User:Woozle/blog/2010/10/27/2135 Josh Mediation

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Josh Mediation
2010-10-27 2135

We're safe until December 11, but they want to move him from the real and appropriate services he's getting right now to inferior services he'll have to wait for, and they don't care what happens to him or us in the meantime.

(This is heavily based on an email I sent to Josh's grandfather, who has a high-up contact at The Durham Center who should be able to answer the questions posed at the end and perhaps make some things happen. We'll see.)

Recap of Plan A

The original plan for Josh's stay at The Hughes Center was that he would remain there until either of the following occurs: (a) he reaches a point where he would be manageable behaviorally at a lower level facility such as an autism group home, or (b) it becomes evident that he is making no further progress, and it becomes necessary to place him long-term in a facility suitable for whatever level of functioning he has achieved at that point.

The original expectation was that this would probably take 9-12 months (this is the average length of stay at Hughes), but that given the unusualness of Josh's condition it could take as long as a couple of years for him to reach an optimum level of capability. He has now been there for 6 months, and ValueOptions announced last month that they want to terminate his stay (by cutting off funding) effective... well, there was some confusion about whether it was October 14 or some earlier date. (Here's the original notice, slightly redacted, if you enjoy reading obfuscatory prose.)

Mediation Outcome

The outcome from the mediation was that ValueOptions has offered to fund Josh for an additional 45 days (until Dec. 11) while we transition him into an ICF/MRDD facility using CAP-MR/DD funding. They declined to name any particular facility or explain why The Hughes Center (which is an ICF/MRDD facility) is unsuitable.

They did not provide an answer for the argument that the training he is receiving now at Hughes is intended (and likely) to reduce the level of care he will need in the long run, and that any interruption in that training (even to move to a new facility with a similar program) would represent a setback in achieving this goal. The long waiting list for CAP slots (Josh has been on a waiting list for about 2 years now) also seemed irrelevant to VO.

The unspoken implication was that if Josh ended up receiving no residential services at all as a result of this change, that was fine with them.

This is obviously unacceptable to us.

We have the following questions which The Durham Center may be able to address:

(Note to the uninitiated: UM stands for Utilization Management, which is bureaucratese for "people who decide how to allocate available funds". VO was doing UM for The Durham Center up until October 1 of this year; The Durham Center is now handling it internally, but there are rules which prevent them from overriding VO's appeal directly.)

1. Would The Durham Center's UM be essentially tied to VO's decision, or could they re-evaluate funding independently and *hypothetically* approve further funding to finish out Josh's stay at The Hughes Center?

2. In the event that TDC's UM is able to make a funding decision overriding VO's decision, can we get any kind of indication as to what that decision would likely be -- or is it better just to have Josh's CM submit the paperwork and actually go through the process?

3. What is the difficulty of ICF/MRDD placement, especially with regard to cases where there are behavioral issues? What are the wait times like at present?

4. Does TDC have any advice at this point as to what our appropriate course of action would be regarding Josh -- given that we consider taking him home at any point, for any length of time, to be a completely unacceptable alternative (for many reasons)? ---

We have until tomorrow at noon to decide whether we're going to accept this decision. Unless TDC comes back with reassurances that of *course* they will pick up Josh's residential funding after VO drops it on 12/11, I'm inclined to think we should not agree to these terms.

Guess that's all for now. Getting really, really tired of this. Should I start keeping track of the time I spend on this, and send VO or Medicaid a bill?