Private Duty Nursing for children under Medicaid: There may be some relief

May 22, 2012

Families whose children receive Medicaid private duty nursing services have seen reductions or terminations of these nursing services since Schaller Anderson, a private company, began administering children’s Medicaid skilled nursing services. Schaller Anderson has required a review or recertification every 12 weeks, regardless of the child’s medical situation, and the review has sometimes resulted in a decrease in nursing services without regard to whether the child’s medical condition improved. At a recent meeting, LisaBritt Solsky, Deputy Medicaid Director at the NH Department of Health & Human Services (the Department), let people know that the Department recognizes the disruption such frequent changes to services has caused families and informed them that the Department “wants to restore for those families the hours that they had of that particular service”. 

For families who appealed a reduction or termination of private duty nursing services
The Department is in the process of contacting families by letter, informing them that private duty nursing hours will be reinstated to the number of hours authorized for the child prior to the review and appeal. The Department will coordinate with the Administrative Appeals Unit on cases currently pending.

For families who did not appeal a reduction or termination of private duty nursing services
For those children who have had services cut in the past, but did not appeal, those services will not be automatically reinstated. If you feel your child requires additional medically necessary services, you may contact the Department and request them. If the request is denied, you may consider filing an appeal (see http://www.drcnh.org/skillednursing.html).

Review period will be modified
Children who have been stable for a long time and have had no changes or disruptions, will be approved for a six month or even twelve month authorization. The 12 week review will still be in place for those children new to the service or who have had a recent hospitalization.  
If you get a call saying a 12 week review is scheduled and your child is not new to the service or hasn’t had a recent change in events, you may call Jane Hybsch, Administrator, Medicaid Care Management Programs, at (800) 852-3345 extension 9423 or LisaBritt Solsky at 271-9408. You may also call Disability Rights Center - NH at 800-834-1721 for assistance.

For more information about the problems with Medicaid skilled nursing services, see the article on page 6 of the latest RAP Sheet, “We Already Have Managed Care in New Hampshire”.  http://www.drcnh.org/RAPSpring2012.pdf. More information on what you can do if skilled nursing services are reduced or denied can be found here: http://www.drcnh.org/skillednursing.html

 

updated September 8, 2015