2006-05-10 Changes to billing procedures for Speech and OT if you have CAP

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The following comes from an email sent to a private mailing list for parents of autistic children in the Durham area. I have cross-posted it here, without specifically asking the author, with the idea that wider circulation would be desirable. Please post replies on the discussion page or email them to me. Thanks. --Woozle 17:50, 10 May 2006 (EDT)

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Hi!

I am wondering if anyone else has had their CAP Speech or OT therapist experience a denial of payment for services that your child may have received either in your home or in a clinic for which you may have previously been billing to Medicaid. I had heard of a few problems with this in Durham County but it really didn’t hit us until yesterday when at my son’s IEP meeting the school asked us to sign a release form so they could bill directly to Medicaid for the Speech and OT that he gets in school. I thought this is rather odd but I signed it as we are not currently getting speech or OT at home or outside of school but it did not take me long to start making some phone calls and sending a few e-mails and low and behold other parents have indeed had their providers DENIED service reimbursement because the school billed for therapies before the home provider could bill. Anybody know what this is all about?

One parent I talked to said she received a phone call from the therapist at school who told her she would be working with her child on Tuesdays and Thursdays and if she wanted to be able to bill for her son’s services for additional therapies that he had been getting under his CAP plan she would need to re-schedule her home plans to not have therapies on those days or else the charges would be denied. Since when does the school get to decide which days out children will get services in addition to their regular school days? Something is very wrong with this system.

It is bad enough that I already pay $948 a month for my son’s CAP slot because our state is backwards and put the CAP Medicaid waiver program in the Adult manual and not in the Children’s Medicaid manual. As a result, my child must forfeit all of his death benefits that he gets from the SS administration each month and return them to the State of NC. The death benefits from the death of his father should be viewed as support for children under the age of 21 and should go to cover things like food, clothing and shelter; but because the CAP program is under the Adult manual they view the death benefits my child receives as income and we must give it all back in order to keep the CAP services. If my child were not so severely affected this would not really be worth it, but unfortunately we really need the services we get through CAP.

So needless to say I want to take a tally how many other people are being affected by this change in billing procedures? They are definitely doing this is the Chapel Hill/Carrboro schools and in Durham; I am also investigating what other counties have had this problem.

[ name redacted ]