Missouri DSS settles with families over ‘private nursing’

The Missouri Department of Social Services and the families of seven children with complex medical conditions have settled a lawsuit against the agency alleging it failed to meet federal requirements for approved nursing home services.

“Medically complex” describes the medical condition of a child who has a medical condition (or several conditions) that requires ongoing specialist care. The condition can range from rare diseases to premature birth and can involve some sort of physical trauma.

By entering into the settlement on August 31, social services disclaims any liability in connection with the plaintiffs’ claims. But social services agree to a number of stipulations.

“Among other things, the settlement agreement includes measures to improve the availability of home nursing and care coordination services for these children,” according to a press release from the Missouri Department of Social Services.

Staff from social services and MO HealthNet, the Missouri Medicaid program, were already trying to figure out how to provide nursing home services, a challenge facing states across the country, according to Todd Richardson, director of MO HealthNet. MO HealthNet is Missouri’s Medicaid system.

“MO HealthNet has been actively leading efforts to increase nursing services and options for children with medical complexity, and this settlement provides us with a unique opportunity to continue to engage with plaintiffs and their attorneys, as well as stakeholders. industry, to bring creative solutions to address nursing shortages and to support these children and families in the best way possible,” said Richardson.

The settlement helps the state avoid protracted litigation, while improving access to care and services, said Jane Perkins, legal director of the National Health Law Program, one of the organizations representing families.

“The stark reality is that there are Medicaid-enrolled children with complex medical needs in states across the country who are not getting the home nursing care they need,” she said in the release. social services press. “Life and death of these children is at stake, and the strain it places on families is enormous. We hope this regulation will be helpful to other states as they work to improve coverage. .”

Rules can be found at https://bit.ly/3xum10G.

“Plaintiffs’ complaint in this action included factual allegations supporting assertions that defendants violated federal laws prohibiting discrimination on the basis of disability (The Americans with Disabilities Act and … the Rehabilitation Act) and Medicaid Act, and sought declaratory and injunctive relief on these claims,” the settlement states.

The parties entered into the settlement to achieve four objectives:

• Implement changes to social services policies, procedures and practices that will provide faster relief to complainants who are not receiving the “private nursing” (PDN) services they were authorized to receive.

• Ensure that children authorized to receive IDP receive as many authorized services as possible.

• Ensure that applicants who do not receive all of the medically necessary services they need to remain safe in the most integrated setting appropriate to their needs receive the necessary services and crisis planning to mitigate the risk of unnecessary institutionalization they face.

• Avoid delays and expense and conserve judicial resources, as the parties recognize that this matter involved legal issues that may take a long time to be fully litigated and resolved and further recognize that pursuing litigation will be costly, time consuming and time-consuming.

Among other things, Social Services should explore the feasibility and adoption of a day medical care model and the expanded use of telemedicine for virtual care management. The department should explore health homes for medically fragile children and crisis support teams to meet the acute needs of children not receiving IDPs.

Social services are required to take all necessary steps to implement increased Medicaid reimbursement rates for IDP services and must issue a bulletin advising IDP agencies of their expectation that rate increases be passed directly to nurses who provide care.

Social Services Coordinators should keep up to date with discharge planning with children’s families and document children’s concerns, expected outcomes and priorities. Coordinators should work with hospitals to arrange in-home IDP services so that children who are medically stable can be transferred to community placements with necessary support services.

Coordinators should document efforts to connect home-based IDP and other support services, and identify any foreseeable barriers preventing children from receiving IDP. When a child is not receiving all authorized PDN hours (and faces imminent hospitalization), the coordinator should work with the family to implement a back-up plan (which should be reassessed quarterly to address crises current). If a child is eligible for additional services due to a change in their needs or because they are not receiving authorized IDP services, the coordinator will refer their family to other providers, the Department of Mental Health or other community resources.

The DSS must ensure that all children who receive services through Managed Care (a Medicaid health care delivery system in which Medicaid pays providers a fixed amount per month to provide health care to people with complex conditions) are assessed for all Medicaid reimbursable services for which they may be eligible, no less than twice a year. DSS shall issue a Provider Bulletin regarding its policy allowing a child to receive more than 16 hours of PDN services in unique circumstances.

The DSS must report to plaintiffs’ attorney quarterly, providing aggregate information broken down by county, recording the number of children authorized to receive IDPs, the amount of IDPs authorized, and the amount of IDPs delivered.

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