epsdt m p pcps o - cerebral palsy · tefra/katie becket waiver--1982 ... environmental...

AACPDM 9/11/2014 Karkos/McNeal BRK 1 EPSDT Advocacy

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EPSDT MEDICAID PROGRAM (AGE

0-21): UNDERSTANDING BY PCPS,

SPECIALISTS, THERAPISTS, AND

FAMILIES CAN ENHANCE OUTCOMES JERIE BETH KARKOS, MD DOUGLAS MCNEAL, MD

[email protected] [email protected]

Joint Federal/state-specific funding + state

specific interpretation of Federal EPSDT

mandates + state specific Medicaid Waivers

=uneven access to home/community based

services in USA.

EPSDT language and resources are available to

advocate more successfully for necessary services

in home and community for eligible children

EPSDT POWERFUL FEDERAL LAW FOR

CHILDREN 0-21

Medicaid rules are DIFFERENT for children 0-21

Covers the FULL RANGE of Health Care and Long Term Care Services and Supports

States are required to cover services and supports under EPSDT even if coverage for the same service/support is optional or limited for adults under the state plan.

There are NO optional Medicaid services for children 0-21 years under EPSDT.

Confusion comes from state-specific variability in program implementation and interpretation of federal law in addition to those of other payor sources, related and unrelated.

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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FUNDING

Private Duty Nursing

Private Insurance--variable

Medicaid

HMO may not cover, but is a mandated service

EPSDT Medicaid

CHIPstate specific, may not cover.

Personal Care Aide

Private Insurance--variable

Medicaid HMO may not cover, but is a mandated service

EPSDT Medicaid

CHIPvariable, similar to private insurers

Habilitation/DME/Medical Supplies.

FUNDINGMEDICAID WAIVERS

TEFRA/Katie Becket Waiver--1982

Children must be 18 years old or younger

Meet States definition of institutional level of care

Have medical care needs that can be safely provided

outside of institutional setting

Cost of care in the community cannot exceed cost of

institutional care.

Children qualify without regard to family income for

Medicaid

States cannot cap enrollment

Caveat: State participation is optional. (State specific

data at http://www.hdwg.org/catalyst/online-chartbook/


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FUNDING: MEDICAID WAIVERS VOLUNTARY

STATE PROGRAMS, MODEST STANDARDIZATION

States CAN apply for additional programs to pay for health care in Medicaid and CHIP, but NOT mandatory. Most common for children are:

Section 1915 (C) Home and Community based services Waivers. Provide long-term care services in home and community settings instead of institution. Eligibility and availability vary by state: Children qualify without regard to family income if:

Require institutional level of care

Meet state specific criteria for diagnosis/condition (i.e. dev. disability, technology dependency, etc.)

Caveat: Enrollment can be capped (i.e. wait list).


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Official Program Name In-Home Operations (IHO) (0457)

Waiver Authority 1915(c)

Expiration Date December 31, 2014

Summary Provides case management/coordination, habilitation services, home respite, waiver personal care, community transition,

environmental accessibility adaptations, facility respite, family training, medical equipment operating expense, PERS installation and

testing, PERS, private duty nursing including shared services, transitional case management for medically fragile and technology-

dependent individuals, ages 0 - no maximum age. For participants that have been receiving continuous care in a hospital for 36

months or more and have physician-ordered direct care services that are greater than those available in the nursing facility/acute

hospital waiver for the participants assessed level of care.

Official Program Name Nursing Facility/Acute Hospital Waiver (NF/AH) (0139)


Expiration Date December 31, 2016

Summary Provides case management, personal care, habilitation, home respite, facility respite, community transition, environmental

accessibility adaptations, family training, PERS, PERS installation and testing, private duty nursing including shared services, transitional

case management, medical equipment operating expenses for individuals aged individuals 65 years and older, physically disabled

under age 65 years, and medically fragile and technology-dependent individuals with no maximum age.

Official Program Name Waiver for Persons with Developmental Disabilities (0336)


Expiration Date March 28, 2017

Summary Provides behavioral intervention, community living arrangements, day service, home health aide, homemaker,

prevocational services, respite care, supported employment (enhanced habilitation), chore, communication aides, community-

based training, dental, environmental accessibility adaptations, FMS, non-medical transportation, nutritional consultation,

optometric/optician services, PERS, prescription lenses and frames, psychology services, skilled nursing, specialized medical

equipment and supplies, specialized therapeutic services, speech/hearing and language services, transition/set up expenses,

vehicle mods and adaptations for individuals w/autism, DD, IID ages 0 - no max age.

Official Program Name Pediatric Palliative Care Waiver (0486)


Expiration Date March 31, 2017

Summary Provides care coordination, home respite care, expressive therapies, family counseling, family training, out-of-home respite

care for medically fragile and technology-dependent individuals ages 0-20.

California 1915(c) Waivers

SCHIP PROGRAM-1997

Buy in program for families with modest incomes and do not qualify for Medicaid. State options Medicaid expansion (7 states, DC, 5 territories

Separate Child Health Insurance program (17 states)

Combination of the above (26 states)

Benefits: States can choose benchmark, benchmark equivalent, or Secretary approved coverage. Standard BCBS PPO service benefit to Federal Employees

State Employee Coverage plan

HMO plan with largest, commercial non-Medicaid Enrollment in state.

State specific Chip Benefits http://www.insurekidsnow.gov/state/index.html

Caveat: Essential Health Benefits(EHB) are NOT comparable to EPSDT EHB


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EPSDT POWERFUL FEDERAL LAW FOR

CHILDREN 0-21

Medicaid rules are DIFFERENT for children 0-21

Covers the FULL RANGE of Health Care and Long

Term Care Services and Supports

States are required to cover services and supports

under EPSDT even if coverage for the same

service/support is optional or limited for adults under

the state plan.

There are NO optional Medicaid services for children

0-21 years under EPSDT.

Confusion comes from state-specific variability in

program implementation and interpretation of

federal law.

EPSDT ALL MEDICALLY NECESSARY

SERVICES MUST BE PROVIDEDFOR

CONDITIONS DISCOVERED BY THE SCREEN

Key is Conditions discovered by the screen

.when PCP conducts the Healthy Children and Youth Evaluation, condition must be listed on the EPSDT screen to be covered.

Medical necessity for home care requires level of care which exceeds familys ability to care for the individual at home.

EPSDT contains outreach and education requirements for each state. States must seek out eligible families and inform them of the benefits of EPSDT and the health and long-term care services and assistance available under the broad parameters of EPSDT law. 42 USC 1396a(a)(43) (examples of state-to-state variation in HOOH & AR)


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MEDICAL LEGAL PARTNERSHIP FOR CHILDREN/TOLEDO-- A PARTNERSHIP: LEGAL AID OF WESTERN OHIO, INC., ADVOCATES FOR BASIC LEGAL

EQUALITY, INC., MERCY CHILDRENS HOSPITAL, AND UNIVERSITY PEDIATRICS AT THE

UNIVERSITY OF TOLEDO MEDICAL CENTER. HTTP://WWW.LAWOLAW.ORG/MLPC/IMAGES/STORIES/DOCUMENTS/MLPC_EPSDT_110112.PDF

What is EPSDT?

EPSDT is the Federal Medicaid Acts Early and Periodic

Screening, Diagnosis and Treatment benefit available to

children under the age of 21. In Ohio, we call this

Healthchek. EPSDT requires that states cover services

necessary to correct or ameliorate a childs physical or

mental condition. 42 U.S.C. 1396d(r)(5).

What does Ameliorate mean? To improve or maintain

the recipients health in the best condition possible,

compensate for a health problem, prevent it from

worsening, or prevent the development of additional

health problems.

What does Medicaid for Children Cover?

Early and Periodic Screening (well-child visits);

Vision screenings and services; Dental screenings and

services; Hearing screenings and services; and Other

necessary care as identified through screening:

Rehabilitative services for developmental disabilities; PT

and OT services; Speech pathology services; Mental

health and substance abuse services; Medical and

adaptive equipment glasses, helmets, wheelchairs,

communication devices;

Transportation to medical appointments;

In-home nursing, personal care, specialized therapies;

Out-of-home residential, facility and hospital services;

Other medically necessary care.

Restrictions of EPSDT services:

Must be determined to be medical in nature;

Must be generally recognized as an accepted method

or medical practice or treatment;

Must not be experimental, investigational;

Must be safe and effective.

Physician Strategies to Increase Patient Access to

Healthcare:

(in addition to recommendations on writing LOMN,

requesting peer-to-peer review and arguing to overturn

decisions, explicit information is in the document)

Appeals can be filed directly with the Managed Care

plan and/or or with the Department of Job and Family

Services (file within 15 days to maintain coverage, 90 day

appeal deadline).

If the appeal filed with Managed Care plan is denied,

another appeal can befiled with the Department of Job and

Family Services (90 day deadline).

For urgently needed care, make sure to request an

expedited appeal Refer the family for legal assistance

with appeal and provide family with documentation in

support of the necessity of the service.

Resources:

MLPC-Toledo mlpc.lawolaw.org (888) 534-1432 Disability Rights Ohio disabilityrightsohio.org (800) 282-

9181National Health Law healthlaw.org

Gives specifics and

concrete examples to

improve access to EPSDT

mandated services for

CSHCN

ARKANSAS LEGAL SERVICES PARTNERSHIP

MEDICAID AND EPSDT-2005 HTTP://WWW.ARLEGALSERVICES.ORG/FILES/FSMEDICAIDEPSDT.PDF

What is Medicaids EPSDT?

The Early and Periodic Screening, Diagnostic, and

Treatment (EPSDT) service is Medicaid's child health

program of prevention and treatment for people under the

age of 21. It includes periodic screening, vision, dental, and

hearing services. The goal of the EPSDT program is to

assess a child's health needs through initial and regular

examinations and evaluations, and also to assure that the

health problems found are diagnosed and treated early,

before they become more complicated and expensive.

What benefits does the EPSDT include? Screening

services must include all of the following services:

Comprehensive health and developmental history --

(including assessment of both physical and mental health

development); Comprehensive unclothed physical exam;

Appropriate immunizations; Laboratory tests -- to be

performed by medical providers for particular age or

population groups; Lead Toxicity Screening - All children

are considered at risk and must be screened; Health

Education; Vision Services -- At a minimum, include

diagnosis and treatment for defects in vision, including

eyeglasses. Dental --At a minimum, include relief of pain

and infections, restoration of teeth and maintenance of

dental health. See also "The Guide to Childrens Dental

Care in Medicaid;" Hearing Services -- At a minimum,

include diagnosis and treatment for defects in hearing,

including hearing aids; and

Other Necessary Health Care Necessary health

care, diagnosis services, treatment, and other

measures to correct or treat defects, and physical

and mental illnesses and conditions discovered by

the screening services.

Do I Qualify for EPSDT?

If you have a Medicaid Card you can apply for items under EPSDT through local Medicaid. It is important to get the proper documentation together when making an application through a service provider in order to avoid delays. The materials that you may need to accompany an EPSDT application include:

1. A physician's order (on a prescription pad).

2. A Letter of Medical Necessity from a physician, physical therapist or other qualified

personnel. This letter should include: Patient history; A diagnosis and prognosis; A description of the benefit to the patient (particularly important, should be very thorough); and How long the patient will need the item.

3. Product information. Any product information that is applicable should be provided. A description of how the particular item will fit the needs of the patient should be supplied as well as pictures, preferably with the patient using the item.

4. Prices from different manufacturers with comparable products that might fit the patient's needs. Contact 1-800-MEDICARE for more information.

The ALSP Law Series is produced by the Center for Arkansas Legal Services, Legal Aid of Arkansas, Inc., and Arkansas Volunteer Lawyers for the Elderly. These agencies provide free legal services to eligible Arkansans. Additional information can be found at:

http\\www.arlegalservices.org or call 1-800-9LAW AID. This fact sheet is given to you as a guide to help you generally understand the way legal matters are handled. Local courts interpret things differently. The information and statements of law contained in this fact sheet are not intended to be used as legal advice. Before you take any action, talk to an attorney and follow his or her advice.

Always do what the court tells you to do.

Info is vague and geared

toward needs of typically

developing child with vague

references services/DME

CSHCNNO info for appeal.


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What the state advertises What EPSDT actually covers!!!

Prescription and some over-the-

counter medicines (with a

prescription)

Dietitian services

Rides to the doctor

Extra medical supplies and

equipment with a doctors

prescription (such as tube feeding

supplies)

Help for children who are

homebound due to long-term

physical problems

Counseling

Eye exams as needed

Eyeglasses and repairs (some

limitations apply)

Hearing screens and hearing aids

(some limitations apply)

Routine teeth cleaning, including

x-rays

Fluoride treatment (some

limitations apply)

Sealants, fillings, and teeth pulled [most above are duplicates only 8 types listed]

Full Scope of Medicaid EPSDT Law

Inpatient Hospital Care (other than in an institution for mental disease). 42 USC 1396d(a)(1).

Outpatient Hospital Care. 42 USC 1396d(a)(2)(A).

Rural Health Clinic Services. 42 USC 1396d(a)(2)(B).

Federally Qualified Health Center (FQHC). 42 USC 1396d(a)(2)(C). Nurse Midwife Services. 42 USC 1396d(a)(17).

Family Planning Services. 42 USC 1396d(a)(4)(C).

Physicians Services can be furnished in the office, the patients home, a hospital, nursing facility, or elsewhere. 42 USC

1396d(a)(5)(A).

Medical and surgical services furnished by a dentist. 42 USC 1396d(a)(5)(B). Laboratories and X-Ray Services. 42 USC 1396d(a)(3).

Pediatric and Family Nurse Practitioner Services. 42 USC 1396d(a)(21).

Early Periodic Screening, Diagnosis and Treatment for Persons Under Age 21. 42 USC 1396d(a)(4)(B).

EPSDT services are defined in 42 USC 1396d(r).

These services include: Screening services (includes appropriate immunizations); Vision services; Dental services Hearing services

Optometrist Services and Eyeglasses. 42 USC 1396d(a)(12).

Chiropractor Services. 42 USC 1396d(g).

Medical care services provided by other licensed health care providers. 42 USC 1396d(a)(27).

Home health services. 42 USC 1396d(a)(7). Home health nursing services. 42 USC 1396d(a)(7).

Home health aide services. 42 USC 1396d(a)(7).

Home health physical therapy services. 42 USC 1396d(a)(7).

Home health occupational therapy services. 42 USC 1396d(a)(7).

Home health speech pathology services. 42 USC 1396d(a)(7). Home health audiology services. 42 USC 1396d(a)(7).

Private Duty Nursing (in the home, hospital or skilled nursing facility). 42 USC 1396d(a)(8).

Clinic Services. 42 USC 1396d(a)(9).

Dental Services. 42 USC 1396d(a)(10). Physical Therapy (includes Occupational Therapy and services for individuals with speech, hearing, and

language disorders). 42 USC 1396d(a)(11).

Prescription Drugs. 42 USC 1396d(a)(12).

Dentures. 42 USC 1396d(a)(12).

Prosthetic Devices. 42 USC 1396d(a)(12).

Diagnostic Services Screening Services

Preventive Services

Rehabilitative Services

#s 29-32 include any medical or remedial services recommended by a physician or other licensed practitioner of

the healing arts for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level. 42 USC 1396d(a)(13).

Intermediate Care Facility Services for Persons with Mental Retardation/Developmental Disabilities and

Related Conditions. 42 USC 1396d(a)(15).

Inpatient Psychiatric Services for Persons under Age 21. 42 USC 1396d(a)(16).

Personal Care Services furnished in a home or other location. 42 USC 1396d(a)(24). Hospice Care. 42 USC 1396d(a)(18).

Case Management Services. 42 USC 1396d(a)(25).

Respiratory Care Services. 42 USC 1396d(a)(20).

Certified pediatric nurse practitioner services. 42 USC 1396d(a)(21).

Certified family nurse practitioner services. 42 USC 1396d(a)(21). Community Supported Living Arrangements*. 42 USC 1396d(a)(23).

* the scope of these services is defined in 42 USC 1396u

Home and Community Based Services. 42 USC 1396n(c)(1), 42 CFR 440.180.

Primary care case management. 42 USC 1396d(a)(25).

Medical care, or any other type of remedial care recognized under State law. 42 USC 1396d(a)(6), 42 CFR 440.170. Mental Health Services. See 42 U.S.C. 1396d(r)(5).

Transportation and Scheduling Assistance. 42 CFR 441.62

Non-medical religious healing. 42 CFR 440.170.

Emergency hospital services. 42 CFR 440.170.

Skilled nursing facility services for individuals under 21. 42 CFR 440.40 Vaccinations. 42 USC 1396d(r)(1)(B)(iii).

Such other necessary health care, diagnostic services, treatment, and other measures. . . to correct or ameliorate defects and

physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered

under the State plan.

Any other medical care, and any other type of remedial care recognized under State law, specified by the Secretary. 42 USC 1396d(a)(28).

USING EPSDT=EASY 1, 2,3

1. List the condition/diagnosis pertinent to the

prescription on the EPSDT Screen form. (State specific sample in this handout)

2. List amount, duration, scope of service or

support needed.

3. Write Letter of Medical Necessity documenting

need per EPSDT mandates (Sample LOMN in this handout)


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EPSDT CRITERIA FOR MEDICAL

NECESSITY

Eligible for habilitation in addition to

curative/rehabilitative when:

Services maintain or improve the current health

condition

Maintenance services (services that sustain or

support rather than cure or improve) are needed.

Services which prevent a condition from worsening or

prevent additional health problems are needed

Physical and occupational therapy services when

they have an ameliorative or maintenance purpose.

CMS: EPSDT- A Guide for States, June 2014 page 10


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LETTERS OF JUSTIFICATION

When you write a letter to Medicaid delineating medical necessity, it may help to cite the category of the federal Medicaid Law discussed above and the reference.

Consider using the following language citing the federal law when prescribing care in the home setting: As you are aware, federal EPSDT law requires states to cover all services within the broad scope of Medicaid. Specifically home health services are mandated pursuant to 42 USD 1396d(a)(7).

Document why it is medically necessary. (Sample LOMN follows).


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EPSDT: MEDICAL NECESSITY SHOULD BE

DETERMINED BY THE CHILDS PHYSICIAN

Determination that a service is medically

necessary lies primarily with the treating

physician or other care provider.

State must review the physician's determination

as to medical necessity.

If the states expert does not agree the service is

medically necessary for a particular child, the

state is responsible for making a decision based

on the evidence.

Decision can be appealed by the child or the

family under the States fair hearing procedure

CMS: EPSDT-A GUIDE FOR STATES,

JUNE 2014

If a state or managed care entity

takes an action to deny, terminate,

suspend or reduce a requested

treatment or service, it must give the

beneficiary written notice of the

action and of their right to a

hearing.


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DENIALS.

Each state has an official Protection and Advocacy

Program providing FREE legal and advocacy support

for persons with disabilities (ADA, Rehabilitation Act

Medicaid Act, IDEA, etc.)

501c3 Public interest, legally-based advocacy agency.

Empowered by federal law to advocate for civil and legal

rights of persons with disabilities.

Part of the national network of federally mandated and

funded protection and advocacy systems.

Special powers to investigate abuse and neglect.

Web site:

http://www.acl.gov/programs/aidd/programs/pa/contacts.aspx

ADDITIONAL ADVOCACY OPTIONS WHEN MEDICALLY

NECESSARY SERVICES /DME ARE DENIED FOR CHILDREN

COVERED BY EPSDT MANDATES

Request a physician peer-to-peer review by person with specific specialty background when possible Obtain information about the reviewers credentials and

expertise at time of arranging meeting (if possible.

Be prepared to give additional data, evidence based when possible, at time of the review.

Advise Parent to file an appeal Adhere to deadlines

For urgently needed care, request an expedited appeal

Involve Medical-Legal Partnership 262 partnerships in 36 states. http://medical-legalpartnership.org/partnerships/


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REFERENCES AND RESOURCES CMS Medicaid Guidelines on ABA/ASD

http://www.medicaid.gov/Federal-Policy-

Guidance/Downloads/CIB-07-07-14.pdf

Partners for Children Waiver, California

http://www.dhcs.ca.gov/services/ppc/Documents/P

FCReferringPhysicianFlyer.pdf

TEFRA/Katie Beckett Waiver:

http://www.hdwg.org/catalyst/cover-more-

kids/tefra

Catalyst Center State at a Glance Chartbook

http://www.hdwg.org/catalyst/online-chartbook/

Waivers by state in Medicaid and CHIP

http://www.medicaid.gov/Medicaid-CHIP-

Program-Information/By-

Topics/Waivers/Waivers_faceted.html

1915 Waivers by State

http://www.cms.gov/Outreach-and-

Education/American-Indian-Alaska-

Native/AIAN/LTSS-Roadmap/Resources/State-

Federal-Relationships/1915c-Waivers-by-

State.html

EPSDT: A Guide for States: Coverage in the

Medicaid Benefit for Children and adolescents

http://www.medicaid.gov/Medicaid-CHIP-

Program-Information/By-

Topics/Benefits/Downloads/EPSDT_Coverage_Gu

ide.pdf

Protection and Advocacy System:

National Disability Rights Network http://www.ndrn.org/index.php

Administration for Community Living (HHS ) http://www.acl.gov/programs/aidd/Programs/PA/Contacts.aspx

National Center for Medical-Legal Partnership. http://medical-legalpartnership.org/partnerships/

Disability Rights Center of Kansas http://www.drckansas.org/

Guidelines for Pediatric Home Health Care 2nd Edition, American Academy of Pediatrics AAP Section on Home Health Care. Edited by Russell C. Libby, MD,FAAP and Sonia O. Imaizumi, MD,FAAP, 2009.

Physicians often unaware that Medicaid pts. qualify for home care services http://aapnews.aappublications.org/content/35/1/1.3.full.pdf+html
http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdfhttp://www.dhcs.ca.gov/services/ppc/Documents/PFCReferringPhysicianFlyer.pdfhttp://www.dhcs.ca.gov/services/ppc/Documents/PFCReferringPhysicianFlyer.pdfhttp://www.dhcs.ca.gov/services/ppc/Documents/PFCReferringPhysicianFlyer.pdfhttp://www.hdwg.org/catalyst/cover-more-kids/tefrahttp://www.hdwg.org/catalyst/cover-more-kids/tefrahttp://www.hdwg.org/catalyst/cover-more-kids/tefrahttp://www.hdwg.org/catalyst/cover-more-kids/tefrahttp://www.hdwg.org/catalyst/cover-more-kids/tefrahttp://www.hdwg.org/catalyst/cover-more-kids/tefrahttp://www.hdwg.org/catalyst/online-chartbook/http://www.hdwg.org/catalyst/online-chartbook/http://www.hdwg.org/catalyst/online-chartbook/http://www.hdwg.org/catalyst/online-chartbook/http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.htmlhttp://www.ndrn.org/index.phphttp://www.acl.gov/programs/aidd/Programs/PA/Contacts.aspxhttp://www.acl.gov/programs/aidd/Programs/PA/Contacts.aspxhttp://www.acl.gov/programs/aidd/Programs/PA/Contacts.aspxhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+htmlhttp://aapnews.aappublications.org/content/35/1/1.3.full.pdf+html