eQHealth Solutions will soon begin providing care coordination services for Medicaid recipients, under the age of 21, who request private duty nursing services, and who are enrolled in a fee-for-service or Medipass benefit plan. (more…)
Posts Tagged ‘eQHealth Solutions’
After months of intense criticism, Florida healthcare regulators have quietly announced new rules that could enable hundreds, perhaps even thousands of Floridians to raise their disabled children at home rather than place them in institutions.
The biggest change: The state will no longer require that parents — and sometimes teenage siblings and grandparents — perform complex medical tasks “that normally could only be provided by a licensed nurse.” Such medical procedures might include the tube-feeding of children, the suctioning or replacement of breathing tubes and the oversight of ventilators. (more…)
The Agency for Health Care Administration is in the process of amending current language in the Florida Medicaid Home Health Coverage and Limitations Handbook and the Florida Medicaid Prescribed Pediatric Extended Care (PPEC) Coverage and Limitations Handbook to more accurately describe the process for evaluating parental responsibility when reviewing requests for both private duty nursing and PPEC services for children under the age of 21. (more…)
By Carol Marbin Miller & Toluse Olorunnipa, The Miami Herald
TALLAHASSEE – In a new and even harsher indictment of Florida’s treatment of severely disabled children, federal civil rights lawyers have issued a comprehensive blueprint for overhauling the state’s system of care for frail youngsters.
The 17-page “settlement proposal” by the U.S. Justice Department demands the state stop slicing in-home nursing services for frail youngsters, stop ignoring the requests of family doctors who treat disabled children and stop sending hundreds of children to geriatric nursing homes — where they often spend their childhoods isolated from families and peers. (more…)
In a drab, cramped conference room in Doral, a 45-year-old single mother is fighting with the state to secure in-home nursing care for her severely disabled daughter — while the 10-year-old fights for her life.
The mother sits across a wooden table from a state hearing officer who will decide whether health regulators were right to insist she get 18 hours each weekday of nursing care for her daughter, and fewer on the weekends, instead of the 24 hours her daughter’s pediatrician says are necessary. As her expert witness — a registered nurse — testifies, the woman’s daughter begins to cough, then vomit, then struggle for breath as her breathing tube becomes clogged. The hearing stops as the child’s mother and the nurse suction the girl’s tube, then clean, change and console her.
Generally lacking in such drama, hearings like the one that occurred Dec. 14 are held hundreds of times each year in Florida as the parents of severely disabled and medically fragile children battle state health administrators for nursing care and services for their children. Without such care, some of the youngsters will end up in nursing homes, something the 10-year-old’s mother is trying to avoid. (more…)
All Medicaid recipient of home health services need to be examined by their physician within 30 days prior to initiating services and at least every 6 months thereafter. In order to get approval for home health services and to ensure that the Medicaid recipient’s medical condition is being monitored closely by a doctor, proof of this physician visit must be sent in to eQHealth Solutions. (more…)
The Agency for Health Care Administration has entered into a contract with Simply Better Health (SBH), to function as a managing entity for the MediPass Program in 31 counties. You will see little change in the way you request authorization for services. The documentation needed to receive approval for services will not change.
As the managing entity, Simply Better Health has partnered with eQHealth Solutions, Inc. to perform prior authorization of inpatient, home health, therapy, and outpatient diagnostic services for MediPass recipients in the 31 counties listed below. Effective October 1, 2012, providers must request an authorization for these services from Simply Better Health for MediPass recipients in these counties: (more…)
The Agency for Health Care Administration has announced upcoming training opportunities for the Telephonic Home Health Services Delivery Monitoring and Verification (DMV) pilot project, which expands on Oct. 1.
The 2012 Florida Legislature made changes to the law impacting the way Medicaid reimburses for home health services. AHCA has contracted with Sandata Technologies, LLC, to implement the DMV project to telephonically verify the delivery of home health services in selected counties. The purpose of the project is to validate and ensure the timely utilization of home health visits, private duty nursing, and personal care services that are prior authorized by the Agency’s Quality Improvement Organization, eQHealth Solutions, Inc., and documented in the recipient’s plan of care. (more…)
This alert provides clarification to the May 2012 Florida Medicaid Health Care Alert regarding therapy service prior authorization requirements for recipients with third party liability (TPL). (more…)
The Agency for Health Care Administration is preparing to expand the Comprehensive Care Management (CCM) Project and Telephonic Home Health Service Delivery Monitoring and Verification (DMV) Project that are currently implemented in Miami-Dade County, as a result of legislation passed this past spring by the Florida Legislature.
Effective October 1, 2012, the CCM and DMV Projects will be expanded statewide to counties deemed cost effective and will include all home health services (i.e., home health visits, private duty nursing, and personal care services). See the list of counties and services below. (more…)