Bureau for Children with Medical Handicaps (BCMH)

Bureau for Children
with Medical
Handicaps (BCMH)
BCMH Mission
• The mission of the Bureau for Children
with Medical Handicaps is to assure,
through the development and support of
high quality coordinated systems, that
children with special health care needs
and their families obtain comprehensive
care and services which are familycentered, community-based and culturally
competent.
Funding Sources
• Federal Maternal
and Child Health
Block Grant
• State general
revenue funds
• County tax
assessments
• Hospital audit
funds
• Donation funds
Diagnostic Program
• To rule-out a
handicapping condition
• To diagnose a
handicapping condition
• To establish a plan of
treatment
• Authorization period –
3 months
Diagnostic Program
Eligibility
• Under age 21
• Permanent resident of Ohio
• Under the care of a BCMH-approved
physician
• Have a possible medical handicap
• No financial eligibility requirement
Diagnostic Program –
Ineligible conditions/Services
• Acute conditions/care
• Emotional/behavioral
problems
• Learning disabilities
• Routine well-child care
• Physical exams
• Experimental services
Diagnostic Program
Services
• Basic Outpatient/Basic Physician
Services (automatically authorized)
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Lab tests, x-rays, special tests
Public health nurse services
PT, OT, ST evaluations
Consults/office visits to BCMH-approved
physicians
• Major Services (must be requested)
• Up to 5 days inpatient hospitalization
• Biopsies/anesthesia
• Psych/Neuropsych evaluations
Treatment Program
• To provide on-going services for
medically and financially eligible
children, based on recognized
standards
• Authorization period: 1 year
• Cases can be renewed yearly to age
21 with continued medical and
financial eligibility
Treatment Program
Eligibility
• Under age 21 (separate
program for adults with
cystic fibrosis)
• Permanent resident of
Ohio
• Have an eligible
medically handicapping
condition
• Financially eligible
Treatment Program - Examples
of Eligible Conditions
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Birth defects
Cerebral palsy
Spina bifida
Congenital heart
defects
Hearing loss
Cystic fibrosis
Diabetes
Severe vision
disorders
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Cleft lip/palate
Hemophilia
Sickle cell disease
AIDS
Scoliosis
Epilepsy
Juvenile arthritis
Chronic pulmonary
disease
• Cancer
Treatment Program –
Ineligible Conditions/Services
• Acute conditions/care
• Common refractive errors
• Emotional/behavioral problems
• Learning disabilities
• Routine well-child care
• Physical exams
• Experimental care
• Routine orthodontia problems
Treatment Services
• Service packages for 27 diagnoses
and diagnostic categories, plus a
“generic” service package
• Service packages contain basic
services as well as major services
appropriate and most usually
authorized for that diagnosis
• Service package is printed out on the
child’s Letter of Approval when case
approved.
Examples of Major Services
on Treatment Program
• Inpatient hospitalization
• Medical supplies/equipment
• Special formula
• Surgery/anesthesia
• Prescription medications
• Therapies
• Orthodontia services
• Orthotics/prosthetics
Example of a Service
Package
• Diabetes
• Blood glucose
monitor
• Community
nutrition consult
• Dental consult
• Routine dental
services
• Emergency room
visits
• Inpatient hospital
• Nutrition consults
• Basic outpatient
services
• PHN services
• Physician care
management
• Basic physician
services
• Prescription meds
• Psycholog. eval.
• Medical supplies
Financial Eligibility
• When medical application form is received
by the Bureau for treatment services for a
child, a financial application packet is sent
to the family
• Packet contains the Combined Programs
Application (CPA), information about the
Medicaid Healthy Start Program, and
instructions on how to complete the
financial application process
Financial Eligibility
• Based on 185% of Federal poverty level
• Financial formula considers child’s service
level credit, actual child care expenses, and
actual expense of health insurance
premiums for the whole family
• If over-income after initial determination,
family placed on costshare.
• Family can apply all their medical, dental,
and vision expenses to help meet their
costshare
• When costshare is met, child is eligible for
one year on the treatment program
Application to the BCMH
Program
• For the diagnostic and treatment programs,
the BCMH managing physician must
complete and sign the Medical Application
Form (MAF).
• For the service coordination program, the
team service coordinator must complete and
sign the MAF
• The parent or legal guardian (or client, if
age 18 or older) must sign the MAF or the
BCMH Release of Information Form before
any action can be taken on the case
Letter of Approval
• When services have
been approved, a
Letter of Approval is
sent to the parent,
managing
physician, hospital
(if known), and the
local health
department
Public Health Nurse
Services
• Authorized for every child on the BCMH
Program
• Identification of CSHCN and referral to
appropriate providers/agencies
• Service coordination
• Home visits
• Child/family/community assessments
• Advocacy for children and families
• Coordination with other agencies and
systems that serve CSHCN, e.g. schools,
MRDD, EI, JFS
Contact Information for
BCMH
• Bureau For Children with Medical
Handicaps
P.O. Box 1603
Columbus, OH 43216-1603
1-800-755-4769 (Parents/clients only)
Email: BCMH@odh.ohio.gov
Or Contact your Doctor’s office to ask for a Medical application
to be started.