Tuesday, August 19, 2014

#OBRA Evaluation

To: Bureau of Developmental Disabilities Services (BDDS) Providers 
From: Julie Reynolds, Director, Bureau of Developmental Disabilities Services
Re: OBRA System Evaluation

Date: August 19, 2014

The Division of Disability and Rehabilitative Services (DDRS) has entered into a contract with Dr. Stephen R. Hall to do a comprehensive evaluation of Bureau of Developmental Disabilities Services (BDDS) state line Objective Budget Reconciliation Act (OBRA) services. 

This review is part of DDRS ongoing mission to improve efficiency and quality in the delivery of services for individuals with intellectual and developmental disabilities that enable them to live as independently as possible in their communities.

Dr. Hall has been contracted to accomplish the following outcomes in regard to the OBRA system:

 Provide a comprehensive plan to research and analyze the current OBRA system
 Conduct focus groups and provide analysis of results
 Conduct onsite reviews of current service delivery locations in collaboration with OBRA providers
 Develop and present a final report which will identify short and long term strategies and recommendations for improvement in the OBRA system
 Provide ongoing technical assistance

Several current providers of OBRA services will be contacted by Dr. Hall over the next few weeks to set up times to visit programs and meet with staff and individuals served through the OBRA program. Providers who have been selected to meet with and assist Dr. Hall will be contacted directly by BDDS staff prior to scheduling taking place.
If you have questions or comments please feel free to contact Wendy Miers, Director of Operations, at Wendy.Miers@fssa.in.gov

You can find more information about OBRA here: http://sweeneylawfirm.com/content/obra-regulations

#Vision Problems & Children with #SpecialHealth Care Needs

from National Center for Family / Professional Partnerships 

Mother , father and 2 daughtersChildren with special needs, particularly those with Cerebral Palsy and Down Syndrome, are at a higher risk of visual and eye health problems than their peers. These children may receive various interventions through their schools' systems including occupational, physical, and/or speech therapy. However, in most cases, they do not receive a comprehensive eye and vision examination.

If your child with special needs has a vision problem, a pediatric eye care provider (pediatric ophthalmologist or pediatric optometrist) may provide the best help. Pediatric eye care providers are doctors who specialize in the eye care of children. All ophthalmologists and optometrists have training in children's eye problems, but the pediatric providers have additional experience and expertise in examining children and the greatest knowledge of possible conditions that affect the pediatric patient. Find a pediatric provider on the  American Association for Pediatric Ophthalmology and Strabismus website or the American Optometric Association website.  

teacher of students with visual impairments  may also be helpful.   This is a professional who has expertise in how visual impairment affect your child's development and learning, as well as the strategies and tools that can help your child learn about the world, perform everyday activities, and participate in the general curriculum and other activities in school.

Learn more:

Friday, August 15, 2014

Meet Our New Specialists in #Lafayette and #Evansville

Brandi Kuhlenschmidt serves as a Health Information Specialist for the Evansville/Southwest Indiana region.  Brandi is mom to two daughters Audrey and Anna. Anna was diagnosed with Autism just before her third birthday.  Brandi was born and raised in Evansville and has spent the last several years learning to navigate the system to provide the best possible future for Anna.
Brandi is excited to work with Family Voices Indiana to help other families on their journey find all of the services and resources they need to give their loved one the supports they need. Brandi has spent the past fifteen years working with families and children in the not for profit sector and will use that experience, as well as all of the experience she has gained raising Anna, to help families educate themselves and feel empowered as they care for someone with a special health care need and/or disability.
Kate Sondgerath is our specialist in the Lafayette/Tippecanoe County area. Kate is the mother of two sons, ages 13 and 12. Her older son was born with seizures and developmental delays due to birth trauma. He is an early intervention success story and is now an active 8th grader who loves school and sports. Kate’s younger son has moderate autism and loves being outside, attending summer day camps and collecting figurines of movie characters.
Before moving to Lafayette in 2011, Kate lived in the Chicago area for close to 20 years. In Chicago, Kate worked as a hospital administrator at two large academic medical centers. Kate’s passion has always been assuring the delivery of the best possible healthcare to children. Since having 2 sons with special healthcare needs, Kate has realized how difficult it can be to secure access to the best care and in turn, find adequate financing to pay for the care. Kate is eager to support families who are facing the challenges that are so familiar to her.
Kate feels the most rewarding aspect of her job as a specialist is the knowledge she is gaining and using that knowledge to advocate for her own sons and the clients Family Voices of Indiana serves.

Churn & Families of #CYSHCN

by Lauren Agoratus, FVNJ, SPAN 

“Churn” in health care coverage means moving from health plan to health plan based on changes in eligibility.  If families of children with special health care needs have a change in income or life circumstances, such as getting or losing a job and insurance that goes with it, they and their child may lose or gain eligibility for different health care plans.  And, families whose income fluctuates during the year may lose or gain Medicaid or CHIP coverage.   Such churn often causes disruptions in coverage, even if a child becomes eligible for a public program due to a decrease in income.

Good News/Bad News
The Commonwealth Fund discovered that the Affordable Care Act (ACA) will help families who have income or life changes by not dropping coverage completely.  However, there is concern about what will happen when children with disabilities move back and forth between Qualified Health Plans (QHP) in the Marketplace and Medicaid or CHIP (State Children’s Health Insurance Program).

Possible Problems
There are serious implications for families moving either from a Marketplace plan to Medicaid/SCHIP or vice versa.  These include:
  • This affects a large number of families; 50% of families who have incomes that are below two times the poverty level will have at least one change in income which would switch them from Medicaid to the Marketplace or vice versa, even in states with no Medicaid expansion. 
  • When families change plans, they have to change to providers that participate in the new plan.
  • Families moving from Marketplace to Medicaid plans or vice versa may lose family practitioners who were their usual source of care.  This means that families may lose the primary doctor most familiar with their child’s special needs, affecting continuity of care. 

Possible solutions
  • Health plans could become multimarket plans to ensure smooth transition.  However, benefit limits, copays, and deductibles will still change for families with a new plan.
  • Using premium assistance, states can utilize Medicaid funding to help pay for private plan premiums, which will lead to a stable group of providers for families.
  • States should have continuous enrollment for 12 months using annual enrollment which will ensure continuity of care for children with special needs. 
  • The Basic Health Program option could be used by states for consistency in benefit coverage.  Note that 16 states have transition policies in place.
In summary, “In some cases, states establish general directives to plans to coordinate transfers; in others, state policies designate policies for issues such as transfer of medical records, maintenance of established patient–provider relationships for some time, and transi­tion protocols for designated populations and conditions.” (Commonwealth Fund report)

Another good resource recently released by Community Catalyst is the “Churn Toolkit.”  Several key points were found to affect churn reduction.  These include consideration of:
  • Application literacy level
  • Language access to applications
  • Conflicting information confusing to families
  • Out-of-date family contact information
  • Denial due to incomplete application
  • Income/life changes
  • Complexity of renewal process

Methods to mitigate these barriers are:
  • Addressing health literacy will eliminate the single largest barrier to health care access.
  • Applications in multiple languages will address underserved populations.
  • Availability of both in-person and phone help will assist families with information integration.Using email, if available, could eliminate problems with returned mail due to incorrect addresses.
  • “Express lane” eligibility determinations -- that is, using income data from another public program (e.g., WIC or food stamps) to determine eligibility for Medicaid or CHIP -- will reduce the need to provide income information for applications. 
  • Continuous eligibility for a set period of time will avoid the need to switch plans due to income or life changes.
  • Express lane, continuous eligibility and administrative verification (i.e. using other sources) will help simplify renewal and aid in retention.

The ease of renewal is an important component of reducing churn by maintaining retention.  Enroll America noted that the U.S. Department of Health and Human Services is proposing automatic enrollment for renewal (see “Renewal” under Resources.)  Enroll America issued guidance to help families keep coverage through the Marketplace and automatic enrollment in states that have federally run Marketplaces.  “These plans would give existing consumers a simple way to remain in the same plan next year unless they want to shop for another plan and choose to make changes.”  Key factors include the provision of:
  1. consistent information and “…this information needs to be available by early September when new federal Navigator grantees are announced, so that Navigators can learn about renewals as part of their training and certification/recertification.”
  2. No action needed if no change to family information and “…HHS should build a renewal system that can accommodate enrollees whose situations are uncomplicated.”
  3. Minimize information required when reporting changes in family circumstances so that applicants need not submit a new application or resubmit information that is unchanged, such as verification of identity and citizenship.
  4. Clear messaging on deadlines, which will remind families how to keep continuous coverage, and reminders that people can enroll in Medicaid at anytime.
  5. Streamline transitions between the Marketplace and Medicaid by shortening the 9 page “model” form and by using prepopulated information fields and pretesting the forms with families.

Many emerging strategies are being proposed for states to reduce churn and aid in retention of families in health plans.  Families can find help with children’s policy and family advocacy organizations (see “Finding State Resources” below.)  Parents of children with special health care needs will benefit from these initiatives, resulting in consistent care. 


  1. Commonwealth Fund: Reducing churn
  2. Community Catalyst: Churn Toolkit-stabilizing coverage
  3. Community Catalyst: Finding state resources
  4. Community Catalyst: Policy approaches to churn
  5. Health & Human Services: Renewal – auto enrollment plans
  6. Enroll America -Policy recommendations for renewal
Feel free to contact Family Voices Indiana if you have any insurance questions for your child with special health care needs 317 944 8982 info@fvindiana.org

Wednesday, August 13, 2014

Federal #Health Insurance Marketplace: Send in Requested Documents Now to Keep #Marketplace Coverage

Family Voices shares this important information from CMS:

Administration has closed approximately 450,000 citizenship and immigration status data matching cases and another 210,000 are in progress; warns remaining consumers to respond quickly or their Marketplace coverage could end

The Federal Health Insurance Marketplace began sending notices this week to consumers with a citizenship or immigration data matching issue (also called an inconsistency) who have not responded to previous notices via mail, email, and phone. While the Federal Marketplace has already received documents and cleared a large number of data inconsistencies related to citizenship or immigration status, consumers who have not yet responded must act now and submit supporting documents by September 5 or their Marketplace coverage will end on September 30.

A citizenship or immigration data matching issue can happen when the information reported in a consumer’s application, such as a Social Security or Permanent Resident Card number, is incomplete or different than the information the government has on file.  A data inconsistency does not necessarily mean there is a problem with an individual’s eligibility for enrollment; it means that additional information is needed to verify the information provided in an application. However, if these supporting documents are not received, health insurance plans will be terminated in order to ensure program integrity and protect taxpayer dollars.

“The Affordable Care Act is working to make quality health care more affordable and accessible for families. Over the last several weeks, the Marketplace has reminded affected enrollees in the Federally-facilitated Marketplace via mail, email, and phone to send in their supporting documents so they can keep their Marketplace coverage, and insurance companies have reached out directly to these customers as well,”said CMS Administrator Marilyn Tavenner. “The good news is that many have responded — we’ve closed about 450,000 of these cases and have an additional 210,000 cases in progress. However, some still have not responded. We want as many consumers as possible to remain enrolled in Marketplace coverage, so we are giving these individuals a last chance to submit their documents before their coverage through the Marketplace will end.”

We have worked hard to reach each consumer with a data matching issue multiple times. Specifically, the Marketplace has asked consumers five to seven times — via mail, phone and email — to submit their information.  These Federal Marketplace and issuer outreach efforts have produced results. In May, we had roughly 970,000 people with citizenship or immigration data-matching errors.  Since then, we’ve closed about 450,000 of these cases and have an additional 210,000 cases in progress. We continue to receive up to 60,000 documents a day. 

Today, we sent out letters to the approximately 310,000 consumers with citizenship or immigration data matching errors who have not responded asking them to submit their documentation.  These notices remind them that in order to keep their coverage they have to submit the outstanding documents by September 5th.  If they do not, their Marketplace coverage will end by September 30th.   

Consumers whose information are currently being processed or have been verified will not receive these notices. Consumers who have outstanding income verification issues will hear from the Marketplace at a later date.  In addition, States that are running their own Marketplaces are reconciling any data matching issues separately – as such, only enrollees who have not submitted any necessary citizenship or immigration documents to the Federally-facilitated Marketplace will receive these notices.

Notices are being sent in English and Spanish and provide straightforward instructions on how to submit the necessary information and keep their coverage. Those receiving this letter should log into their HealthCare.gov account and select their current application to upload their documents. They can also mail their information to our London, KY address. To ensure timely processing, consumers mailing in a copy of their documents should include the bar code page from our notice with their documents. Consumers may also contact our call center at 1-800-318-2596 to see what documents they need to submit and see whether the Marketplace has received their information.

We will continue our outreach to these individuals with two more calls and one more email ask about citizenship and immigration documents before the September 5 deadline. Those who do not respond will receive a final notice in September informing them that their last day of Marketplace coverage will be September 30.   In addition, a network of partners, local assistors and other stakeholders including community health centers have been activated in order to help to get the word out and make sure consumers keep their coverage. Consumers may contact one of our partners in their community to get one-on-one help. To find one of these local partners, visit Find Local Help on HealthCare.gov.

“Since this is an urgent matter, we are activating our networks on the ground to reach people directly in the communities where they live. Whether it is online, via our call center, or with one of our local partners, consumers will have a number of ways to find the help they need to continue their coverage,” said Tavenner.

For more helpful tips and the steps these consumers need to take, visit https://www.healthcare.gov/blog/still-need-to-send-documents/

For the number of letters going out by state in the federally facilitated Marketplace visit: http://www.hhs.gov/healthcare/facts/factsheets/2014/08/data-matching-map.pdf

Tuesday, August 12, 2014

Sunny Start Fact Sheets

The Indiana State Department of Health’s Sunny Start: Healthy Bodies, Healthy Minds initiative is a comprehensive, collaborative, statewide effort to implement a strategic plan to support a coordinated system of resources and supports for young children from birth through age five and their families.

Sunny Start, in collaboration with Family Voices Indiana, has updated a series of financial fact sheets to aid families in locating and understanding important resources to assist them and their children, including those with special healthcare needs. These fact sheets are an overview of state and federal programs that support the health and well-being of children. They include eligibility guidelines when applicable, and link the family or professional with the appropriate agency.

Families and professionals find these fact sheets to be easily understood and a reliable source of information. The recent update assures that they include any recent changes to these programs. They have also been professionally translated into Spanish.

We invite you to utilize these fact sheets in your home, medical practice, agency, or community. You can find the English fact sheets here and the Spanish version here.

Thursday, August 7, 2014

BDDS and VR office in #Indy area moving to new address/phone

INDIANAPOLIS (August 7, 2014) – On August 11, 2014, the Indiana Division of Disability and Rehabilitative Services’ (DDRS) Bureau of Developmental Disabilities (BDDS) and Vocational Rehabilitation Services (VRS), located at 7155 Shadeland Station in Indianapolis will relocate to 
2620 Kessler Blvd. East Drive, Suite 105 in Indianapolis. 

DDRS is part of the Indiana Family and Social Services Administration (FSSA). 
This move is intended to make it easier for Hoosiers in Marion and surrounding counties to receive more comprehensive service from FSSA, as the new office will be co-located with FSSA’s Division of Family Resources (DFR).

The service area for the VRS office at this location includes Hancock and Marion counties’ ZIP 
codes: 46201, 46202, 46205, 46208, 46216, 46218, 46219, 46220, 46226, 46228, 46229, 46235, 
49236, 46250, 46256, 46260, 46268 and 46278. The BDDS office service area includes Boone, 
Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan and Shelby counties. 

At close of business on August 8, 2014, the office’s address and phone numbers will be: 
Address: 2620 Kessler Blvd East Drive, Suite 105
Indianapolis, IN 45220
Phone: (BDDS) 317-205-0101 or 1-877-218-3530
(VRS) 317-205-0100 or 1-877-715-5296