BATON ROUGE, La. (AP) — Louisiana is toughening regulations governing a four-year-old state Medicaid program aimed at helping "medically fragile" children that has ballooned in cost from $2 million to as much as $30 million this year.
The Pediatric Day Health Care program is praised for offering nearly 700 disabled children specialized health services at daycare facilities they couldn't get in a regular daycare or school setting. But its skyrocketing price tag is drawing scrutiny in a state struggling with severe budget woes.
"We have more pediatric day health care centers in this state than the whole state of Florida does. We have providers opening them left and right. We've got them beating down the door trying to get into this program. Just on the surface that causes all kinds of red flags," Jeff Reynolds, chief financial officer for the state health department, told lawmakers recently.
In a recent round of budget cuts, the Department of Health and Hospitals proposed eliminating the program entirely, but lawmakers rejected the idea.
Department leaders now plan to tighten admissions criteria, and nurses were assigned to review the cases of children currently in the pediatric centers. The effort is aimed at controlling costs, which are shared by the state and federal government through the Medicaid program.
New regulations are planned for May.
Meanwhile, the House is scheduled to debate a proposal next week that would place a one-year moratorium on new pediatric day health care centers, not allowing any new ones into the state-financed program until July 2017.
Rep. Rogers Pope, R-Denham Springs, said he proposed the temporary halt to new licenses to give the health department time to rewrite regulations, improve oversight and look for additional financing sources. He worried without changes, the state might scrap the program entirely.
"They do offer tremendous service in my opinion," Pope told the House health committee, which supported the moratorium.
The Pediatric Day Health Care program, created in 2011, is designed to help children who have multiple medical problems that require extended care like spina bifida, lung problems, heart disease, neuromuscular disease and seizure disorders.
Children under the age of 21 can receive physical therapy, speech therapy, education programs, nursing care and other assistance at the facilities.
Tommy Pittenger, the owner of two pediatric daycare facilities in Denham Springs and Lake Charles, said 90 percent of the children in the program aren't school-aged. Without the program, parents would be forced to resort to home health care or providing the care themselves rather than being at work.
"It is a tremendously valuable program. It's not just a place where the kids are parked," Pittenger said Thursday.
The therapeutic and nursing services have a goal "to get our kids to the point where they don't have to come to our clinics."
Reynolds said the program started with an initial budget of about $2 million when children began receiving the services in 2012. Costs grew quickly.
Twenty-three pediatric day health care centers now receive some funding from the state, which spent $22 million on the program's 630 recipients in the last budget year — about $34,500 per child, according to data from the Department of Health and Hospitals.
"We've seen in essence a doubling in every fiscal year of that program," Reynolds told the Senate Finance Committee this week.
The health department has raised concerns that some disabled children in the program could be in less-restrictive environments. Questions have been raised about whether children were being improperly steered to the centers by doctors.
Pittenger said the program enrollment is leveling off, and he rejected suggestions the pediatric daycare facilities were packed with children who didn't need to be there.
"These kids are really sick, and the idea that a lot of these kids don't belong in these clinics, it's insulting and it's not correct," he said.
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Posted on Tue, April 5, 2016
by MELINDA DESLATTE Associated Press