Re: [MedicaidforHDOT] Regarding Medicaid and HBOT

July 11, 2003

That is in a hospital setting we are trying to get coverage for a Free

standing facility. Plus no documentation has been shown to this date that they

have

paid. Not trying to damper you mood here these people need to see the

proof they do not need to be lead down a road of wicked path.

Darin

July 11, 2003

>Hello list please I hope you guy's understand IM not her to discourage any of

>you. I do want you all to know that there has been a lot of talk about states

>paying for HBOT. However all of these cases have been appealed. Though it has

>been lead to believe that these services are being paid. Freels case in

>Georgia was appealed and is still being battled there has been no

>disbursement to this date. Also there is a new case in PA that is claiming

>to have

>services paid. However it was appealed also. So therefore those services

>are not

>being paid as of yet either. Please folk's were still along way away and

>we are

>making progress but do not get false hope because someone claims these

>services

>are being paid. I would love and continue to battle Medicaid everyday. There

>are 3 cases we are working on right now. This case is going to have to be

>fought on a national level. I hope you all understand they are making

>progress

>with these cases and we need these cases like 's and the pa case. Now

>when

>we fight on a national level we can show that these cases have been won in

>all

>these states with no payment to date because the state keep's appealing

>it. So

>keep the fight up but if you see a post that say's Texas pay's for HBOT don't

>believe it till I show you where the disbursement was paid out. Goodluck to

>all of you.

>

>Darin

>

Darin,

Pennsylvania Medicaid is paying for this child right now. Do you think any

hyperbaric clinic would treat without a guarantee of payment, particularly

a hospital--which traditionally has refused to treat anything beyond the 13

covered indications?

Remember that Florida Medicaid is on record that they will reimburse a

Medicaid child getting HBOT in a hospital.

Medicaid in Maine has also paid--in a hospital clinic too.

Colorado Medicaid has paid and will pay again if anybody bothers to request it.

In our case, we won the right to anything that is " necessary to correct or

ameliorate " our son Jimmy's brain-injury. We've asked for off-label HBOT

and our proof of efficacy are his before/after SPECT-scans. The state court

remanded the case back to the Administrative Law Judge (ALJ) to make

another decision based on the " new " standard which has rendered the old

excuses of

1. experimental and investigational

2. not medically necessary

3. not the standard of medical practice

totally irrelevant, as is the Georgia state Medicaid plan, and since this

decision came from a state appeals court, every state Medicaid plan must

take this decision into consideration when they review an EPSDT request for

HBOT in pediatric brain-injury. To ignore this decision is a virtual

guarantee of a loss by the state agency before an Administrative Law Judge

(ALJ).

Now the only standard for any child in any state is whether or not the

treatment and/or service is necessary to correct or ameliorate.

As for us, we've waited over 6 months for this next ALJ hearing, but the

Georgia Department of Medical Assistance is refusing to schedule a hearing.

Why?

Why do you think? It's because they don't have a leg to stand on, and they

either know it or they're figuring it out that they don't have a leg to

stand on. They're doomed. They cannot say Hyperbaric Oxygen Therapy is not

" necessary to correct or ameliorate " Jimmy's brain-injury because we've

proved that it is working.

Think terror Darin because that's what's going on. The parents are right.

The parents have found something that helps, and the parents are dictating

a change to the the standard of medical practice in pediatric neurology,

and we're backed by the full force of the United States government--the

same people who recently undid another dictator in Iraq.

This forces a new level of accountability and destroys the ivory tower.

Georgia Medicaid might just throw in the towel any minute. Then again, they

might decide to keep appealing all the way to the supreme court.

In a way, I hope they do.

For the sake of our children, I hope they do.

It's time for a change.

```````````````````````````````````````````````````````

" Rarely do we find men who willingly engage in hard, solid thinking. There

is an almost universal quest for easy answers and half-baked solutions. "

--The Reverend Luther King, Jr.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

720/269-5289 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 11, 2003

Yes, but the while purpose to open the field was to get it in an FRE standing

facility. After all went they the one that started off labeled usage.

July 11, 2003

Darin,

Medicaid is not going to pay free standing clinics if they are not medicaid

providers.

God Bless, Pat

Mom to , 28 yrs old, 1/98 MVA/Near Drowning

Come meet <A HREF= " www.georgemelendez.org " >www.georgemelendez.org</A>

July 11, 2003

Darin, I'm not sure I understand. If we get Medicaid coverage why must it

be in a freestanding facility. Why not a hospital setting?

Every step in the right direction, no matter how small is a good step.

Hartsoe

Re: [MedicaidforHDOT] Regarding Medicaid and HBOT

> That is in a hospital setting we are trying to get coverage for a Free

> standing facility. Plus no documentation has been shown to this date that

they have

> paid. Not trying to damper you mood here these people need to see

the

> proof they do not need to be lead down a road of wicked path.

>

> Darin

>

July 11, 2003

In a message dated 7/11/2003 8:30:09 PM Central Daylight Time,

mmeshke@... writes:

> What I learned from this little investigatory exercise is that if my

> son becomes a Medicaid recipient, there is no way our local hospital

> can provide HBOT for him unless HBOT becomes a Medicaid-approved

> therapy for brain-injuries. Not that I think our local hospital will

> ever agree to treat my son, that option is completely lost as soon as

> he becomes a Medicaid recipient.

>

This is the hole key IM glad somebody finaly got it. Regardles if other

hopitals have been ordered to treat all of them do not have to. It will be a

case

by case basis. As I have said in the past email false hopes for so many by

saying a state pay's. When you say a state pay's that means a state will pay

regardless if you take them to court or not. What I have been trying to say is

like

you said these states have been ordered to pay it doesn't mean they have done

it yet and if they have it doesn't mean they pay it just means one case has

been one. This will be discusse at this years symposium I will be there if all

goes well IM supposed to be on a panel. My only beef with saying a state pays

is it didn't sdo it by choice and will not do it for every child unless it is

tooken to court everytime. And I have yet to see one case that has been paid

for. None has provided proof that Medicaid has paid for an off labeled usage ye

t. don't try to use es Case like I said that was not medicaid itr

was a community based alternative program.

Darin

July 11, 2003

No, they are not going to pay Pat you are correct. However that is what many

have been trying to accomplish. There is a bigger picture to this whole issue.

I wish would lay it on the line as it is. Rather than build false

hopes. These hospitals are only going to treat one at a time if ordered by a

court

to do so. What we have to do is fight this on a national level. But no we are

to busy building blocks and dreams. I have worked my ass off on this. We need

to get off our ass and fight this issue. But Let someone else do it is much

easier to do it that way. e Creacy is one of the most strongest advocates

int his business she starts as soon as her feet hits the floor. We speak daily

on insurance issues. We have made trips to Austin Texas for the cause.

Darin

July 11, 2003

In a message dated 7/11/2003 7:37:22 PM Central Daylight Time,

rhartsoe@... writes:

> Darin, I'm not sure I understand. If we get Medicaid coverage why must it

> be in a freestanding facility. Why not a hospital setting?

> Every step in the right direction, no matter how small is a good step.

> Hartsoe

>

to be honest it doesn't matter if it is one or the other. The problem

here is people do not realize this is only gonna happen if the battle is

fought everytime. We don't wont that. What we wont is to file a claim and it b

epaid the only way to do that is on a national level. Goodluck in getting anyone

to do that.

Darin

July 11, 2003

I have heard that hospitals which receive Medicaid reimbursement

claim they cannot treat brain injuries because it is not a Medicaid-

recognized application of HBOT and would, therefore, jeopradize all

Medicaid reimbursement to that hospital. Based on what I know of the

health care racket, that claim just didn't ring true - Medicaid may

be able to designate what services/therapies they will and won't

reimburse, but they certainly have no authority to dictate what other

services/therapies a hospital provides. I contacted the State of

Wisconsin Medicaid office and asked about this. Here's what I was

told - in cases where the patient is a Medicaid recipient and the

hospital is billing Medicaid, it must be for a Medicaid-approved

service/therapy. In cases where the patient is a Medicaid recipient

but the service/therapy is not Medicaid-approved, the hospital cannot

allow the patient to pay out-of-pocket for the service as that would

be discriminatory (i.e. higher income Medicaid recipients could

afford to pay for services out-of-pocket that lower income Medicaid

recipients could not). In short, if you are a Medicaid recipient,

the hospital can and will perform only Medicaid-approved

services/therapies for which it will seek Medicaid reimbursement - it

will not perform any services to Medicaid recipients for cash. The

hospital does jeopradize its Medicaid reimbursement if it performs

services (both Medicaid approved services or non-Medicaid approved

services) on Medicaid recipients for cash. If the patient is not a

Medicaid recipient, Medicaid has no authority whatsoever. The

hospital can perform whatever services/therapies it deems appropriate

and the patient can pay out of pocket - it is a simple exchange of

cash for services and does not/cannot jeopradize the hospital's

Medicaid reimbursement for other services.

What I learned from this little investigatory exercise is that if my

son becomes a Medicaid recipient, there is no way our local hospital

can provide HBOT for him unless HBOT becomes a Medicaid-approved

therapy for brain-injuries. Not that I think our local hospital will

ever agree to treat my son, that option is completely lost as soon as

he becomes a Medicaid recipient.

Lynn

July 11, 2003

Lynn,

you are correct in your explanation.

In addition, once a center becomes a Medicaid provider, even if they decide

to later no longer be a Medicaid Provider, they are required to provide the

Medicaid reimbursed service free of charge for a certain period of time.

In addition, they are notoriously slow pay which makes it very difficult for

an average freestanding facility to operate. On top of all that, most free

standing facilities do not qualify to become Medicaid providers for HBOT

unles they are located at and directly connected to a Medical center.

That is why it is so important to see the hospitals become providers

treating brain injury with Medicaid paying. But now what about those who

do not get Medicaid? They can still go to free-standing centers so it is a

win-win situation. Some of the insurance companies have been paying for

hbot for brain injury. The single biggest mistake I have seen is asking

them first. They almost always say no. The most success we have had is

simply file for reimbursement with the correct codes as prescribed by their

doctor.

Hartsoe

www.miraclemountain.org

Re: [MedicaidforHDOT] Regarding Medicaid and HBOT

> I have heard that hospitals which receive Medicaid reimbursement

> claim they cannot treat brain injuries because it is not a Medicaid-

> recognized application of HBOT and would, therefore, jeopradize all

> Medicaid reimbursement to that hospital. Based on what I know of the

> health care racket, that claim just didn't ring true - Medicaid may

> be able to designate what services/therapies they will and won't

> reimburse, but they certainly have no authority to dictate what other

> services/therapies a hospital provides. I contacted the State of

> Wisconsin Medicaid office and asked about this. Here's what I was

> told - in cases where the patient is a Medicaid recipient and the

> hospital is billing Medicaid, it must be for a Medicaid-approved

> service/therapy. In cases where the patient is a Medicaid recipient

> but the service/therapy is not Medicaid-approved, the hospital cannot

> allow the patient to pay out-of-pocket for the service as that would

> be discriminatory (i.e. higher income Medicaid recipients could

> afford to pay for services out-of-pocket that lower income Medicaid

> recipients could not). In short, if you are a Medicaid recipient,

> the hospital can and will perform only Medicaid-approved

> services/therapies for which it will seek Medicaid reimbursement - it

> will not perform any services to Medicaid recipients for cash. The

> hospital does jeopradize its Medicaid reimbursement if it performs

> services (both Medicaid approved services or non-Medicaid approved

> services) on Medicaid recipients for cash. If the patient is not a

> Medicaid recipient, Medicaid has no authority whatsoever. The

> hospital can perform whatever services/therapies it deems appropriate

> and the patient can pay out of pocket - it is a simple exchange of

> cash for services and does not/cannot jeopradize the hospital's

> Medicaid reimbursement for other services.

>

> What I learned from this little investigatory exercise is that if my

> son becomes a Medicaid recipient, there is no way our local hospital

> can provide HBOT for him unless HBOT becomes a Medicaid-approved

> therapy for brain-injuries. Not that I think our local hospital will

> ever agree to treat my son, that option is completely lost as soon as

> he becomes a Medicaid recipient.

>

> Lynn

>

> _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

> Join the International Hyperbaric Medical Association

http://www.hyperbaricmedicalassociation.org/forms/Friends_of_IHMA_Join.pdf

>

> Unrestricted downloads of 50+ pdf files on HBOT efficacy

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http://www.drneubauerhbo.com/papers.htm

>

> Download your state EPSDT program

http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on the word

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http://www.medi-cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver

programs: http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

>

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>

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>

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..

>

July 11, 2003

The whole purpose to open the field was to get hbot for the brain injured in

any shape and form. We all know that only Medicaid providers will be used

and most free standing centers do not qualify to become a Medicaid provider.

So what? If all 500+ facilities across the USA opened up to brain injury

with Medicaid paying, WOW!!!!!!!!!!! Look at the problems that would

solve.

Now that would be exciting.

Hartsoe

www.miraclemountain.org

Re: [MedicaidforHDOT] Regarding Medicaid and HBOT

> Yes, but the while purpose to open the field was to get it in an FRE

standing

> facility. After all went they the one that started off labeled usage.

>

July 12, 2003

>That is in a hospital setting we are trying to get coverage for a Free

>standing facility. Plus no documentation has been shown to this date that

>they have

>paid. Not trying to damper you mood here these people need to see the

>proof they do not need to be lead down a road of wicked path.

>

>Darin

>

Darin,

Wicked path?

Wicked?

What are you talking about?

There are people who have put the pieces together and have gone to their

state Medicaid agencies and those agencies have paid for their

brain-injured children to get Hyperbaric Oxygen Therapy.

What is wicked about that?

I have spoken personally with the staff at the hospital in ton, Maine

where the first child got 90 treatments. They were ecstatic at seeing the

life of this child turn around. They were ecstatic to be able to help

someone so much and have since pledged to help other parents of

brain-injured children get extra oxygen.

What is wicked about that?

The proof is forthcoming in the Maine case as is the proof in the

Pennsylvania case. When I get it, it will be posted.

, I've " cc:'d " you on this email, can you fax to me at 720/269-5289

(new fax number) some kind of tangible proof (with dollar amounts--I guess)

that Colorado Medicaid has paid for 's HBOT?

I will then post that as well.

```````````````````````````````````````````````````````

" Rarely do we find men who willingly engage in hard, solid thinking. There

is an almost universal quest for easy answers and half-baked solutions. "

--The Reverend Luther King, Jr.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

720/269-5289 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 12, 2003

>No, they are not going to pay Pat you are correct.

Darin--while I appreciate your thoughts and your comments, I believe it

might be helpful if you were better informed on the law.

If a hospital won't treat off-label, why is that?

Whose " rules " are they following?

Is that decision based on facts or based on ignorance?

Not treating off-label is because of Medicare covered indications, which is

based on the UHMS " standards. "

The International Hyperbaric Medical Association was specifically formed to

change this--and it is--and will continue to do so. That's why it's

critical that everyone one here join. It's the best 25 bucks you'll ever

spend.

>However that is what many

>have been trying to accomplish. There is a bigger picture to this whole

>issue.

>I wish would lay it on the line as it is. Rather than build false

>hopes.

I have never, ever attempted to deceive anyone about any of this and never

will. While I have never censored anyone on this list except for the

occasional pornographer, I encourage you to step back and be very careful

about making such accusations. You're not making much sense here Darin and

your comments are far more destructive than constructive.

If a hospital or any other Medicaid provider is not treating

Medicaid-recipient brain-injured children, the number one reason is

because they won't get reimbursed. They won't get reimbursed because the

diagnosis is not " covered. "

The goal of this list is to get the coverage policy changed, state by

state. Once a state Medicaid agency has reimbursed off-label HBOT then it

becomes Medicaid policy to reimburse off-label HBOT for pediatric

brain-injury. For a Medicaid provider to remain a provider then that

provider must provide the service. Period.

>These hospitals are only going to treat one at a time if ordered by a court

>to do so.

False. Please see the above paragraph.

>What we have to do is fight this on a national level.

Why do you think the listserv was created? What do you

think we're doing here? And the IHMA?

>But no we are

>to busy building blocks and dreams. I have worked my ass off on this. We need

>to get off our ass and fight this issue.

Watch your language.

>But Let someone else do it is much

>easier to do it that way. e Creacy is one of the most strongest

>advocates

>int his business she starts as soon as her feet hits the floor. We speak

>daily

>on insurance issues. We have made trips to Austin Texas for the cause.

>

>Darin

>

That's fine, but Mrs. Creacy is also a member of the UHMS, the primary

culprit in all of this.

```````````````````````````````````````````````````````

" Rarely do we find men who willingly engage in hard, solid thinking. There

is an almost universal quest for easy answers and half-baked solutions. "

--The Reverend Luther King, Jr.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

720/269-5289 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 12, 2003

and the rest of the Group. IM glad all this is happening. IM

Glad to see your getting somewhere. It may sound if IM attacking you. You don't

have to quote me on anything I know what I said. if I offended you IM

sorry. IM not afraid to apologize or as say's look stupid from time to

time. At least I will say what's on my mind to get to the bottom of something

and

not be afraid of looking stupid. there are several issues that I was

talking about that I thought you knew about that's what I was talking about when

I say lay it on the line. I guess and see now you did not know.

The goal of this list is to get the coverage policy changed, state by

state. Once a state Medicaid agency has reimbursed off-label HBOT then it

becomes Medicaid policy to reimburse off-label HBOT for pediatric

brain-injury. For a Medicaid provider to remain a provider then that

provider must provide the service. Period.

After speaking with the Medicaid office in Washington there are sevral

factors that play into this. Im speaking with a Lady on Monday to talk about

this

Issue.

Darin,

Wicked path?

Wicked?

What are you talking about?

that was the wrong word to use. I don't no what to say. I guess

it is time for me to back away IM letting my emotions run wild here. I just see

people getting there hopes up to fast . This is not something that is going

to happen over night.

Basically what I have tried to say over and over again and no one understands

me maybe it is the way we talk in Texas I don't no. IS simply this. We do not

need to say TEXAS MEDICAID NOW PAYS FOR HBOT that is and incorrect statement.

The Correct statement would be TEXAS MEDICAID HAS BEEN FORCED TO PAY FOR HBOT

that shows the members on the list that there was a fight and a complicated

one at that. So see whre the difference is here.

Another thing we need to look at are these case that have been one a Medicaid

waiver or traditional Medicaid. I know you say it don't matter but I

disagree. Washington disagrees as well. Medicaid Waivers are totally different

and if

this is what is paying then there is a bigger issue at hand. Make sure this is

traditional Medicaid not a Wavier.

Once again My emotions have run high I will back away give you time to

provide the proof to these people. Hopefully it is what we have all been

looking for. I will be prying to GOD it is. But please don't close you eyes to

the

full picture make sure this is not a Medicaid Waiver Make sure it is

Traditional Medicaid. Also that it is MEDICAID NOT KAISER WORKING UNDER THE

MEDICAID

PROGRAM. That would be another issue. It needs to be Medicaid with no name

attached to it. Regarding the law you stated once a state pay it has to continue

that applies to Medicaid not waivers. What I have found is that many belive they

are on traditional Medicaid in there state when in fact there not.

I hope you understand IM not a Book worm and I don't present myself very well

when talking but I do do my research. IM sorry if I ofended you or anyone

else.

Darin

July 12, 2003

Darin,

You do have a tendency to put your foot in your mouth. I think you often

speak without thinking but we understand you zest as we all share it. It is

sometimes better to think a little longer before making statements. Many

are working tirelessly putting in long hours to make hbot possible for brain

injury for anyone who needs it. has done a remarkable and tireless

job in setting up this listserve and making records and files available to

anyone who needs it to fight their battle. I do realize and know that you

have also worked hard for those with brain injury. So what we need to be

able to do is agree to disagree from time to time. Don't simply make

statements you cannot substantiate, it does not help the cause.

,

Just because someone is a member of the UHMS does not make them an enemy.

Many of the freestanding centers are members of the UHMS to take advantage

of any training and updates they may have available and there is nothing

wrong with that. I would consider being a member for that reason myself

except when I get around them I see tar and feathers with my name on it back

in the corner. Do not forget e's hard work in making hbot available

for brain injury. This is against being a member of the UHMS so therefore

being a member has nothing to do with anything. Also, e heads up the

IHA which was set up to help make mild hyperbarics available to more. I can

assure you the UHMS would not have a part of that and would love to shut

down both the IHA and the IHMA.

Folks,

Once again we come back to working as a team. If you take two strong,

beautiful well trained horses that work perfect alone and try to team them

up, they must first learn to work side by side and become a team before they

can pull the plow and stay on track. The same goes for humans. The same

goes for HBOT. Darin and I do not always agree. e and I do not

always agree. and I do not always agree. Ed and I do not always

agree. But if you take all of us and put us together we are all interested

in accomplishing the same thing, providing hbot for the thousands of brain

injured who need and deserve it. And I can assure you all we would stand

side by side, hand in hand, and fight any force that comes along to try to

prevent us from doing so.

I myself sometimes come across too harsh and brash about some issues. It is

because I vigorously defend what I believe in and do not always select my

words wisely, especially when I am tired and don't feel like putting up with

a lot. I should vent my frustration in other directions but that is one of

my flaws. I hope others do not think badly of me because of it. The same

goes for everyone who posts to this and other lists. First remember the

long term goals and that we are all aiming in the same direction. I

personally believe that if we forget to include God in our lives and goals,

we begin making mistakes because we are trying to do it on our own when we

have such a powerful Father and Leader to take us in the right direction.

Let's get back on track.

Hartsoe

www.miraclemountain.org

Re: [MedicaidforHDOT] Regarding Medicaid and HBOT

> >No, they are not going to pay Pat you are correct.

>

> Darin--while I appreciate your thoughts and your comments, I believe it

> might be helpful if you were better informed on the law.

>

> If a hospital won't treat off-label, why is that?

>

> Whose " rules " are they following?

>

> Is that decision based on facts or based on ignorance?

>

> Not treating off-label is because of Medicare covered indications, which

is

> based on the UHMS " standards. "

>

> The International Hyperbaric Medical Association was specifically formed

to

> change this--and it is--and will continue to do so. That's why it's

> critical that everyone one here join. It's the best 25 bucks you'll ever

> spend.

>

> >However that is what many

> >have been trying to accomplish. There is a bigger picture to this whole

> >issue.

> >I wish would lay it on the line as it is. Rather than build false

> >hopes.

>

> I have never, ever attempted to deceive anyone about any of this and never

> will. While I have never censored anyone on this list except for the

> occasional pornographer, I encourage you to step back and be very careful

> about making such accusations. You're not making much sense here Darin and

> your comments are far more destructive than constructive.

>

> If a hospital or any other Medicaid provider is not treating

> Medicaid-recipient brain-injured children, the number one reason is

> because they won't get reimbursed. They won't get reimbursed because the

> diagnosis is not " covered. "

>

> The goal of this list is to get the coverage policy changed, state by

> state. Once a state Medicaid agency has reimbursed off-label HBOT then it

> becomes Medicaid policy to reimburse off-label HBOT for pediatric

> brain-injury. For a Medicaid provider to remain a provider then that

> provider must provide the service. Period.

>

> >These hospitals are only going to treat one at a time if ordered by a

court

> >to do so.

>

> False. Please see the above paragraph.

>

> >What we have to do is fight this on a national level.

>

> Why do you think the listserv was created? What do you

> think we're doing here? And the IHMA?

>

> >But no we are

> >to busy building blocks and dreams. I have worked my ass off on this. We

need

> >to get off our ass and fight this issue.

>

> Watch your language.

>

> >But Let someone else do it is much

> >easier to do it that way. e Creacy is one of the most strongest

> >advocates

> >int his business she starts as soon as her feet hits the floor. We speak

> >daily

> >on insurance issues. We have made trips to Austin Texas for the cause.

> >

> >Darin

> >

>

> That's fine, but Mrs. Creacy is also a member of the UHMS, the primary

> culprit in all of this.

>

> ```````````````````````````````````````````````````````

> " Rarely do we find men who willingly engage in hard, solid thinking. There

> is an almost universal quest for easy answers and half-baked solutions. "

>

> --The Reverend Luther King, Jr.

>

> ```````````````````````````````````````````````````````

>

> Freels

> 2948 Windfield Circle

> Tucker, GA 30084-6714

> 770/491-6776 (phone and fax)

> 720/269-5289 (efax, sends fax as email attachment)

> mailto:dfreels@...

>

> http://www.freelanceforum.org/df

>

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> Join the International Hyperbaric Medical Association

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>

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medicaid/files/ ,

HDO-documentation/files/ and

http://www.drneubauerhbo.com/papers.htm

>

> Download your state EPSDT program

http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on the word

" ameliorate " . State Medicaid websites

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programs: http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

>

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July 12, 2003

Waivers came out long after the paragraph 5. I have been totally open

to both sides of the fence to get what information I can. If I turn and say no

everytime they open there mouth (that is the law and the Medicaid office) I

would get no where. You have to be able to listen and Like you know the law. But

that paragraph 5 was written a long time ago. Yes, education is going to be

the key.

Just because a state contracts with an HMO to administer the program, it

still does not absolve the state's responsibility to provide such other

necessary health care, diagnostic services, treatment, and other measures

to correct or ameliorate defects and physical and mental illnesses and

conditions discovered by the screening services, whether or not such

services are covered under the State plan.

OK then I have a task for you to complete if you can since CHIP " S that is the

Children's Health Insurance of Texas is a Medicaid program Medicaid

authorizes the claim it receives federal funds from Medicaid as well as state

and local

funds. All claims for prescriptions are being processed through the Medicaid

Help desk I you need the phone number I can give it to you. Then answer me why

they ( CHIP " S) are not bound by paragraph 5. If you say these others states

and Kaiser acting on behalf of Medicaid for another state is. Fix that one I

have worked on it and fought hired some of the best attorneys to figure it out

as well.

Also you say that a waiver program is the same as Medicaid you disagree with

me on that

Maybe there's a distinction between services in Texas, but I've never heard

of there being a difference anywhere else. If there is a difference in

Texas, it's illegal--because that's not what the law says. See

http://caselaw.findlaw.com/casecode/uscodes/42/chapters/7/subchapters/xix/sect

io

ns/section_1396d.html

In Minnesota I believe there waiver program is called the Katy Becet waiver

all waiver programs are different names each state has one. You said if I know

something tell you so you can fight it. How can do that? You guy's don't even

believe there is a problem your all stuck on Paragraph 5. Stop look at the

whole picture find out what IM talking about I have been to the office sit there

with the attorney do I understand all of it. Not enough to explain it to

someone else. Paragraph 5 pertains to traditional Medicaid the Medicaid that was

in

affect when that bill was passed. IF you put it before 10 judges you going to

get different answers from all of them most likely.

Darin

July 23, 2003

Hello all. I want to revise my message below. Just yesterday I

received a final answer from WI Medicaid as far as whether

administering HBOT for an off-label application can jeopradize a

hospital's Medicaid reimbursement. The answer is no, as we all

knew. However, the original information I received (see below) was

misleading in that it said that if a child is a Medicaid recipient

and his/her family wants to pay a hospital out-of-pocket for HBOT for

brain injury, the hospital still cannot perform the service as it

would amount to discrimination against Medicaid families who cannot

afford to pay out-of-pocket. This is not true. What needs to happen

is this: The parents request prior authorization from Medicaid for

HBOT for brain injury. Medicaid, of course, denies. At that point,

the hospital can accept payment directly from the patient/patient's

families, for the service. But Medicaid has to deny payment first.

So, you are probably asking why this matters since the ultimate goal

is Medicaid reimbursement? It matters because many of us are told by

hospitals with chambers that they are unable to provide brain-injured

children with HBOT because it would jeopradize their Medicaid

reimbursement. I cannot speak for other states but, in WI, this is

NOT true and they are simply telling us that because they do not want

to come out and say they are denying our children treatment.

Lynn

> I have heard that hospitals which receive Medicaid reimbursement

> claim they cannot treat brain injuries because it is not a Medicaid-

> recognized application of HBOT and would, therefore, jeopradize all

> Medicaid reimbursement to that hospital. Based on what I know of

the

> health care racket, that claim just didn't ring true - Medicaid may

> be able to designate what services/therapies they will and won't

> reimburse, but they certainly have no authority to dictate what

other

> services/therapies a hospital provides. I contacted the State of

> Wisconsin Medicaid office and asked about this. Here's what I was

> told - in cases where the patient is a Medicaid recipient and the

> hospital is billing Medicaid, it must be for a Medicaid-approved

> service/therapy. In cases where the patient is a Medicaid

recipient

> but the service/therapy is not Medicaid-approved, the hospital

cannot

> allow the patient to pay out-of-pocket for the service as that

would

> be discriminatory (i.e. higher income Medicaid recipients could

> afford to pay for services out-of-pocket that lower income Medicaid

> recipients could not). In short, if you are a Medicaid recipient,

> the hospital can and will perform only Medicaid-approved

> services/therapies for which it will seek Medicaid reimbursement -

it

> will not perform any services to Medicaid recipients for cash. The

> hospital does jeopradize its Medicaid reimbursement if it performs

> services (both Medicaid approved services or non-Medicaid approved

> services) on Medicaid recipients for cash. If the patient is not a

> Medicaid recipient, Medicaid has no authority whatsoever. The

> hospital can perform whatever services/therapies it deems

appropriate

> and the patient can pay out of pocket - it is a simple exchange of

> cash for services and does not/cannot jeopradize the hospital's

> Medicaid reimbursement for other services.

>

> What I learned from this little investigatory exercise is that if

my

> son becomes a Medicaid recipient, there is no way our local

hospital

> can provide HBOT for him unless HBOT becomes a Medicaid-approved

> therapy for brain-injuries. Not that I think our local hospital

will

> ever agree to treat my son, that option is completely lost as soon

as

> he becomes a Medicaid recipient.

>

> Lynn

July 23, 2003

>Hello all. I want to revise my message below. Just yesterday I

>received a final answer from WI Medicaid as far as whether

>administering HBOT for an off-label application can jeopradize a

>hospital's Medicaid reimbursement. The answer is no, as we all

>knew. However, the original information I received (see below) was

>misleading in that it said that if a child is a Medicaid recipient

>and his/her family wants to pay a hospital out-of-pocket for HBOT for

>brain injury, the hospital still cannot perform the service as it

>would amount to discrimination against Medicaid families who cannot

>afford to pay out-of-pocket. This is not true. What needs to happen

>is this: The parents request prior authorization from Medicaid for

>HBOT for brain injury. Medicaid, of course, denies. At that point,

>the hospital can accept payment directly from the patient/patient's

>families, for the service. But Medicaid has to deny payment first.

>So, you are probably asking why this matters since the ultimate goal

>is Medicaid reimbursement? It matters because many of us are told by

>hospitals with chambers that they are unable to provide brain-injured

>children with HBOT because it would jeopradize their Medicaid

>reimbursement. I cannot speak for other states but, in WI, this is

>NOT true and they are simply telling us that because they do not want

>to come out and say they are denying our children treatment.

>

>Lynn

>

Lynn,

I met a WI mom at the symposium last week who has a check on the way from

WI Medicaid for off-label Hyperbaric Oxygen Therapy (HBOT), which will be

posted ASAP on medicaid/files/ , which

should make the issue above moot.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

720/269-5289 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 23, 2003

Hi Lynn, Keep us posted on your progress. My own experience

is similar with local hospitals refusing access to HBOT even

we offered to self pay. Bottom line they are hiding behind the

bureaucracy.

dubblmom wrote: