Meeting Medicaid’s Criteria to Fund Medical Equipment

Letters of Justification

Meeting Medicaid’s Criteria to

Fund Medical Equipment

May 24, 2012
2:00 – 3:45 p.m.
(Eastern Daylight Time) (See registration form)

This 105-Minute Teleconference for attorneys, advocates, assistive technology (AT) specialists, and others will provide a detailed overview of what should go into a quality letter of medical justification to meet Medicaid’s legal funding criteria for specialized medical equipment (such as a power wheelchair, speech generating device, or other specialized equipment). Our nationally-recognized expert will discuss Medicaid criteria for funding equipment; typical medical necessity standards followed by Medicaid agencies; who the health professional is writing for; key elements needed in a letter of justification; and how the letter of justification becomes important if a Medicaid denial goes to a fair hearing or later into court. Continuing legal education (CLE) credits will be available.

SPONSORED BY:

The National Assistive Technology Advocacy Project A Project of Neighborhood Legal Services, Buffalo, NY

The Advocacy Center New Orleans, Louisiana

Presenter

Marge Gustas
Staff Paralegal
NY Protection and Advocacy for Assistive Technology Project, Neighborhood Legal Services, Inc.
Buffalo, N.Y.

Ms. Gustas has successfully represented individuals denied funding for medical equipment at more than 250 Medicaid fair hearings over the past 20 years. She has lectured extensively on this topic at events throughout New York State and at national conferences.

Registration Fee

A fee of $35 is payable for each registrant phone line. This fee covers the first two attorneys from your agency/office needing CLE credits for the event. Any additional attorneys needing CLE credits will be charged an additional $10 per attorney.

Phone Connection, Handouts:

Handouts and a telephone call-in number will be emailed to participants one day before the event.

CLE Credits

This event is approved for 1.5 hours (90 minutes instructional time) in Continuing Legal Education (CLE) credits by the Louisiana MCLE Committee. Check with your state CLE rules to determine if they will recognize these credits (e.g., the New York bar recognizes Louisiana CLE credits).

Program Objective

Trainees will learn about key legal requirements, under federal Medicaid law as applied by states, for approval of medical equipment. Trainees will learn about the importance of letters of medical justification to support Medicaid funding of medical equipment. Trainees will thereby be better equipped to: prepare for and represent children and adults with disabilities in Medicaid fair hearings and court appeals.

Agenda

A brief period for live participant questions and questions submitted to a designated email address will be allowed at the end of each topic.

Introduction

Presenter will explain what we will cover during the session and the important role that letters of justification can play in a request for Medicaid prior approval of medical equipment or in a later appeal.

Getting a Document with a Strong Probative Value

Presenter will explain the importance of documenting medical need and communicating to the therapist or doctor how that is accomplished. Will stress the importance of knowing who the audience or reader(s) will be (e.g., agency reviewer, administrative law judge).

Establishing the Writer’s Credentials

Presenter will stress the importance of including key elements in the letter to confirm the therapist or doctor’s expertise, specialty area(s) of practice, and depth of experience serving the particular patient and knowledge of the patient’s medical condition, functional limitations, and equipment needs.

Five Key Principles for Writing Reports

Presenter will explain the importance of prioritizing information; staying focused on one issue at a time; educating the reader about the patient/patient needs; striving for clarity; and limiting opinions to his/her area of expertise.

Writing the Report: Seven Key Components

Building off the preceding section, the presenter will work through the specifics of how best to set up the letter of justification. She will provide examples of what makes for a good letter and what makes a letter insufficient to support an equipment request. She will address the need to use the letter to meet Medicaid’s medical necessity criteria.

Time for Additional Participant Questions

 

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