Rishi K. Agrawal MD, MPH
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2 Moderator Rishi K. Agrawal MD, MPH Associate Professor of Pediatrics, Northwestern University Feinberg School of Medicine Pediatric Specialist, Lurie and La Rabida Children s Hospital in Chicago
3 MARCH 2018 VOLUME 141 SUPPLEMENT 3 Visit lpfch.org/aapsupplement to access all the articles in this series
4 Ask Questions! We look forward to a lively discussion with our audience. Enter questions in the GoToWebinar question box.
5 Meet Our Speakers Jane Perkins JD, MPH Legal Director, National Health Law Program Jeffrey L. Goldhagen MD, MPH Professor of Pediatrics, University of Florida College of Medicine-Jacksonville President, International Society for Social Pediatrics and Child Health Edwin Simpser MD President and CEO, St. Mary s Healthcare System for Children
6 Protecting Rights of Children with Medical Complexity in an Era of Spending Reduction Lucile Packard Foundation for Children's Health September 2018
7 Opening the Conversation Overview of Child Status Importance of Insurance Coverage Private Insurance Medicaid Importance of Enforcement
8 Private Insurance (employer-sponsored, individual, ACA marketplace) Affordable Care Act Essential Health Benefits Pediatric oral & vision; rehabilitation & habilitation ACA, Section 1557 NOTE: Variation, e.g. state mandated benefits Limited long term services & supports
9 Importance of Medicaid Low-income children (e.g., <133% FPL; children with disabilities) Early & Periodic, Screening, Diagnostic & Treatment (EPSDT) Children & youth <21 years
10 EPSDT Screening Requirements: Medical, including 2X3 lead blood assessment Vision, including eyeglasses Hearing, including hearing aids Dental, including relief of pain, restoration of teeth, maintenance of dental health
11 EPSDT Treatment Requirements: All services that can be covered under state Medicaid plan (mandatory and optional), e.g. Case management In-home skilled nursing Home health aides Personal care services Medical equipment and supplies Physical, occupational, and speech therapy Respiratory therapy Rehabilitative services Transportation and related services
12 EPSDT Treatment Requirements: Services necessary to correct or ameliorate physical and mental illnesses and conditions Arrange for corrective treatment the child need, directly or through referral
13 EPSDT Interplay with ADA/504 Disability Rights Integration mandate to ensure qualified individuals with disability is living in least restrictive setting Standards, criteria, or methods of administration that have the effect of discriminating on the basis of disability; or that perpetuate discrimination Remedy: Reasonable Accommodations
14 Enforcing Children s Rights, e.g. O.B. v. Norwood (IL): (1) arrange in-home nursing for children with medically complex conditions (2) with reasonable promptness, (3) ensure least restrictive setting Rosie D. v. Romney (MA): support services for children with serious emotional disturbances, including crisis intervention, in-home behavioral supports Radaszewski v. Maram (IL): in-home services for individual reaching 21 years Salazar v. D.C. (DC): clinical guidelines for Medicaid in-home services
15 THANK YOU Washington DC Office Los Angeles Office North Carolina Office 1444 I Street NW, Suite 1105 Washington, DC ph: (202) fx: (202) nhelpdc@healthlaw.org 3701 Wilshire Blvd, Suite #750 Los Angeles, CA ph: (310) fx: (213) nhelp@healthlaw.org 200 North Greensboro Street, Suite D-13 Carrboro, NC ph: (919) fx: (919) nhelpnc@healthlaw.org
16 Jeffrey L. Goldhagen, MD, MPH Professor of Pediatrics, University of Florida College of Medicine-Jacksonville President, International Society for Social Pediatrics and Child Health Key Thoughts How do the legal rights discussed in the manuscript of Perkins and Agrawal relate to the basic child right to health? How can the principles, standards and norms of child rights, social justice and health equity be used to expand the context and approach to advancing the rights of children with medical complexities? What is a Child Rights-based Approach (CRBA) to health and well-being and how can it be used to structure and advance the care of children with medical complexities? A Conversation on Protecting Rights of Children with Medical Complexity in an Era of Spending Reduction Visit lpfch.org/aapsupplement to access article
17 Edwin Simpser, MD President and CEO, St. Mary s Healthcare System for Children Key Thoughts Why don t Children with Medical Complexity receive the care that is mandated? What causes the gaps between their rights and mandates and the actual services received? My kingdom for a nurse! What parent of a medically complex child has the time and energy to file a lawsuit? Where is the oversight? How do we overcome the lack of evidence and the lack of value-based models in determining service delivery for this population? A Conversation on Protecting Rights of Children with Medical Complexity in an Era of Spending Reduction Visit lpfch.org/aapsupplement to access article
18 Submit your questions in the question box Jane Perkins JD, MPH Legal Director, National Health Law Program Jeffrey L. Goldhagen MD, MPH Professor of Pediatrics, University of Florida College of Medicine-Jacksonville President, International Society for Social Pediatrics and Child Health Edwin Simpser MD President and CEO, St. Mary s Healthcare System for Children
19 Upcoming Conversations Ethical Considerations for a Fair and Effective Health Care System October 24, 2018 Visit: lpfch.org/aapsupplement
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