The "New System"

However, the Welfare Division was not finished yet. On June 14, 1976, NSWD instituted the complex SAMI 25 invoice from and the 3246-SM medical history form, for EPSDT screening. These new invoices were to take effect July 1, 1976. Up until this point, EPSDT invoices were the SAMI 1 and 2 forms. They were very simple forms with no more than a couple of lines that were filled in by the provider of screenings. SAMI 1 and 2 forms were basically identical and were used interchangeably by the clinic over the years. The clinic had received $32 no matter which form was sent in and no matter who signed it. Blank SAMI 1 and 2's were kept at the clinic. OLCHC had been run on a walk in basis. If the child was eligible for screening, he/she was screened on the spot. A blank SAMI 1 or 2 was filled in sent directly to Nevada Blue Shield, which was the fiscal intermediary for Medicaid reimbursements to providers. Over the years the SAMI 1 or 2 was used, Dr. Ice signed every form. Since it didn't matter who signed the forms and who did the screenings, in terms of how much the clinic would get, it had become standard procedure for Dr. Ice to sign every form. Now starting on July 1., 1976, the new SAMI 25 was taking over. First of all, the OLCHC could no longer stock blank invoices at the clinic. Under the "new system", parents had to go down to their district welfare office and pick up the invoice from their caseworker. The caseworker had to verify eligibility under the periodicity schedule. If the child was eligible, the caseworker would sign the form and was ready to be taken to the clinic. Needless to say, this aspect of the new form alone added great obstacles for screening. Many parents found the added burden of going down to the welfare office and waiting for an appointment with their caseworker to be not worth the benefit of the free screening. Plus the fact that the new procedure nullified the clinic's ability to be a "walk-in" clinic. Mostly what the clinic got in return for all their trouble, were unpaid invoices from the Welfare Division. NSWD claimed that those SAMI 25's returned, were done so because the child was ineligible for EPSDT screenings. There were 140 such returned forms during the period of July 1 to September 30, 1976. When the clinic complained about the "new system", NSWD would argue that the SAMI 25 process was "to protect your clinic from screening ineligible children". However, in light of the 140 returned forms, the argument did not go over too well. In fact, it did not make sense to anyone at OLCHC that SAMI 25's had to be authorized by caseworkers who verified eligibility only later to find the authorized forms returned because of ineligibility. What was the point of making the parent go through all that trouble of going to the district office?