The Clinic Co-Ordinators in Chapala, and Jocotepec use a number of criteria to verify that the family qualifies for entry into the PPNI program. The financial support that PPNI provides is one of ‘reimbursement’ for the costs directly related to the sick child’s medical, diagnostic and medication needs.
BACKGROUND:
In most cases, one of the adult parents stays at home with the sick child, while the other
finds work in their local community. Since this work is often ‘occasional or part time’, the working parent does not qualify for IMSS because they do not have fulltime employment and thus, no employer to pay the annual IMSS fee. Although family status in this regard is verified, most of our families do not qualify for IMSS.
If the family does not have IMSS coverage, PPNI may consider paying this fee, if it
makes economic sense. Seguro Popular (SP) coverage is available to all Mexican families
at the local “Centro de Salud” (Health Centre). Clinic Co-Ordinators will direct the
parents to their local health centre to register.
To qualify for our program, the families typically have a total monthly income of less than $4000 pesos. Clinic Co-Ordinators will use their discretion based on the size of the family and monthly income.
If at any time a fraudulent claim is made or false information is knowingly given by the parent, the family will be asked to leave the program.
FAMILY STATUS: VALIDATION METHODS:
VALIDATION OF “EXPENSES” FOR THE CHILD….JANUARY, 2015
The Clinic Co-Ordinators use a number of methods to verify that the reimbursed costs are related only to the child that is enrolled in the PPNI program. These costs are directly related to the enrolled child’s medical, diagnostic and medications needs. Transportation costs are reimbursed only if they are directly related to the child’s treatment plan.
CHILD SPECIFIC COSTS: VALIDATION METHODS:
Hospital Civil or the Family doctor provides a signed and stamped letter identifying the child and indicates the diagnosis, treatment plan and expected outcome. This documentation, along with the current medical condition of the child, is updated annually and kept as part of the childs’ PPNI medical record.
PPNI Drug Formulary: is used to verify that the drug prescribed is written for the enrolled child and that the drug(s) is for the condition(s) diagnosed by the prescriber.
Pharmacies: Parents are encouraged to shop for least expensive medications. Receipts are examined by the Clinic Co-Ordinator to ensure PPNI is reimbursing for the prescribed drug(s) for the approved child. Any concerns can be referred to other members of the Medical Team which currently includes Doctora Carla Flores, Pedro Ramirez (pharmaceutical industry expert) and Bill Dingwall (Pharmacist).
Exceptions: The Clinic Co-Ordinator will use their discretion for the reimbursement of complementary needs, related only to the enrolled child and as prescribed by the treating physician…for example:
Family Participation: where financially possible, families are often willing to make a
‘token’ financial contribution, especially for high cost items such as a wheelchair.
Facturas and Invoices: ‘official’ receipts are required for any amount of reimbursement.
Transparency and Accountability: given all of the above measures, the Clinic Co- Ordinators are more than willing to discuss how this ‘process’ works, on an individual basis, with any of our donors, volunteers and/or supporters.
BACKGROUND:
In most cases, one of the adult parents stays at home with the sick child, while the other
finds work in their local community. Since this work is often ‘occasional or part time’, the working parent does not qualify for IMSS because they do not have fulltime employment and thus, no employer to pay the annual IMSS fee. Although family status in this regard is verified, most of our families do not qualify for IMSS.
If the family does not have IMSS coverage, PPNI may consider paying this fee, if it
makes economic sense. Seguro Popular (SP) coverage is available to all Mexican families
at the local “Centro de Salud” (Health Centre). Clinic Co-Ordinators will direct the
parents to their local health centre to register.
To qualify for our program, the families typically have a total monthly income of less than $4000 pesos. Clinic Co-Ordinators will use their discretion based on the size of the family and monthly income.
If at any time a fraudulent claim is made or false information is knowingly given by the parent, the family will be asked to leave the program.
FAMILY STATUS: VALIDATION METHODS:
- Economic Report: provided by DIF, outlines the financial status for each qualifying family in Jocotepec. However, a similar report is not provided by DIF in Chapala.
- Hospital Civil: the treating doctor(s) will provide a complete diagnosis and treatment plan, including medication(s), for the sick child.
- Interview: each family and sick child is carefully assessed by the Clinic Co-Ordinator before admission into the program.
- Community networking: provides information on the family and the sick child.
- Doctors, Nurses and Social Workers: provide information on family status.
- Home Visits: may occur if the resources are available.
- A full medical “team approach” may be necessary for the admission of a child who has a complex medical condition(s) or for any other concern identified by the Clinic Co- Ordinator.
VALIDATION OF “EXPENSES” FOR THE CHILD….JANUARY, 2015
The Clinic Co-Ordinators use a number of methods to verify that the reimbursed costs are related only to the child that is enrolled in the PPNI program. These costs are directly related to the enrolled child’s medical, diagnostic and medications needs. Transportation costs are reimbursed only if they are directly related to the child’s treatment plan.
CHILD SPECIFIC COSTS: VALIDATION METHODS:
Hospital Civil or the Family doctor provides a signed and stamped letter identifying the child and indicates the diagnosis, treatment plan and expected outcome. This documentation, along with the current medical condition of the child, is updated annually and kept as part of the childs’ PPNI medical record.
PPNI Drug Formulary: is used to verify that the drug prescribed is written for the enrolled child and that the drug(s) is for the condition(s) diagnosed by the prescriber.
Pharmacies: Parents are encouraged to shop for least expensive medications. Receipts are examined by the Clinic Co-Ordinator to ensure PPNI is reimbursing for the prescribed drug(s) for the approved child. Any concerns can be referred to other members of the Medical Team which currently includes Doctora Carla Flores, Pedro Ramirez (pharmaceutical industry expert) and Bill Dingwall (Pharmacist).
Exceptions: The Clinic Co-Ordinator will use their discretion for the reimbursement of complementary needs, related only to the enrolled child and as prescribed by the treating physician…for example:
- an antibiotic or similar medication, for an acute condition which could affect the chronic (long term) condition of the child
- special dietary needs such as lactose free milk
- incontinence diapers
- feeding tubes
- special treatments such as equine or hydro therapies
- transportation costs directly related to the treatment plan for the child
- 'Capping' the amount of money that PPNI will reimburse the family on a monthly
Family Participation: where financially possible, families are often willing to make a
‘token’ financial contribution, especially for high cost items such as a wheelchair.
Facturas and Invoices: ‘official’ receipts are required for any amount of reimbursement.
Transparency and Accountability: given all of the above measures, the Clinic Co- Ordinators are more than willing to discuss how this ‘process’ works, on an individual basis, with any of our donors, volunteers and/or supporters.