this is in referrence to the released Medicaid Memo.  The issues that I have when trying to get auth is the Part V which is basically our 485.  To me a year long 485 should be sufficient.  The next biggest issue is having to break down our PDN hours between RN and LPN.  When I have addressed this issue in the past the answer I get is we follow DMAS guidelines.  Well that is not correct.  DMAS nor our MCO/HMO’s make us break those hours down.  We request RN/LPN hours for the same amount each week for both.  This makes it easier when I have an LPN and RN working on the same case.  If someone is on vacation then the other can fill in.  Currently there is no way to make this easy with DD Waiver.  Then the hours don’t get filled.  The only person who suffers for this is the patient and the parents not getting coverage.  Is there a way to fix this?  Can we please follow DMAS and our MCO's guidelines in reference to RN/LPN hours?  Thank you for your attention to this issue.