What are optional Medicaid services?
1.
Occupational
therapy, Physical therapy, speech language therapy
2.
Durable
medical equipment
3.
Services
provided by independently practicing licensed professionals including
psychologists, psychiatric social workers, and other mental health
professionals
4.
Targeted
case Management
5.
Prescription
medication
6.
Dental
care, eyeglasses
7.
Crisis
response services
8.
Transportation
9.
Psychiatric
inpatient services for persons aged under 21 or over 65
10.
Related services
(including OT) provided by school systems to children with disabilities (note:
This provision overlaps IDEA legislation and has led to questioning as to
whether services to Individual children should be funded as an educational or a
health care service)
What is Medicaid reform?
1.
Due to
rapidly rising costs there is an increased press for cost containment
2.
States
are examining ways to reformulate Medicaid benefits
3.
Reform
options may Include placing caps or other Limitations on types and length of
therapy, reducing or eliminating optional benefits, and/or developing and
implementing managed care approaches
4.
Individual
states can APPLY to the federal government for a waiver which GIVES the state
flexibility in the types of services and delivery systems they Provide under
Medicaid
Discuss Workers' compensation
1.
Designed
to compensate employees who have Job-related illness or injuries
2.
Funded
jointly by Individual employers or groups of employers and state governments
3.
Each
state has a workers' compensation commission board which determines regulations
for employer participation, benefit provision, employee coverage, and insurance
administration
4.
Administration
can be through contract with private insurance companies or through Individual
employers or groups of employers who administer their own programs. This is
known as Self-insuring
5.
Coverage
varies from state to state, with many states initiating cost-containment
measures including limits on choice of providers, use of set fee schedules,
utilization review, and managed care
6.
Workers
compensation programs Include cash benefits and medical benefits. OT services
may be included
7.
Rehabilitation
and disability Management to return the person to gainful Employment is a
primary focus
What is personal payment and "Pro Bono" care?
1.
Individuals
whose health insurance has discontinued Coverage of OT services may elect to
pay for these services personally, providing that benefit can be derived from
continued services
2.
Individuals
without health insurance or with no Coverage for rehabilitative services may
also pay for OT personally
3.
The
services of OTs practicing in non-medical settings, (ie. wellness and
prevention programs) are generally not covered by insurers so their clients
must private pay
4.
"Pro
Bono" or free or reduced rate care may be supported by the individual
therapist's personal donation of services or through philanthropic donations
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