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more costly than the price of the magnifer. We suggest,
therefore, that in addition to items on the list a statement
"other items available with prior authorization" be included.

Question 6

What is the meaning of the statement "where no home health agency exists"? (45 CFR 249.10(b)(7) (1) (A))

Answer

In many States there are geographic areas not covered by a
certified home health agency or there may be an agency that
refuses to accept Medicaid patients; in both cases, services to
recipients in their own homes are not available. If there is
no agency in such jurisdiction, the State under its "Statewideness'
provisions must arrange for this mandatory service by having
a provider agreement with a local registered nurse who is
currently licensed in the State according to the State's Nurse
Practice Act. The nurse then provides nursing services, when
the patient's physician orders such care.

Question 7

Must every home health agency provide home health aide services?
Answer

No. The home health agency must meet all standards in Medicare's
"Conditions for Participation as a Home Health Agency". This
requires the agency to provide at least one service in addition
to "skilled" nursing. That additional service need not be home
health aides, but may be a therapy or medical social work.
The State, however, has an obligation to make home health aide
services available on a Statewide basis. This does not mean
that every agency must provide home health aide services. The
State may impose such a condition in accordance with State law,
but is not required to do so under Federal regulations.

SRS-AT-77-26 (MSA)

February 16, 1977

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May home health services be utilized in Early and Periodic
Screening, Diagnosis and Treatment programs?

Answer

Yes, just as any other Medicaid service. Follow-up of care
for individuals in EPSDT programs is a legitimate home health
service in appropriate cases. In some instances a single
visit may be all that is needed, and in other cases intermittent
visiting may be required.

Question 9

Will Medicaid reimburse home health agencies for follow-up
visits by registered nurses to monitor drug and diet therapy
and complications resulting from renal dialysis?

Answer

Yes. Follow-up visits in situations involving drug therapy, diet or other complications resulting from the patient's medical condition or treatment may be made when ordered by a physician. In some instances a single visit may be sufficient.

SRS-AT-77-26 (MSA)

February 16, 1977

Exhibit No. 13

Information supporting the Department of Health, Education and Welfare's Policy of Targeting Preventive Health Care Services to Young Children.

The following items were submitted for this exhibit by Robert A. Derzon, Administrator, Health Care Financing Administration, Department of Health, Education, and Welfare, and are on file at the U.S. Commission on Civil Rights:

1.

11

Joe L. Frost and Billy L. Payne, "Hunger in America: Scope and Consequences. Nutrition and Intellectual Growth in Children; the Association for Childhood Education International, Washington, D. C. pp. 5-61.

2. M. B. Stock and P. M. Smythe, "Does Undernutrition During Infancy Inhibit Brain Growth and Subsequent Intellectual Development?" Archives of Disease in Childhood, Vol. 38, 1963, pp. 546-552.

3. Nevin S. Scrimshaw, Ph.D., M.D., "Malnutrition, Learning and Behavior," The American Journal of Clinical Nutrition, Vol. 20, No. 5, May 1967, pp. 493-502.

Jane S. Lin-Fu, Children, Vol. 17, No. Jan/Feb. 1970.

4.

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5. George C. Cunningham, M.D., "Phenylketonuria Early Detection, Diagnosis and Treatment, California Medicine, Vol. 105, No. 1, January 1966, pp. 1-7.

6. John Gordon Freymann, M. D., "Medicine's
Great Schism: Prevention vs. Cure: An
Historical Interpretation," Medical Care,
Vol. 13, No. 7, July 1975, pp. 525-536.

7. A. Frederick North, Jr., M.D., "Screening in Child Health Care: Where Are We Now and Where Are We Going," Pediatrician, Vol. 54, No. 5, November 1974.

8.

2

Kathryne Bernick, "Issues in Pediatric Screening," A paper prepared by the Harvard Child Health Project under a grant from the Robert Wood Johnson Foundation, July 1976.

9. U.S. Department of Health, Education, and
Welfare, Office of the Assistant Secretary
for Program Coordination, "Maternal and Child
Health Care Programs," "1 October 1976.

10. Vera Caback and R. Najdanvic "Effect of
Undernutrition in Early Life on Physical and
Mental Development," Archives of Disease in
Childhood, Vol. 40, 1965, pp. 532-534.

11. Lester Breslow, M.D. and Anne R. Somers,
"The Lifetime Health-Monitoring Program: A
Practical Approach to Preventive Medicine,"
The New England Journal of Medicine, Vol. 296,
No. 11, March 17, 1977, pp. 601-608.

12. Carol H. Ehrlich, Esther Shapiro, Bud D. Kimball, and Muriel Huttner, "Communication Skills in Five-Year-Old Children with High Risk Neonatal Histories," Journal of Speech and Hearing Research, Vol. 16, No. 3, September 1973, pp. 522-529.

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13. Herbert G. Birch, M.D., Ph.D., "Malnutrition, Learning, and Intelligence, A paper presented at Leadership Institute held by the President's Committee on Mental Retardation in Charleston, South Carolina, DHEW Publication No. (OS) 73-96.

14. William K. Frankenburg, M.D. and A. Frederick North Jr., M.D., A Guide to Screening for the Early Periodic Screening, Diagnosis and Treatment Program (EPSDT) Under Medicaid, prepared by the American Academy of Pediatrics under Contract SRS 73-31, Social and Rehabilitation Service, U.S. Department of Health, Education, and Welfare, June 1974.

Exhibit No. 14

[ FACSIMILE]

STATEMENT OF DAVID S. TATEL,

DIRECTOR, OFFICE FOR CIVIL RIGHTS,

BEFORE UNITED STATES CIVIL RIGHTS COMMISSION

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The Office for Civil Rights is pleased to have the opportunity to share with the Commission on Civil Rights its plans for enforcement of the Age Discrimination Act of 1975. Under the statute, the Department of Health, Education, and Welfare must issue general regulations establishing

standards and broad guidelines for interpretations of the Individual agencies will subsequently issue

statute.

specific regulations.

The Department has already been working actively to develop an understanding of the implications of the current statutory language, recommendations for possible changes, and proposed interpretative regulations.

Our staff has worked closely over the past several months with Civil Rights Commission officials who are responsible for preparation of the study of age discrimination mandated by the Congress. We have shared information with each other and exchanged impressions and ideas about the strength and weaknesses of the law as it is currently worded. As does Secretary Califano, the Office for Civil Rights looks forward to the completion and publication of your study, which we know will provide needed guidance both to the Congress and to executive agencies as preparation for enforcement of the act goes into high gear.

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