Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 >: > >What is the story behind your letter, do you know what they are going >to say? > >Ken Federal law requires Medicaid reimbursement decisions for EPSDT children be made based on whether a treatment and/or service is " necessary to correct or ameliorate " and " whether it's covered by the state [Medicaid] plan or not. " Right now these decisions are being made by Quality Improvement Organizations (QIOs)--quasi-public, quasi-private, quasi-government agencies originally created by HCFA/CMS to make Medicare reimbursement decisions. They are contractually obligated to the states to make reimbursement decisions based only on the state plan--which creates an inherent conflict of interest when services " necessary to correct or ameliorate " are needed but not covered under the state plan. With such a request, the QIOs have no choice but to deny services because they are contractually obligated to the states. What's needed here is federal oversight by HCFA/CMS. I believe it would be in everyone's best interest if they would take this letter and pass it on to their US Representative in the House and also your two US Senators and have them put pressure on CMS. CMS now has a legal reason via federal law and case law to ensure that this sort of bureaucratic snafu doesn't repeat itself. If they issue the order then it could be one more thing to accelerate the whole HBOT reimbursement process. The state QIOs: State/Territory Organization Name Phone Number Web Site ALABAMA Alabama Quality Assurance Foundation (205) 970-1600 http://www.aqaf.com ALASKA PRO-West - Alaska Branch Office (907) 562-2252 http://www.pro-west.org ARIZONA Health Services Advisory Group, Inc. (602) 264-6382 http://www.hsag.com ARKANSAS Arkansas Foundation for Medical Care, Inc. (501) 649-8501 http://www.afmc.org CALIFORNIA CMRI (California Medical Review, Inc.) (415) 677-2000 http://www.cmri-ca.org COLORADO Colorado Foundation for Medical Care (303) 695-3300 http://www.cfmc.org CONNECTICUT Qualidigm (860) 632-2008 http://www.qualidigm.org DELAWARE Quality Insights of Delaware (302) 475-8100 http://www.qualityinsights.org DISTRICT OF COLUMBIA Delmarva Foundation for Medical Care (202) 293-9650 http://www.dfmc.org FLORIDA Florida Medical Quality Assurance (813) 354-9111 http://www.fmqai.com GEORGIA Georgia Medical Care Foundation (404) 982-0411 http://www.gmcf.org HAWAII (Guam & American Territories) Mountain-Pacific Quality Health Foundation (808) 545-2550 http://www.mt.net/~mtwy IDAHO PRO-West (Idaho Branch Office) (208) 343-4617 http://www.pro-west.org ILLINOIS Illinois Foundation for Quality Health Care (630) 571-5540 http://www.ifqhc.org INDIANA Health Care Excel, Incorporated (812) 234-1499 http://www.hce.org IOWA Iowa Foundation for Medical Care (515) 223-2900 http://www.ifmc.org KANSAS Kansas Foundation for Medical Care, Inc. (785) 273-2552 http://www.kfmc.org KENTUCKY Health Care Excel, Incorporated (812) 234-1499 http://www.hce.org LOUISIANA Louisiana Health Care Review, Inc. (225) 926-6353 http://www.lhcr.org MAINE Northeast Health Care Quality Foundation (603) 749-1641 http://www.medicarequality.org MARYLAND Delmarva Foundation for Medical Care, Inc. (410) 822-0697 http://www.dfmc.org MASSACHUSETTS MassPRO (781) 890-0011 http://www.masspro.org MICHIGAN Michigan Peer Review Organization (734) 459-0900 http://www.mpro.org MINNESOTA Stratis Health (612) 854-3306 http://www.stratishealth.org MISSISSIPPI Information and Quality Healthcare (601) 957-1575 http://www.iqh.org MISSOURI Missouri Patient Care Review Foundation (573) 893-7900 http://www.mpcrf.org MONTANA Mountain-Pacific Quality Health Foundation (406) 443-4020 http://www.mt.net/~mtwy NEBRASKA The Sunderbruch Corporation/Nebraska (515) 223-2900 http://www.ifmc.org NEVADA HealthInsight (702) 385-9933 http://www.healthinsight.org NEW HAMPSHIRE Northeast Health Care Quality Foundation (603) 749-1641 http://www.medicarequality.org NEW JERSEY Peer Review Organization of New Jersey, Inc. (732) 238-5570 http://www.pronj.org NEW MEXICO New Mexico Medical Review Association (505) 998-9898 http://www.nmmra.org NEW YORK IPRO (516) 326-7767 http://www.ipro.org NORTH CAROLINA Medical Review of North Carolina, Inc. (919) 851-2955 http://www.mrnc.org NORTH DAKOTA North Dakota Health Care Review, Inc. (701) 852-4231 http://www.ndhcri.org OHIO Ohio KePRO, Inc. (216) 447-9604 http://www.ohiokeproinc.com OKLAHOMA Oklahoma Foundation for Medical Quality, Inc. (405) 840-2891 http://www.ofmq.com OREGON Oregon Medical Professional Review Organization (503) 279-0100 http://www.ompro.org PENNSYLVANIA KePRO, Inc.-Pennsylvania (717) 564-8288 http://www.kepro.org PUERTO RICO QIPRO, Inc. (787) 641-1240 netdial.caribe.net/~qipro RHODE ISLAND Rhode Island Quality Partners (401) 528-3200 SOUTH CAROLINA Carolina Medical Review (803) 731-8225 http://www.carolinaqio.org SOUTH DAKOTA South Dakota Foundation for Medical Care (605) 336-3505 http://www.sdfmc.org TENNESSEE Mid-South Foundation for Medical Care, Inc. (901) 682-0381 http://www.tnproqio.com TEXAS Texas Medical Foundation (512) 329-6610 http://www.tmf.org UTAH HealthInsight (801) 892-0155 http://www.healthinsight.org VERMONT Northeast Health Care Quality Foundation (603) 749-1641 http://www.medicarequality.org VIRGIN ISLANDS Virgin Islands Medical Institute PRO, Inc. (340) 712-2400 VIRGINIA Virginia Health Quality Center (804) 289-5320 http://www.vhqc.org WASHINGTON PRO-West (206) 364-9700 http://www.pro-west.org WEST VIRGINIA West Virginia Medical Institute, Inc. (304) 346-9864 http://www.wvmi.org WISCONSIN MetaStar, Inc. (608) 274-1940 http://www.metastar.com WYOMING Mountain-Pacific Quality Health Foundation (800) 768-2572 http://www.mt.net/~mtwy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 11, 2007 Report Share Posted December 11, 2007 Hi Sally, You always make me smile, and proud. Thank you! Betsy and I divided up the Ways & Means list and called each represenative on it. About half the time I had to leave a voice message which I did (detailed each time; some better than others), othewise I had what felt to be good conversations with the Legislative Assistants (LAs), some felt very good ... ie, I was asked to send additional information and provided their emails for that purpose.Only a few said that they were aware of the issue, and two LAs said that our request would be supported. It appears the BIG story (distraction) in Washington today is that the CIA destroyed some tapes. Which is kinda like being shocked your pet cat killed a mouse .... also, CIA destroying evidence is not exactly a time-sensitive issue or one that can be undone. ie, you can't unburn a tape. The long and the short of it: almost all the LAs I talked to today seemed genuinely interested in our problem. Probably, it was refreshing to hear about an issue that was truly important, real, and that could be fixed ... if attended to. ~ Karl Subject: [nhl-info] CMS Karl et al, Finally finished faxing all representatives on Ways and Means. My stupid trick of the day was to address Rep Rangel as 'Dear Senator last name'. Duh! Ah well, maybe he secretly aspires to being a senator - I hope his aide has a sense of humor. Will also fax my Senators and refax (new word there?) the Finance Committee. Next time we have a crisis, let's avoid the Christmas season. OTOH, we'll all feel like we've received a huge Christmas present if we succeed here. Sally Quote Link to comment Share on other sites More sharing options...
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