Specialty Care Coordination

Specialty Care Coordination is one of three programs offered by Appalachian Mountain Project Access (Project Access for short).  Coordination means connecting things together in a way that adds value. Project Access connects community-minded medical providers willing to donate their services (testing, treatment, medical equipment, etc.) with local residents who have low-income, are uninsured, and have a current documented, medical need which requires intervention.  The added value comes from the thorough financial screening for patient eligibility, the shared communication among all providers for a particular patient, the decrease in the use of Emergency Departments for routine care or neglected specialty care issues, and the social work case management which seeks a harmonious balance for an individual’s bio-psycho-social well-being.

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There are 5 services offered as part of Project Access’s Specialty Care Coordination program.
 (1) Patient Financial Screening
Project Access has the most intensive financial screening process in the area.  This means that we interview each applicant/potential patient, request documentation, and follow-up with fact-checking.
  • Project Access considers Gross Income instead of Net Income.
    Definition of Gross Income – an individual’s total personal income before taking taxes or deductions into account.
  • Income and resources are based on a Patient’s Household rather than the Individual Patient’s.
    Definition of Household – any person or group of persons who have a shared experience (together at least 6 consecutive months), drawing from or contributing to a mutual pool of resources.
  • In December of 2012, Project Access’s Board of Directors voted to extend the Household Income Limit to 200% of the Federal Poverty Level (FPL), due to the significant burden specialty diagnoses and events bring with them despite the income difference between 150% and 200% of the FPL.
    Definition of Poverty – Following the Office of Management and Budget’s (OMB) Statistical Policy Directive 14, the Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who is in poverty. If a family’s total income is less than the family’s threshold, then that family and every individual in it is considered in poverty.  The official poverty thresholds do not vary geographically, but they are updated for inflation using Consumer Price Index (CPI-U). The official poverty definition uses money income before taxes and does not include capital gains or noncash benefits (such as public housing, Medicaid, and food stamps).  http://www.census.gov/hhes/www/poverty/methods/definitions.html
  • Project Access also reviews the Value of Household Assets [IRA, Stocks, Bonds, Inheritance, Property, Equity, Vehicles].  A limited amount of assets is allowed and a Spend-Down provision is in place.