of these services can be covered by Medicaid.
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Medicaid services for children.
- Medicaid requires that children under age 21 get Early and Periodic Screening, Diagnostic, and Treatment services, or EPSDT.
- EPSDT covers screenings (checkups) and treatment for medical, mental health, dental, vision, and hearing problems.
- Treatment includes services that can provided in schools, like:
Physical, occupational, and speech therapy.
Hearing and vision screenings.
Behavioral health services.
By Abbi Coursolle, David Machledt, Wayne Turner
In the fourth paper in our “What Makes Medicaid, Medicaid?” series, NHeLP experts explain the provisions and protections that ensure Medicaid beneficiaries gain access to quality health care services. Senior Attorney Abigail Coursolle, Senior Policy Analyst David Machledt, and Senior Attorney Wayne Turner write, “Medicaid is designed to include many protections that ensure that beneficiaries get more than a coverage card. Medicaid ensures that beneficiaries have access to a range of services specifically designed for their needs.”
Source: What Makes Medicaid, Medicaid? — Access – DOWNLOAD PUBLICATION
- Under current law, states have tremendous flexibility in designing their Medicaid programs to determine low-income people eligible and enroll them in coverage.
- Medicaid operates efficiently by ensuring that low-income people are enrolled into coverage when they need it.
- Medicaid coverage is designed to provide continuous coverage for pregnant women and newborns.
- Medicaid ensures that beneficiaries can get to their medical and specialty care appointments through transportation assistance.
- Medicaid contains protections designed to get beneficiaries who need prescription medication access to their treatment quickly.
- Medicaid gives beneficiaries the right to access the providers they need to treat their health conditions.