AAP News: Focus on Subspecialties: How to help Medicaid patients receive medically necessary services

AAP News: Focus on Subspecialties: How to help Medicaid patients receive medically necessary services

By Alexander L. Okun, M.D., FAAP

You are asked to write a letter of medical necessity (LMN) for a patient covered by Medicaid who may need home care or therapeutic services initiated or sustained. These might include durable medical equipment, skilled nursing services, a personal care (home health) aide or other services by a licensed professional, such as applied behavior analysis.

How can you write the most influential letter on your patient’s behalf?

Regardless of how Medicaid is financed in your state, certain benefits are mandated under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. This article details how you can leverage knowledge about EPSDT to fortify your LMN.



Jane Perkins, J.D., M.P.H., legal director of the National Health Law Program, and Douglas McNeal, M.D., FAAP, a member of the AAP Section on Home Care Executive Committee, presented a session at the 2015 National Conference & Exhibition titled “In-Home Pediatric Care: Children Need It, and the Law Requires It.” They recommend that an LMN be paired with a physician’s order on a prescription, practice letterhead, EPSDT screen form or other claim form. [….]

“EPSDT-mandated services are a legal entitlement,” Perkins said, “just like a free and appropriate public education.” Read the full article here. »

Related Content

For almost 50 years, the National Health Law Program has fought to expand access to quality health care to low-income individuals and underserved communities. Today we are pleased to launch a newly designed website for our future work to make health care a reality for all people. Please take time to peruse our new site, and sign up for our email updates to learn about us, watch the work we do, and become engaged.

Continue to site