Before we get started with all the details …

 

We know as caregivers of medically fragile and developmentally disabled children you have a lot of questions, which is why we created a Frequently Asked Questions page. To answer a few of the most common concerns:

  • YES - We are 100% paid through Medi-Cal

  • NO - This will NOT interfere with IHSS or Respite Care Hours

  • YES - We do take foster children

 

 

"Their nurses are able to work with children who are unable to voice their issues, in a manner that is both professional and caring! It heals your heart, and your child's."

- Hadell, LLM Mommy since 2010

 

The Enrollment Process

 

We do not require an official referral for families to inquire or receive services at Loretta's. However the enrollment process is approximately 2-6 weeks, based on all parties involved. We recommend you begin the process in advance to any deadline of necessary care! 

 
 
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1. Make an appointment for a Tour

** Case Managers and Service Providers: Referrals: Please download a referral form or have the family book a tour online in your presence. We encourage Case Managers accompany families on their initial tour to help them feel comfortable!


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2. Complete Enrollment Packet & Nurse's Assessment  

Please bring your child to the initial tour so our RN/PNP can do a nursing assessment.

At time of tour, or 2nd appointment provide following Documents:

  • Medi-Cal card & all insurance cards for child

  • Immunization history

  • Current medication list

  • All medications must physically be brought to your appointment

  • Any discharge summaries from hospitals and/or doctor’s appointments


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3. TB Screen

Title 22 requires a Tuberculosis Screen done on all children within 30 days prior to starting at Loretta's Little Miracles.


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4. Physical performed by Primary Physician 

Title 22 requires a complete physical done on all children with in 30 days prior to starting at Loretta's Little Miracles.


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5. RN/PNP Creates A Plan of Treatment (POT)

This requires signed approval for your child’s plan of treatment (POT) by: 

  • Loretta's Little Miracles RN/PNP, Loretta Hicks

  • Primary Care Physician


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6. attend Loretta's for 5 days for medi-cal approval

Medi-Cal and Insurance require 5 days of care at LLM for their review to determine if the child qualifies.


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7.  Your child is Enrolled! 

After POT is approved by Medi-Cal, you’re officially enrolled!

  • The Child’s allotment of hours are determined by Medi-Cal based on diagnosis.

How To Qualify For Medi-Cal + Insurance

 

While few, if any, private insurances cover PDHC Nursing Services, if your child has a qualifying diagnosis but does not have Medi-Cal, you may still qualify!

We can help make this process frustration free. Contact us for more information on obtaining coverage for your child.  

COMBINATION OF SERVICES

  • Loretta’s Little Miracles will not affect your IHSS hours or pay

  • Loretta’s Little Miracles will not affect your Respite hours

  • You can use both home health and Loretta’s Little Miracles hours together

You can maximize all these services and benefits to best serve your child and your family in conjunction with Loretta’s Little Miracles nursing care. 

+ Medi-Cal

Our services are covered and billed directly to Medi-Cal. The child's allotted bank of hours to use at LLM are deemed by Medi-Cal based on the child’s diagnosis + review of their LLM physician approved Plan of Treatment (POT).

These hours will not compete with your IHSS or respite hours and can be used in conjunction with home health.

+ My child has not qualified for Medi-Cal

If your child is between the ages of 0-3 and has yet to receive a formal medical diagnosis, Loretta’s Little Miracles will assist you in qualifying for Medi-Cal even if you have been unsuccessful previously.

In addition if your child is covered under private insurance your child may still qualify for Medi-Cal. In both cases you will need to complete the below form:

*Medi-Cal Home and Community-Based Alternatives Waiver Application

+ Private Insurance

Few, if any, private insurances cover PDHC Nursing Services. However if your child has a qualifying diagnosis, they should qualify for Medi-Cal.

If you need help obtaining Medi-Cal coverage for a qualifying diagnosis we can assist you. You can get started by completing the below form below with help of LLM, CVRC or hospital social worker:

* Medi-Cal Home and Community-Based Alternatives Waiver Application

PLEASE NOTE: Medi-Cal will not pay for PDHC services until they receive a denial of coverage letter from your private insurance. This is completed by Loretta's Little Miracles and is a process that can be completed frustration free

If appropriate LLM may write a rebuttal letter for the child to help persuade Medi-Cal to approve the child.

+ Private/Independent Pay

Private/Independent Pay accepted upon approval.

Contact us for more information.

 

Qualifying For Care

Please refer to FAQ's for more information

To be eligible for Pediatric Day Health Care services, the the child must be medically fragile with an acute or chronic health problem(s) that requires skilled nursing care and therapeutic intervention (developmental delays included) during all or part of the day.

 
  • Age 0-21 

  • Medical Diagnosis

  • Has a Medical Need for Nursing Care

  • All conditions/diseases must be non-contagious

The child must reside with parent(s), foster parent(s) or legal guardian(s) and may not reside in any 24-hour inpatient facility.


Diagnoses List

THE BELOW DIAGNOSES MAY INDICATE THE NEED FOR PEDIATRIC DAY HEALTH CARE NURSING SERVICES.

(Other medical diagnoses may qualify)


  • Asthama

  • Blindness  

  • Bronchopulmonary Dysplasia

  • Cardiopulmonary Defects

  • Cerebral Palsy

  • Chromosomal Disorders

  • Colostomy Care

  • Congenital Defects

  • Cystic Fibrosis

  • Developmental Delay

  • Diabetes

  • Down Syndrome

  • Endocrine Disorders

  • Failure to Thrive

  • Feeding Disorder/Oral Aversion

  • Fetal Alcohol and Drug Disorders

  • Gastrophy, Gastro Jujemenum

  • Genetic Chromosomal Disorders/Syndromes

  • Hypertonia/Hypotonia

  • Metabolic Disorder

  • Nasogastric Feedings

  • Nephrological Monitoring Catheterizations

  • Neurologic Disorders/Paralysis

  • Nutritional/Gastrointestinal Conditions

  • Orthopedically Impaired (use of walkers, standers and wheelchairs)

  • Reflux Disorder

  • Respiratory Disorders

  • Seizure Disorder/Management

  • Spina Bifida

  • Tracheostomy

** This list indicates possible qualifying diagnoses, but is not limited to only the above conditions.