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Medicaid waivers Home and Community-Based Services Waivers What are Medicaid Waivers? A Home and Community-Based Services (HCBS) waiver is an extra set of Health First Colorado (Colorado's Medicaid program) benefits that you could qualify for in certain cases. These benefits can help you remain in your home and community. Learn More: General Info on HCBS Waivers Adult Waivers Children's Waivers Flowchart for choosing a Children's Waiver Children's Waivers (Spanish) Flowchart for choosing an Adult Waiver

Helping you stay healthy Medical Resources Justifying Medical Necessity Seizure Protocol Blank Medication Schedule Justifying Medical Necessity Please click here to download the PDF Clic aquí para descargar un modelo de la carta con guía en Español Writing a Letter of Medical Necessity Include the following information: Full name of child, names of parents (parents and child may have different names) Date of birth of child Insurance plan name (there may be more than one plan) Relevant diagnoses (codes are helpful only if they are accurate! Ask the doctor.) Item/service being requested Why the item/service is medically necessary (refer to the insurance plans’ definition) What positive/negative impacts the item/service will result in (include financial) Scope and duration of treatment Supplemental documents (pictures, letters from other providers, research articles, product information, Prior Authorization Request) Include funding streams NOT able to help (denial letters, help) Terms to use: medically necessary clinically based promoting independence preventing secondary disability cost-effective safety Terms to avoid: custodial rehabilitate developmental delay/disability speech delay (without a diagnosis such as aphasia) Caregiver convenience Ask if your Letter of Medical Necessity answers the following: Is there a licensed provider stating in writing the item/service is medically necessary? Is this item/service not for care giver convenience? Is this item/service costs effective and if so have you explained how? Is this item/service considered standard medical practice? Have you explained how long and how often the item/service will be used. Is this item/service right for the need of individual? The Responsibilities of Each Role Care provider needs to: Know the process if the parent is not yet skilled Know pertinent benefits Know limitations and exclusions Know the appeals process Know terms and their definitions Distribute instructive materials to parents (empowerment) Write perfect letters of medical necessity Parent needs to: Become knowledgeable about the policy Supply information to providers Keep a paper trail of all communications Confront conflicting information Advocate’s role is to: Assist with the appeals process Guide providers and parents to resources Influence systems’ change Example Letter: Full name of parent’s Insurance ID: Full name of Child: Date of Birth: Diagnosis codes: Dear Insurance person: Date: This letter is to communicate the medical need for a ________________________. My child____________________, has the medical diagnosis requiring this device/service. I have researched other devices but feel this is the best device for my child. Other devices don’t have the ability to tilt in space, the __name of device_________________ has this ability, allowing for multiple positions. Multiple positions are important as _name of child__________must be repositioned often to reduce spasticity. The positions also allow this device to grow with my child. Reducing the need for another device to be purchased in a few years. This device was recommended by a licensed therapist, see attached letter. Without this device my child will require additional therapies and costly surgeries in the future. I am sure you get letters asking for things every day. I am including a picture of __name of child____________ using this device, to assist you in understanding the importance having this device. If this device is not approved the child will – cost more money, lose mobility, lose community access. I do plan to go through the appeal process if this device is not funded. Your company’s definition of medical necessity is: I am communicating that this device for my child fits your definition for the above reason. Don’t hesitate to call or email if you need additional information, related to this decision. I look forward to hearing from you. Sincerely, Name, ID# Address Phone Email Attachments: Doctors, therapist or professional letter Picture Marketing material about device Justifying medial necessity Seizure Protocol Click here to download the PDF in English Clic aquí para descargar PDF en Español Example of a Seizure Action Plan Name: DOB: Diagnosis: Emergency Contact: Phone: Name_______________'s MEDICAL History: MEDICATIONS: _______________________ HISTORY:____________________________ Patient, has a history of seizures, displayed by for Seconds/minutes. NOTE: If has a seizure lasting longer than minutes: Call: parent: name: phone: Call 911 if seizure lasts longer than 5 minutes and no rescue medications are available. Seizure Protocol Blank Medication Schedule Click here to download the Blank Medication Schedule Form in English Click aquí para descargar un modelo del horario de medicamentos en Español Blank Medicatin Schedule

Who we are Get to know Family Voices Colorado Overview of Family Voices Colorado Family Voices Colorado is a grassroots organization run by parents of children with special healthcare needs. The support you receive is from someone who understands the many challenges of having a child with special health care needs in their life. Every day we give parents the information and knowledge they need to navigate complex health care systems in order to get things like wheelchairs, oxygen, or a surgery for their children. With our help, parents are able to be the heroes their children are counting on! Parents also receive the information about other systems they should access based on their child’s diagnosis and needs. Family Voices CO works at the policy level to ensure children with special health care needs have a voice. We listen to the challenges from the family perspective, tracking trends, in order to create systems change. We monitor policy activities to ensure families receive the services they need. Colorado’s health care systems – both public and private –are difficult for families to navigate . Family Voices CO understands these systems. They also understand how both these systems can work together. Through working with Family Voices CO, parents are supported and empowered , resulting in stronger families and an increased ability to advocate effectively on behalf of their children. Families of children with special healthcare needs often access multiple systems. Consequently, they experience the system barriers more quickly. Family Voices CO collaborates with the systems working to reduce the barriers through policy work and systems change. Family Voices CO promotes improved decision-making, better outcomes and higher quality services for all. Family Voices Colorado... Provides public awareness of the challenges and barriers of children and youth with special health care needs and their families

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