Children with heritable disorders often have complex needs, best addressed through services integral to the medical home model. While responsibilities associated with care coordination require a good deal of time on the part of physicians and other staff, often they are not reimbursed. Reimbursement issues may stem from billing policies of the providers, reimbursement policies and practices of third party payers, or both.
Medical foods and formulas, which can be extremely expensive, are not always covered by private insurance or programs such as Medicaid. Also, children with some rare heritable conditions require special foods and formulas in order to maintain health and avoid serious consequences including medical emergencies.
The Reimbursement Workgroup will focus on addressing reimbursement issues that are barriers to quality care.
