Transcript Medical Adoption Subsidy 2012

Michigan
Department Of
Human Services
Adoption Subsidy
Program
www.michigan.gov
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Medical Subsidy
• Adoption Medical Subsidy is intended to assist
with paying for services related to the
treatment of physical, mental or emotional
conditions that are certified by the Adoption
Subsidy Office.
• Applications can be made prior to the
adoption or any time up to the child’s 18th
birthday (Form: Parent’s Request for Medical
Subsidy For An Adopted Child 1341 A)
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Adoption Subsidy Program
By the Numbers
Approximately 27, 000 active support subsidy
cases
Approximately 13, 900 active medical subsidy
cases (with support subsidy)
Approximately 1,100 active medical subsidy
cases (without support subsidy)
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Medical Subsidy Program
Key Points
1. Medical Subsidy is not Medicaid or an insurance
2. DHS is payer of last resort (use of Private health
insurance, Medicaid, Children’s Special Health
Care Services, Local and intermediate school
districts, Other public resources.)
3. Services covered by the Medical Subsidy must
be necessary to treat a certified condition
4. Payments for services require prior approval
from the Adoption Subsidy Program (i.e.
ongoing case workers)
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Types of Services covered under the
Medical Subsidy
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Outpatient Counseling
Assisted Care Services (Physical Care Services & Behavioral Services
Temporary Out-Of-Home Placement (16 days max)
Placement Outside the Family Home
Travel Expenses
Educational Services (speech therapy, physical therapy, occupational therapy, tutoring)
Summer Camps
Dental Services (Orthodontic treatment)
Durable Medical Equipment
Medical Supplies and Prescriptions (Prescriptions, Glasses/Contact Lenses & Incontinence
Supplies)
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Outpatient Counseling
• Outpatient mental health and related services
are those psychological, psychiatric,
counseling, psychotherapy, or other similarly
defined services for evaluation and/or
treatment of emotional/mental conditions
certified eligible by the Adoption Subsidy
Program Office.
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Outpatient Counseling
Requirements
• Child must have an approved medical Subsidy from the
Adoption Subsidy Office.
• Service must be necessary to treat certified conditions.
• DHS is payer of last resort ( use of Private health insurance,
Medicaid, Children’s Special Health Care Services, Local and
intermediate school districts, Other public resources).
• Does NOT require prior authorization but child must have a
certified emotional condition approved by Adoption Subsidy
Office.
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Assisted Care Services
(Physical Care Services & Behavioral Services)
Adoption medical subsidy may pay for
assisted care services in certain cases.
There are two types of assisted care
services: physical care services and
behavioral services.
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Physical Care Services
Physical care services are assistance in caring for
the special physical condition(s) of a child (e.g.,
quadriplegia, tube feeding, ostomy care, oxygen
dependency, severe multiple impairments).
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Physical Care Services Requirements
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Child must have an approved medical Subsidy from the Adoption Subsidy Office.
Service must be necessary to treat certified conditions.
DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s
Special Health Care Services, Local and intermediate school districts, Other public
resources.)
Parents must seek prior authorization by the Adoption Subsidy Office.
Requires a written medical treatment plan related to a physical condition that has
been certified by the Adoption Subsidy Program Office.
A written caregiver plan must be provided, which includes the specific treatment
and times needed.
The service provider is qualified by education, training or experience, as
determined by the Adoption Subsidy Program Office, and is not a member of the
immediate household.
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Behavioral Services
Behavioral services are short-term training of
the child and/or parent(s) in modifying the
child's behavior that is related to the child's
mental or emotional condition that has been
certified by the Adoption Subsidy Program
Office prior to service.
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Behavioral Services Requirements
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This service is not intended for care of the child in the parent's absence.
Payment for behavioral services will be made at a rate set by the Adoption Subsidy Program
Office for a maximum twelve month period.
Child must have an approved medical Subsidy from the Adoption Subsidy Office.
Service must be necessary to treat certified conditions.
DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special
Health Care Services, Local and intermediate school districts, Other public resources.
Parents must seek prior authorization by the Adoption Subsidy Office.
A treatment plan needs to be submitted to the Adoption Subsidy Office for review.
The treatment plan will need to include: an assessment of the behavior problems, a
statement of intervention techniques to be utilized, and expected outcomes at the
end of the treatment period.
The treatment plan needs to be created by a licensed physician, psychologist, limited or
licensed master social worker.
The author of the treatment plan is responsible for training and supervision of the service
provider.
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Temporary Out-Of-Home Placement
(16 days max)
• Payment requirements for temporary out-of-home placement are:
– Prior authorization by the Adoption Subsidy Program Office based on a
local office worker’s written recommendation.
– The temporary out-of-home placement is consistent with a treatment
plan developed for the child by one of the following professionals; a
licensed physician, psychologist, or limited or licensed master social
worker.
– The temporary out-of-home placement is not less than 24 or more
than 72 consecutive hours. The placements are not to exceed 96 hours
per month. The maximum number of hours in a 12-month period
cannot exceed 384 hours (16 days).
• Daily subsidy payment rates for temporary out-of-home placement are set
by the department.
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Placement Outside the Family Home
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Short-term treatment outside the family home can be covered as a last resort
when treatment goals are not being achieved in the family setting. Adoption
medical subsidy policy limits the amount of coverage to six months. Approvals will
not be granted for periods of more than six months and may be granted for lesser
periods of time.
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The goals of placement outside the family home are to address the child’s
emotional and behavioral problems, strengthen the adoptive family, and to
facilitate the reunification of the child with his/her adoptive family. In order to
meet these goals, it is required that adoptive parents be actively engaged in the
treatment of their child. Parental involvement may include participation in family
therapy, family weekends, and home visits.
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Placement Outside the Family Home
Requirements
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Memo/Application from adopted parents/agency requesting funding for placement.
Child must have an approved medical Subsidy from the Adoption Subsidy Office.
Service must be necessary to treat certified conditions.
DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special
Health Care Services, Local and intermediate school districts, Other public resources.)
Parents must seek prior authorization from the Adoption Subsidy Office.
The goal is family reunification.
Assessing the least restrictive placement to meet child’s needs.
All community resources must be exhausted.
MiTeam meeting scheduled for approval.
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Travel Expenses
• The medical subsidy program does not
routinely pay for travel expenses.
• In excess of 30 miles round trip, and
Necessary for the treatment of a certified
condition, and is not included in the child’s
DOC rate for adoption support subsidy.
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Travel Expenses Requirements
• Child must have an approved medical Subsidy from the
Adoption Subsidy Office.
• Service (travel) must be necessary to treat certified
conditions.
• DHS is payer of last resort ( use of Private health insurance,
Medicaid, Children’s Special Health Care Services, Local and
intermediate school districts, Other public resources.)
• Parents must seek prior authorization from the Adoption
Subsidy Office.
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Educational Services
(speech therapy, physical therapy, occupational therapy, tutoring)
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The Michigan Mandatory Special Education Act (Act 198, P.A. 1971) places responsibility for
providing educational services to handicapped children with the Michigan Department of
Education and local and intermediate school districts. The costs of private school tuition are
beyond the scope of the adoption medical subsidy program.
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The Education costs and services such as speech therapy, physical therapy, occupational
therapy, and tutoring can be covered under the adoption medical subsidy.
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Educational Services (speech therapy,
physical therapy, occupational therapy, tutoring) Requirements
• Child must have an approved medical Subsidy from the Adoption Subsidy
Office.
• Service must be necessary to treat certified conditions.
• DHS is payer of last resort ( use of Private health insurance, Medicaid,
Children’s Special Health Care Services, Local and intermediate school
districts, Other public resources.)
• Parents must seek prior authorization from the Adoption Subsidy Office.
• Services require individual education planning (IEP) for Speech therapy,
physical therapy, and/or occupational therapy.
• Services are limited to the same level as the services stated in the child’s
current IEP document.
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Summer Camps
The adoption medical subsidy program may cover up to $500 per
year for the cost of specialized treatment summer camp. The
camp must provide specialized services related to a certified
medical condition. An overnight camp must be licensed in the
state where it is located. Adoption medical subsidy will not cover
the costs of transportation to or from the camp.
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Summer Camps Requirements
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Child must have an approved medical Subsidy from the Adoption Subsidy Office.
Service (camp) must be necessary to treat certified conditions.
Parents must seek prior authorization from the Adoption Subsidy Office.
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Dental Services (Orthodontic)
• The adoption medical subsidy program does not cover routine dental care.
• For orthodontic conditions certified with effective dates after August 1,
2002, total lifetime payments through the adoption medical subsidy
program will be limited to $3,500.
• Adoption medical subsidy will not pay for missed appointments.
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Dental Services Requirements
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Child must have an approved medical Subsidy from the Adoption Subsidy Office.
The date of service is on or after the effective date of the adoption medical
subsidy agreement
Service (orthodontic ) must be necessary to treat certified conditions.
DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s
Special Health Care Services, Local and intermediate school districts, Other public
resources. (i.e. The parent’s private health and dental insurance has been
exhausted.)
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Durable Medical Equipment
• The adoption medical subsidy program does not pay for structural
changes, improvements to the home, or items that provide for the
comfort, education or recreation of other family members.
• The adoption subsidy program does not purchase cars or vans.
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Durable Medical Equipment Requirement
• Child must have an approved medical Subsidy from the Adoption Subsidy
Office.
• Durable medical equipment must be necessary to treat certified
conditions.
• DHS is payer of last resort ( use of Private health insurance, Medicaid,
Children’s Special Health Care Services, Local and intermediate school
districts, Other public resources (Trust Fund for Children with Special
Needs).
• Prescribed by a physician to treat the condition certified by the Adoption
Subsidy Program Office, and
• The least expensive alternative.
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Medical Supplies and Prescriptions
• Medical Supplies include:
Supply/prescription
Glasses/Contact Lenses
• Adoption medical subsidy will pay for one pair of glasses or contact lenses per year if the
child is covered by Medicaid. If the child does not have Medicaid, adoption medical subsidy
will pay for up to two pairs of glasses or contact lenses in a calendar year.
Incontinence Supplies (i.e. Diapers & pull-ups)
• Medicaid and Children’s Special Health Care Services must be used for diapers and pull-ups,
or other incontinence supplies. If there are no other resources for those items, adoption
medical subsidy will pay for diapers, pull-ups, or other incontinence supplies only when there
is written documentation of a medical need and the child is four years of age or older.
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Medical Supplies &
Prescriptions Requirements
• Child must have an approved medical Subsidy from the Adoption Subsidy
Office.
• Medical Supplies must be necessary to treat certified conditions.
• DHS is payer of last resort ( use of Private health insurance, Medicaid,
Children’s Special Health Care Services, Local and intermediate school
districts, Other public resources (Trust Fund for Children with Special
Needs).
• The date of purchase is on or after the effective date of the adoption
medical subsidy agreement.
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How to access Medical Subsidy ?
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All Adopted children under Adoption Subsidy are assigned with an ongoing case
worker.
Ongoing case workers are assigned according to adopted parents last name (see
packet for information).
Parents can contact their worker with questions.
Parents can make a written request for funding approvals to their workers .( Note:
outpatient counseling and orthodontics do not require prior authorization but
child must be approved with a certified medical condition by the Adoption Subsidy
Office.
Parents that are receiving Family Support Subsidy via CMH will not qualify for
medical subsidy benefits.
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Medical Certification
• Pre-Adoption: It is important for foster care
workers and adoption workers to document
medical conditions that child may have prior
to adoption. The adoption worker can submit
medical condition to the Adoption Subsidy
Office by using the DHS 1341
• Post- Adoption: Parents can make an
application (DSH-1341 A) for new medical
condition(s) up to the child’s 18th birthday.
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Recap
For the most part, the above services require:
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Child must have an approved medical Subsidy from the Adoption Subsidy Office.
The services must be necessary to treat certified conditions.
DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s
Special Health Care Services, Local and intermediate school districts, Other public
resources (Trust Fund for Children with Special Needs).
Please contact your worker with questions.
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References
1. DHS Public Website
http://www.michigan.gov/dhs
2. Adoption Subsidy Manual: Post Placement – Use of the Adoption Medical Subsidy Program
(AAM 640 pages 1-17)
http://www.mfia.state.mi.us/olmweb/ex/aam/aam.pdf
3. Post-Adoption Parent Resources (Adoption Subsidy Payment Schedule & Electronic Funds
Transfer (EFT)
http://www.michigan.gov/dhs/0,4562,7-124-60126_7116_11423---,00.html\
4. Adoption Subsidy Contact Phone Listing
http://michigan.gov/documents/dhs/DHS-AdoptionSubsidy-Contacts_253834_7.pdf
5. Post Adoption Medical Request Form DSH 1341 A (PARENT’S REQUEST FOR MEDICAL SUBSIDY
FOR AN ADOPTED CHILD)
http://www.michigan.gov/documents/FIA1341A_9550_7.pdf
6. MICHIGAN’S ADOPTION SUBSIDY PROGRAMS, Information for Prospective Adoptive Parents
http://www.michigan.gov/documents/DHS-Pub538_132926_7.pdf
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