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Senate breathes new life into therapy bill

By Dave Williams

dave.williams@graypub.com

ATLANTA - Helping children with disabilities would seem to be a warm and fuzzy issue that any politician would readily embrace.

But legislation aimed at making it easier for disabled kids to receive physical, speech and occupational therapy has had a rocky road in Georgia.

The bill sailed through the General Assembly last year only to be vetoed by Gov. Sonny Perdue.

But parent advocates who have been pushing for the measure say they're optimistic that a new version will pass muster with state health officials and, ultimately, the governor.

Parents of children with disabilities began complaining about new restrictions on therapy services two years ago, after the state privatized a large portion of the Medicaid program.

The Department of Community Health hired three "care-management organizations," HMO-like insurance companies, to run Georgia Medicaid.

Almost immediately, parents encountered new barriers to obtaining prior approval for therapy services for their kids, including more complicated paperwork, and more frequent denials of coverage.

Therapists complained that the CMOs were slow to reimburse them for their services.

The new legislation, which cleared the Senate unanimously last week, instructs the state to develop streamlined procedures for the CMOs. Prior approvals would be for up to six months, twice as long as the CMOs were allowing during the program's early stages.

"It's obvious that most of these children need long-term therapy," said Heidi Moore of Alpharetta, mother of an 8-year-old son with Down syndrome. "I hope that logic wins out."

The bill also would require the CMOs to either approve or deny coverage within 15 days of an application.

Those provisions are similar to legislation that was sponsored in the House last year by Speaker Pro Tempore Mark Burkhalter (R-Alpharetta). His bill cleared both legislative chambers easily before grinding to a halt at Perdue's desk.

The House voted in January to override the governor's veto of last year's measure. However, the Senate hasn't shown any interest in taking up the old bill.

Kaleb McMichen, a Perdue spokesman, said Friday that the governor vetoed the bill because its provisions on prior approvals inadvertently conflicted with federal requirements for Medicaid, which is a joint state-federal program.

"Since such changes at the state level require federal approval, this conflict made federal approval unlikely," McMichen said.

But Moore said she suspects the DCH was worried about the potential costs of a different section of last year's bill, a provision that would have required the state to cover children for 16 units of therapy per month, up from eight units currently. Four units equals one hour of therapy.

"Most children who need therapy need it once a week, which means they'll never get prior approval," she said.

But Moore said the bill's supporters agreed to drop that language from the new version of the measure in order to gain Perdue's approval.

The parent advocates then worked with another Alpharetta Republican, Sen. Dan Moody, to introduce the revamped legislation into the Senate.

"Governor Perdue appreciates that Senator Moody and the co-sponsors recognized his concerns when drafting [the bill]," McMichen said. "Should it ... make it to his desk, he will give it the careful consideration that legislation affecting health care deserves."

DCH spokeswoman Dena Brummer said the state agency does not comment on pending legislation.

The bill's fate now lies with the House, its next stop after passing the Senate last week. It has been assigned to the Health and Human Services Committee.