Beckett and MedicaidforHBOT

[Guest guest]

Senator Unterman,

This email is also " cc:'d " to State Senate Majority Leader

and a few other interested parties. I attempted to speak with Senator

while he was a guest on WGKA talk radio several months ago.

I wanted to talk with him about the Beckett program, and he

told me to email him, which I've done several times, but he's never

replied. I've also tried to call him, but he's never called back.

I thank you for taking my call today, and I appreciate your

conversation and your candor. I especially appreciate that you

confirmed that it was in fact our 2002 decision from the Georgia

State Court of Appeals, forcing Georgia to comply with the Federal

Medicaid law for children that led Georgia DCH to revise the

beckett eligibility criteria.

However, I've been distressed all day, realizing that in trying to

correct or ameliorate our son's brain-injury, to ensure his God-given

right to reach his maximum potential, you've changed the rules and

now 2000 disabled children have been thrown off the Beckett

program--and will remain disabled.

It's too bad you couldn't let them get HBOT first and eliminate or

minimize their disability before kicking them off the program.

I've also been wondering how all this would look on 60 Minutes or the

front page of the Journal-Constitution. It is after all an election

year.

Attached pdf is the Administrative Law Judge (ALJ) decision made on

August 9th, almost two weeks ago. It's critical for you to understand

this decision came from the same ALJ who ruled against us in 2000.

This was a stunning and devastating defeat for DCH. We've now had

four decisions on this; DCH won the first one, and we've won everyone

of them since. Since this latest decision comes from the judge who

ruled against us the first time, that means we're pretty much 4 and 0.

We've made the case. We've won. We've proven that HBOT is " necessary

to correct or ameliorate " pediatric brain-injury.

The question now becomes how to provide the service. As I said on

the phone today, the same Medicaid law for children gives DCH an out.

Instead of having to pay $2000/hour for Medicaid's HBOT providers at

Crawford Long, you can just send them to a free-standing clinic where

the fee is typically just 10% of what the hospitals charge.

Here's the law (found at

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

ns/section_1396d.html)

which mandates every state Medicaid agency provide to children:

" (5) 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. "

The key phrase for you is " whether or not such services are covered

under the State plan. "

It's your state plan that says HBOT must be provided by a $2000/hour

Medicaid provider. It's the Medicaid law for children that allows you

to provide HBOT through other providers.

Let's talk further.

--

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770-491-6776 (phone)

404-725-4520 (cell)

815-366-7962 (fax)

mailto:dfreels@...

http://www.freelanceforum.org/df