Update from Raising Special Kids

about CRS.

Raising Special Kids
ACTION ALERT

November 3, 2009

What's next?

Dear Friends and Families:

This week, 2,000 parents of children with disabilities and special health conditions are receiving letters from APIPA. These families are being informed that their eligibility for CRS services has been terminated. This is not like the previous letter, moving families into 100% self-pay status, this means their eligibility to use CRS services has ended.

As the budget crisis deepens, the ability of the state to provide for its most vulnerable children is being tested as never before.
We all have a stake in seeing that our elected representatives understand the critical nature of these services for children with disabilities and special health needs. Without access to health care services and the ability to manage serious and chronic medical conditions, more children suffer needlessly, become more severely affected by their disability, and have a less favorable prognosis. What is the legislature doing to see that the state meets its basic obligations to children for health, education, and essential services? And what program is on the next list of cuts?

Find your legislators and their contact info at http://www.azleg.gov/

Please refer to our website www.raisingspecialkids.org or contact us at 602-242-4366, Toll Free 1-800-237-3007 or info@raisingspecialkids.org

For additional advocacy tips and support visit http://www.pafcoalition.org/

More info about CRS

Here is some more info about CRS from a press release by St. Joseph's Children's Health Center.

Update on Children’s Rehabilitative Services (CRS)

What is the Children's Rehabilitative Services (CRS) program?

· The CRS program is administered by the Arizona Department of Health Services (ADHS), and funds multidisciplinary medical services for Arizona children with special healthcare needs.

Who is Served by the CRS program?

· There are many special healthcare diagnoses that make a child eligible for the CRS program. Examples of eligible conditions include epilepsy, cystic fibrosis, spina bifida, congenital heart anomalies, muscular dystrophy, scoliosis, cerebral palsy, and cleft lip or palate. Children with such conditions are eligible for CRS from birth to their 21st birthday. Adults with cystic fibrosis or sickle cell anemia are also eligible for the program, if they meet certain financial criteria.

· Almost 21,000 Arizona children are currently enrolled in CRS.

How Does the State Pay for the Services Provided to These Children?

· The Arizona Legislature and ADHS, in collaboration with the Arizona Health Care Cost Containment System (AHCCCS) have historically funded CRS through a unique blend of Title 19, Title 21 and Title 5 federal dollars, and designated Proposition 204 and state General Fund dollars.

How are the New Budget Cuts Impacting Families?

· The budget cuts that were recently enacted by the state legislature will withdraw CRS coverage to about 800 patients, who fall within a “state-only” category of financial support. The savings to the state budget is between $700,000 and $800,000 through the end of this fiscal year. The coverage to these patients is supposed to stop on March 20^th.

· Patients are still medically eligible for the CRS Program, but they will now have to pay all their medical expenses. The costs are calculated at the existing AHCCCS rates.

· The average cost increase per family will be about $200-$300 per month per patient, but some families will now be required to spend thousands of dollars a month on prescriptions and medical care.

What are Providers Doing to Help These Families?

· APIPA is allowing some critical services to be covered through June 2009, including medications authorized prior to March 20 and post-operative care. Other special circumstances can be submitted for review by APIPA-CRS' medical director.

· After June 30, families will either have to find commercial insurance to cover the children or will have to spend down their financial resources until they become eligible for traditional AHCCCS coverage.

Who are the CRS providers? Where are CRS services provided?

· ADHS currently subcontracts its CRS service to APIPA in a statewide contract, with service delivery responsibilities located in four sites: Flagstaff Regional Medical Center in Flagstaff, Yuma Regional Medical Center in Yuma, and Children's Clinics for Rehabilitative Services in Tucson, and St. Joseph's Hospital and Medical Center in Phoenix. Other participating hospitals include Tucson Medical Center and University Medical Center in Tucson, and Banner Desert Children's Hospital and Phoenix Children's Hospital in Maricopa County.

· In addition, each of the CRS sub-contractors offers CRS outreach clinics in communities throughout their respective catchment areas. As examples, the Phoenix-area CRS program conducts outreach clinics in cities such as Prescott, Globe, Show Low, and Springerville; and the Southern (Tucson) CRS program conducts outreach clinics in Douglas, Nogales, Safford, and Sierra Vista.

The Children's Rehabilitative Services program organizes and provides uniquely necessary services for the most vulnerable of Arizona's children. Through its subcontractors, the CRS program provides coordinated medical, surgical and hospital care to a population of children that have very complex illnesses, typically requiring extensive specialty care for their entire lifetime.

Please help continue Arizona’s support for this extremely

vulnerable population of children.

Cuts to CRS Funding

From an action alert by Raising Special Kids

Due to recent budget cuts at the Department of Health Services, 1,200 children with serious health conditions will be removed from coverage in Children's Rehabilitative Services or CRS. The elimination affects children who are not eligible for Medicaid or ALTCS. Families will become responsible for 100% of the costs of care, even though most have no other health insurance.

CRS provides health coverage to "chronically ill or physically disabled children" under twenty-one years of age, with a primary diagnosis of a severe physical condition that may require ongoing, medical or surgical intervention.
Children are eligible for the CRS program based on specific medical diagnoses, such as Cerebral Palsy, Cystic Fibrosis, Sickle Cell Anemia, Metabolic Disorders, Spina Bifida, Cleft Lip/Cleft Palate, and Congenital Heart Anomalies

Without CRS coverage, many of these children will experience life-threatening conditions from not receiving medications that keep them out of the ER and hospital. Children with serious illnesses will not receive needed surgeries which may lead to increasing disability and in some cases, preventable deaths.
State budget cuts will affect the lives, health, and safety of children in many ways and throughout all systems of care.
Governor Brewer has 18 days left to request $185 million in federal stimulus funds available for Arizona. We can correct this situation by using stimulus funding to restore coverage for CRS:

Please ask Gov. Brewer to request Arizona's stimulus funds before it is too late.

Mailing address: EMAIL: http://azgovernor. gov/Contact. asp

The Honorable Jan Brewer
Governor of Arizona
1700 West Washington
Phoenix, Arizona 85007

Telephone (602) 542-4331 Toll Free 1-(800) 253-0883

These cuts continue to cut deeper and deeper into groups that can ill afford it. Please, please call, e-mail, or write to let Gov. Brewer know that these cuts are hurting families and children.
If this change will present financial hardships for your family you should contact your service coordinator/ support coordinator and ask them to reconvene your IFSP team to assist you in identifying another service provider who will not present such a financial hardship.

If you benefit from CRS (Child Rehabilitative Services)

you may have received, or may soon receive the following letter:

March 9, 2009

State Budget Cut Impacts CRS Program.
State-only 0% Members Move to State-only 100%.

Dear APIPA-CRS Member:
The state of Arizona is faced with very difficult budget challenges. To help balance Arizona's Fiscal year 2009 budget, the Arizona Department of Health Services carefully examined how to eliminate more than $30 million from its budget. Because of these budget cuts, it was necessary to end state funding for medical services for Children's Rehabilitative Services (CRS) members who are not enrolled in the Arizona Health Care Cost Containment System (AHCCCS).
AHCCCS members who are enrolled in CRS do not pay for CRS services. Children who are CRS eligible, but who are not on AHCCCS, may participate in CRS as "State Only" members. These members were divided into two groups, according to their family income levels. One group could access the CRS network of providers, but paid for CRS services themselves, or through other insurance coverage. These members were referred to as 100% pay members. The other group was eligible for services at no cost, and was referred to as 0% pay members.
Beginning March 20, 2009 the following changes will occur:
• Existing CRS members that do not have coverage under AHCCCS will become 100% pay members, which means they will have to pay for all costs for CRS services after any other insurance coverage.
• AHCCCS members are not affected by this change, unless their enrollment in AHCCCS ends. At any point that a CRS member is not covered by AHCCCS, they will be considered to be 100% pay members, and will have to pay for all costs for CRS services while not enrolled in AHCCCS.
• A Continuity of Care Plan will continue from March 20, 2009 through June 30, 2009. During this time, for members who have been moved from the State Only 0% payment group into the State only 100% payment group, APIPA-CRS will pay for CRS services that are approved before March 20,2009 and provided before June 30, 2009. APIPA-CRS will also pay for maintenance drugs related to CRS conditions through June 30, 2009.
You can get an application for AHCCCS and see the eligibility requirements for AHCCCS at
http://vvww.azahcccs.gov/Members/HowToApply.asp or call to 602-417-4000. For those who are not on AHCCCS, a Payment Agreement Form indicating that you accept 100% payment responsibility isenclosed for your signature. You cannot receive CRS services, except for services that are approved before March 20, 2009 and provided before June 30, 2009 until this form is signed and returned to
APiPA-CRS at
Attn: APIPA-CRS Enrollment,
PO Box 33320,
Phoenix, AZ 85067-3320.
Appeals of this decision are limited to disagreements about temporary coverage described under the continuity of care plan. An appeal must be filed within 60 days from a denied request, and may be filed over the phone, in person or in writing. To appeal over the phone, you can call us at 1-866-275-5776.
If you want to appeal in writing mail to Attn: APIPA-CRS Appeals, 3141 N 3rd Ave, Phoenix, AZ 85013.
Our Member Services Department is available to assist you or answer your questions at 1-866-275-5776.
Sincerely,
APIPA-CRS Member Services
Enclosures:
CRS Payment Agreement Form

Advocacy and contact info will be in the next entry.