If your child is now covered by private insurance or your employer changed insurance plans, you MUST notify ACP immediately. We will need a copy of the front and back of your insurance card. State Medicaid guidelines require ACP to use Medicaid as the payer of last resort, which means we are required to exhaust any home care benefits from the private insurance before billing Medicaid.

We will need to know the schedule and location of both parents. We will need to notify Medicaid of the split addresses and perform a home safety check in both houses.

Once your child is approved by Medicaid for the first time or if their prior authorization was renewed, you will receive a letter from the State, detailing the hours approved. The appeal (reconsideration) process is as follows:

1. The patient’s primary caregiver receives a letter from the Medicaid office stating the approved hours. The primary caregiver has 30 days from the date of the letter to request a reconsideration. 
2. Begin to collect additional documentation to support the request:
   • Primary caregiver letter stating why it is medically necessary for her/his child to have additional hours — must have a number of hours requested
   • Letters of Medical Necessity from doctors to support the request 
   • Any additional discharge summaries, hospital notes, etc. that would support the request
3. Mail all letters and documentation to the address on the letter within 30 days of the date on the letter.
4. Medicaid has 30 days to approve or deny the request.
5. If Medicaid denies the request for reconsideration, the primary caregiver can request a hearing.

If your child loses Medicaid eligibility, the home nursing for your child must stop immediately and cannot be restarted until you have it reinstated. Please be sure to open all mail from the Social Security Office and DFCS. In many cases, the loss of Medicaid can be attributed to not reading or receiving the correspondence and following the directions in a timely manner. ACP checks Medicaid eligibility regularly, however, if you know your Medicaid has been rendered inactive, it is your responsibility to notify ACP ASAP.

If the patient has a scheduled surgery or doctor’s appointment, please notify your Scheduler as soon as you have it planned. This is important so we can ensure that your caregivers are scheduled accordingly. Any unscheduled hospitalizations or ER visits must be communicated to ACP. We are required to submit certain paperwork to Medicaid when hospitalizations or ER visits occur as well as perform post-hospitalization visits.

During the school enrollment process, inform your district that you have a medically complex child that requires one-on-one nursing. At that time, they will schedule an Individualized Education Program (IEP). 

The purpose of the IEP is to determine any specialized services your child requires. A member of the ACP team will attend the IEP for additional support and to answer any questions regarding nursing. Be sure to have a letter of medical necessity from one of your child’s doctors stating it is medically necessary for your child to have one-on-one nursing while attending school.

We will need the DFCS case manager’s name, phone number, and email address. They will be the ones signing all documents on behalf of the patient.

Yes. ACP will discharge any patient who does not comply with company, state, and/or federal regulations. ACP takes compliance seriously and will not serve non-compliant clients. ACP will give a 30-day written notice to the client before discharge is completed. When safety or compliance are in jeopardy, ACP will not tolerate broken rules. Below are some of the most common reasons for non-compliant issues:

• Client doesn’t allow Clinical Supervisors to perform monthly supervisory visits or post-hospitalization visits (both are time-sensitive and mandatory by the state).
• Confirmed illegal activities in the home.
•  Anytime the home is verified as an unsafe environment for our caregivers.
• Abuse of the patient. In most cases, DFCS will be involved to resolve the situation.
• Client does not follow the standard of care or Medicaid Letter of Understanding.
• ACP can no longer staff the case due to unforeseen circumstances.
• Client disrespects, mistreats, or discriminates against ACP’s caregivers.
• Client constantly fails to open the door to ACP’s caregivers.
• Client constantly fails to communicate changes to ACP such as patient’s hospitalizations, ER visits, MD appointments, vacations, etc.
• Client fails to obtain proper medication or supplies that are not ACP’s responsibility but vital for the patient’s care and health.
• Client fails to communicate the truth to ACP.
• Client constantly requests ACP’s caregivers to perform tasks that are not part of their duties.