[rehab] Medicaid Payments for O&M Services

[Edward Bell]

Hi Jim, 

As you know, I head up a professional prep program in O&M here at Tech, so I
am pretty familiar with these issues. Here are some thoughts for you to
consider. 

1. It may be correct that allowing O&M to become medicalized  can become a
major problem. I have already seen in one state where school officials told
a parent that her child could not use a white cane unless she had a
prescription for it, and a prescription from the O&M instructor. This did
not help with independence, but limited it. 
2. Other states, (i.e., New York)  are also trying to get O&M as a
licensure. Their primary reason for doing this is so that they can charge
Medicare/Medicaid for their services. Their plan will make the cost of O&M
services increase substantially, and also limit those who can legally
provide O&M services. 
3. Cost will undoubtedly double or triple.  Currently, a white cane costs
about $28, and the going rate for O&M instructors is about $50-$75 per hour.
I am certain that once Medicaid/Medicare is paying for these services, the
costs will go to $70 for a cane and $150--200 per hour for instruction. I
fear that this will also limit services. 
4. In your email, you said that this O&M would be for a school-age kid.
Well, there is already state and federal money available for these services
in school. I am hard-pressed to believe that Medicaid is the only, or most
efficient avenue to get these services provided. 
5. As we have seen in New York, allowing this bill to pass for Medicaid
funding may very likely also result in some instructors, (those who are NOMC
certified in particular) being left out and excluded from providing the
services. Now, I don't know that there are any NOMC instructors in your
state right now, but this bill could very likely prevent their being hired
at all. 

In a nut shell, my 15 years in the field, and 5 years in the professional
prep side of things has taught me that the move, or rather push, towards
Medicare/Medicaid billing, as well as the push for licensure really has two
aims in mind, (1) to increase the amount of money O&M instructors can make,
and (2) to make the profession of O&M more exclusive and inaccessible. If I
had to bet money, I would say that passing such a bill will make O&M
services less available in your state, not more, will make obtaining such
services increasingly clouded with mounds of paperwork and red tape, will
result in doctors/nurses making decisions, not the O&M instructors, and in
short, make obtaining travel services more difficult to obtain for children,
not easier. 

My $.02 for your consideration, 

 

Edward C. Bell, Ph.D., CRC, NOMC
Director, Professional Development and Research
Institute on Blindness
Louisiana Tech University
210 Woodard Hall
PO Box 3158
Ruston LA  71272
318.257.4554 (Office)
318.257.2259 (Fax)
ebell at latech.edu
www.latech.edu/instituteonblindness
********************
"I am somehow less interested in the weight and convolutions of Einstein's
brain than in the near certainty that people of equal talent have lived and
died in cotton fields and sweatshops." 
-- Stephen Jay Gould 


-----Original Message-----
From: rehab-bounces at nfbnet.org [mailto:rehab-bounces at nfbnet.org] On Behalf
Of Marks, Jim
Sent: Tuesday, January 18, 2011 3:03 PM
To: 'NFBNet Rehab (rehab at nfbnet.org)'
Subject: [rehab] Medicaid Payments for O&M Services

The Montana Legislature is considering a bill that would require Medicaid to
pay for orientation and mobility services for qualified children in K-12
education.  It may overlap to adult services as well.  The primary advocate
for the bill is an Orientation and Mobility Instructor working for her local
school district.

While it's nice to have new funding streams for services, I'm concerned
about the medicalizing of blindness rehabilitation services.  It would be a
shame to involve medical doctors in things like buying a long white cane
when the docs know almost nothing about blind rehab.

What have other states done?  Are there issues/pitfalls to consider?

Thanks in advance for your replies.




-----
Jim Marks
Disability Transitions Programs Director
Montana Department of Public Health & Human Services
jimmarks at mt.gov
http://vocrehab.mt.gov
(406) 444-2591

"The legitimate purpose of society and its governments is not to govern
people and to promote the good life for them, but to empower them to govern
themselves and to provide the good life for themselves and their fellow
humans."  Justin Dart

_______________________________________________
rehab mailing list
rehab at nfbnet.org
http://www.nfbnet.org/mailman/listinfo/rehab_nfbnet.org
To unsubscribe, change your list options or get your account info for rehab:
http://www.nfbnet.org/mailman/options/rehab_nfbnet.org/ebell%40latech.edu