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Tags Posts tagged with "Pediatrics"

Pediatrics

The Republican-controlled U.S. House adopted a federal budget resolution last week that instructs the House Energy and Commerce Committee, which has jurisdiction over Medicaid, to identify at least $800 billion in mandatory spending cuts during the next 10 years. The resolution is now in the GOP-controlled U.S. Senate.

Medicaid, which is jointly funded by states and the federal government through a federal matching program with no cap, is seen as a prime target for cuts, as it is one of the largest federal programs at a cost of more than $600 billion a year. Approximately 70 million people in the United States receive Medicaid benefits, with about 3 million — including 1.2 million children — of those in Pennsylvania. While officially the federal government did not name Medicaid as the target, there are virtually no other areas to turn to in order to generate such spending cuts.

Proposals being considered in Congress to cut Medicaid are estimated to cost Pennsylvania as much as $2 billion a year. These cuts will inevitably result in:

  • Fewer insured Pennsylvanians;
  • Fewer covered services for those who remain insured;
  • Lower reimbursement rates paid to providers;
  • Increases in uncompensated care; and
  • Higher healthcare costs for those who are insured.

In addition to broad, negative consequences, each segment of the human services sector will be affected.

Behavioral Health

Medicaid is the largest payer of behavioral healthcare services in the United States, where nearly 40 percent of non-elderly adult Medicaid beneficiaries have a mental health or substance use disorder. Additionally, Medicaid is an essential revenue source for behavioral healthcare organizations. With the potential of fewer covered individuals and lower reimbursement rates, access will be squeezed, with existing providers less incentivized to accept Medicaid patients.

These potential cuts come on the heels of a compromised post-public health emergency unwinding of Medicaid, in which Pennsylvania’s actuarial analysis for the behavioral health capitation was severely underestimated. The eventual Medicaid rolls included more individuals with acute and chronic conditions, resulting in higher levels of care and services. Despite mid-year adjustments to the HealthChoices’s primary contractors, Pennsylvania will start the new fiscal year with the need to increase its BH Medicaid capitation by nearly $640 million.

Intellectual and Developmental Disabilities

Medicaid is the primary funding source for IDD services. If the proposed multi-billion dollar funding cuts occur, Pennsylvania’s intellectual disability system will face serious consequences, including service reductions, longer waitlists, and limited access to essential care. Providers already under strain may have to discharge individuals from community-based services, potentially returning them to institutional settings and undoing decades of progress towards independence and inclusion.

Pediatric Rehabilitation

Medicaid is a key funding source for healthcare and rehabilitation services for infants, children, and adolescents living with disabilities and medical complexity. Even for families with a private primary insurance, Medicaid as a secondary insurance fills in the gaps in covered care. Children with disabilities, regardless of household income, are Medicaid eligible to offset the high costs of care. Medicaid cuts will negatively impact the most vulnerable in our state: children with disabilities and special health needs.

Early Intervention

Medicaid is a supplemental funding source for Early Intervention services in Pennsylvania. All Pennsylvanian families currently enjoy access to these crucial home- and community-based services with no cost-share. Cuts in funding to this program may cause tighter eligibility requirements or cost-shares for families, ultimately decreasing access to essential services.


How the Cuts Might Be Done

Work Requirements

At this point, work requirements appear to be one of the most likely paths to Medicaid cuts.

According to the Pennsylvania Health Access Network (PHAN), approximately 1 million adults in Pennsylvania would be subject to the work requirement.

Medicaid work requirements would require certain Medicaid enrollees to work, look for work, or conduct another qualifying activity (e.g., education, caretaking) as a condition of receiving health insurance. As part of such a requirement, all working age Medicaid enrollees may be required on a monthly basis to report their work or verify their eligibility for an exemption because they are in school or a job training program, caring for others, or disabled/in treatment. Failure to do so would result in them losing Medicaid coverage.

On the surface, increasing support for work requirements is understandable. Able-bodied citizens on Medicaid who can work, should work. What is not being discussed is the fact that most of these individuals are already working but at an income that still qualifies them for Medicaid. Further, studies from states that have attempted to implement a Medicaid work requirement show that the cost to the state to implement and administer such a requirement is in the tens of millions of dollars.

If work requirements become a reality, advocates must lobby for waivers for special populations.

Federal Medical Assistance Percentage (FMAP)

At this point, according to Speaker of the U.S. House Mike Johnson, FMAP (as well as per-capita caps, see below) are not a consideration for reducing Medicaid spending.

Each state’s FMAP determines its federal share of Medicaid funding. FMAP is a formula that uses the state’s most recent three-year average per capita income data to provide higher matching rates to states with lower per capita incomes relative to the national average. FMAPs have a statutory minimum of 50 percent and a maximum of 83 percent.

In Pennsylvania, 56 percent of Medicaid costs are paid with federal dollars, leaving Pennsylvania to cover the balance.

Under the Affordable Care Act’s Medicaid Expansion, the FMAP for what became the newly eligible population — mostly low wage workers who do not have coverage through an employer, disabled workers, caregivers to children or elderly family members, and students — is fixed at 90 percent federal funding, with the commonwealth paying for the balance.

Per Capita Caps

A per capita cap funding arrangement sets an upper limit on federal payments per Medicaid enrollee in each eligibility group. In an aggregated cap (also called a capped allotment) approach, states receive federal matching funds up to a determined maximum. If the cap is exceeded, the state bears 100 percent of that cost with no federal match.


Resources

There are many resources continually being developed and distributed. These include ways to take immediate action with Congress. The following are some of the most relevant to our membership.


Next Steps

RCPA will continue to closely monitor the issue. As Congress’s next steps become clearer, we will work with our partners, including you, to develop and execute strategies to stop Medicaid cuts or minimize the negative effects.

Contact your respective RCPA Policy Director with questions.

Monday, March 24, 2025
12:00 pm – 1:00 pm EDT; 11:00 am – 12:00 pm CDT;
10:00 am – 11:00 am MDT; 9:00 am – 10:00 am PDT
Register Here

Sara Kerrick, PT, C/NDT 

Presenter Bio:

Sara Kerrick brings over 40 years of clinical experience in physical therapy. She is a Board-Certified Clinical Specialist in Pediatric Physical Therapy and is also Certified in Neurodevelopmental Treatment (C/NDT). Sara joined the Mary Bridge Children’s Therapy Services Team (Puyallup, Washington) nearly 37 years ago and currently serves as the Clinical Education Coordinator.

Sara received her Physical Therapy degree from Northern Arizona University and her Masters in Pediatric Rehabilitation with an emphasis on pediatrics from the University of Washington. She has a strong interest in education and has taught courses related to neurodevelopmental treatment and the use of pediatric outcome measures. Sara has a vested interest in evidence- based practices, combining her experience as a clinician and her love of research.

Objectives: At the end of this session, the learner will:

  • Identify the key elements regarding evidence-based practice (EBP);
  • Discuss the responsibility of the frontline clinician regarding EBP; and
  • List examples of how to integrate the best scientific evidence into clinical practice.

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Beginner

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Complimentary webinars are a benefit of membership in IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today.

Friday, February 7, 2025
1:00 pm – 2:00 pm EST; 12:00 pm – 1:00 pm CST;
11:00 am – 12:00 pm MST; 10:00 am – 11:00 am PST
Register Here

Christina Kokorelis, MD

Presenter Bio:

Christina Kokorelis, MD, is a rehabilitation physician specializing in pediatric and adult postural orthostatic tachycardia syndrome (POTS), orthostatic intolerance, and musculoskeletal rehabilitation. She takes a comprehensive, team-based approach to patient care. Dr. Kokorelis also treats children with concussions and chronic pain disorders. An assistant professor in the Johns Hopkins Department of Physical Medicine and Rehabilitation, where she completed her residency, Dr. Kokorelis followed the residency with a pediatric rehabilitation fellowship at the Johns Hopkins Hospital and the Kennedy Krieger Institute. She currently works as an attending physician in the Johns Hopkins POTS clinic and is also the Medical Director of the Pediatric POTS clinic at the Kennedy Krieger Institute in Baltimore.

Objectives: At the end of this session, the learner will:

  • Define POTS;
  • Discuss how to diagnose POTS;
  • Describe treatment approach to POTS; and
  • Discuss long-term outcomes of POTS.

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Beginner/Intermediate

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Complimentary webinars are a benefit of membership in IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today.

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The Centers for Medicare and Medicaid Services (CMS) published and released a summary report from a recent inpatient rehabilitation facility (IRF) listening session that focused on revising the transmission schedule for the inpatient rehabilitation facility Patient Assessment Instrument (IRF-PAI).

The summary highlights the discussion about potential changes to the IRF-PAI transmission schedule for unplanned discharges as well as changes in payer source, providing the rationale for this discussion, and questions posed during the listening session. The listening session also discussed opportunities to improve the assessment and data collection for pediatric patients.

Thursday, January 16, 2025
1:00 pm – 2:00 pm EST; 12:00 pm – 1:00 pm CST;
11:00 am – 12:00 pm MST; 10:00 am – 11:00 am PST

Register Here

Samantha Bohl, OD

Presenter Bio:
Dr. Bohl earned her Doctor of Optometry degree from the University of the Incarnate Word Rosenberg School of Optometry in San Antonio, Texas, and completed a residency in neuro-optometric rehabilitation through the State University of New York College of Optometry. Dr. Bohl joined the team at Madonna Rehabilitation Hospital in 2017, where she supports individuals with vision impairments in the rehabilitation setting.

Objectives: At the end of this session, the learner will:

  • Review the visual system and areas of the brain used for vision;
  • Identify common visual issues found in the pediatric population; and
  • Describe several treatments for pediatric vision deficits, including vision therapy.

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Beginner

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Complimentary webinars are a benefit of membership in IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today.

Friday, February 7, 2025
1:00 pm – 2:00 pm EST; 12:00 pm – 1:00 pm CST;
11:00 am – 12:00 pm MST; 10:00 am – 11:00 am PST
Register Here

Christina Kokorelis, MD

Presenter Bio:

Christina Kokorelis, MD, is a rehabilitation physician specializing in pediatric and adult postural orthostatic tachycardia syndrome (POTS), orthostatic intolerance, and musculoskeletal rehabilitation. She takes a comprehensive, team-based approach to patient care. Dr. Kokorelis also treats children with concussions and chronic pain disorders. An assistant professor in the Johns Hopkins Department of Physical Medicine and Rehabilitation, where she completed her residency, Dr. Kokorelis followed the residency with a pediatric rehabilitation fellowship at the Johns Hopkins Hospital and the Kennedy Krieger Institute. She currently works as an attending physician in the Johns Hopkins POTS clinic and is also the Medical Director of the Pediatric POTS clinic at the Kennedy Krieger Institute in Baltimore.

Objectives: At the end of this session, the learner will:

  • Define POTS;
  • Discuss how to diagnose POTS;
  • Describe treatment approach to POTS; and
  • Discuss long-term outcomes of POTS.

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Beginner/Intermediate

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Complimentary webinars are a benefit of membership in IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today.

Thursday, January 16, 2025
1:00 pm – 2:00 pm EST; 12:00 pm – 1:00 pm CST;
11:00 am – 12:00 pm MST; 10:00 am – 11:00 am PST

Register Here

Samantha Bohl, OD

Presenter Bio:
Dr. Bohl earned her Doctor of Optometry degree from the University of the Incarnate Word Rosenberg School of Optometry in San Antonio, Texas, and completed a residency in neuro-optometric rehabilitation through the State University of New York College of Optometry. Dr. Bohl joined the team at Madonna Rehabilitation Hospital in 2017, where she supports individuals with vision impairments in the rehabilitation setting.

Objectives: At the end of this session, the learner will:

  • Review the visual system and areas of the brain used for vision;
  • Identify common visual issues found in the pediatric population; and
  • Describe several treatments for pediatric vision deficits, including vision therapy.

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Beginner

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Complimentary webinars are a benefit of membership in IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today.

IPRC Webinar Transition Readiness: Strategies to Prepare Pediatric Patients and Their Families for the Next Steps
Thursday, April 6, 2023
12:00 pm – 1:00 pm EDT; 11:00 am – 12:00 pm CDT;
10:00 am – 11:00 am MDT; 9:00 am – 10:00 am PDT
REGISTER

Speakers and Panelists:
Carrie Cuomo, DNP, CPNP
Julie H. Corder, RN, MSN, CNP
Tim Flynn, PT
Kara M. Pickering, MA, CCC-SLP

Speaker Bios:

Carrie Cuomo
Carrie Cuomo, DNP, CPNP, is the Director of Advanced Practice Registered Nurse services in the Pediatric Institute at Cleveland Clinic. She is a clinical provider in the Department of Pediatric Hospital Medicine at Cleveland Clinic. Dr. Cuomo holds a Bachelor’s Degree in Nursing from Case Western Reserve University, a Master’s Degree from The University of Akron, and a Doctor of Nursing Practice Degree from The University of Akron. She has experience in teaching, nursing leadership, and clinical practice. She was a fellow in the Duke Johnson and Johnson Nurse Leadership program 2014–2015 and 2020–2021. Dr. Cuomo is a member of the National Association of Pediatric Nurses Practitioners and Ohio Association of Advanced Practice Nurses. She is a Co-Investigator on the Project IMPACTT grant sponsored by HRSA. She serves on the Advanced Practice Registered Nurse Council and the Advanced Practice Registered Nurse Preceptor Council. Dr. Cuomo’s professional interests are in the area of pediatric to adult transition.

Julie H. Corder
Julie H. Corder is a Pediatric Nurse Practitioner in the Pediatric Complex Care Clinic at the Cleveland Clinic. This multidisciplinary program cares for pediatric patients with multiple chronic conditions with a dependence on technology. A primary interest and passion for Julie is developing processes to ensure high level care for this population throughout their lifespan as they transition from pediatric to adult care. Julie holds a Bachelor’s Degree in Nursing from The University of Akron, a Master’s Degree in Nursing from Case Western Reserve University, and was a fellow in the Duke Johnson and Johnson Nurse Leadership program from 2020–2021. Julie is a member of the National Association of Pediatric Nurses Practitioners. She is a Co-Investigator on the Project IMPACTT grant sponsored by HRSA. She serves on the Advanced Practice Credentialing and Privileging Committee for the Cleveland Clinic.

Objectives:
At the end of this session, the learner will:

  • Define the (6) core elements of transition and review how they can be incorporated into practice;
  • Identify tools available to assist providers and examine ways to incorporate them into clinical workflow;
  • Explore one organization’s process to enhance care and assist with the transition of care for young adults to adult providers; and
  • Discuss tools to utilize with clients and families to support transition of services.

Audience: This webinar is intended for all members of the rehabilitation team, including medical staff, nurses, physical therapists, occupational therapists, speech language pathologists, licensed psychologists, mental health professionals, and other interested professionals.

Level: Intermediate

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Registration: Registration is complimentary for members of IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today. Multiple registrations per organization are permitted.

REGISTER