>David, You said you had written letters to the different medicaid
>offices about reimbursement of hbo. Do you recall what the state of IN
>had to say about it?
>
>Sincerely, Judy Sapp
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>David:
>
>Have you done any work, or know of anything being done in Ohio to get
>HBOT covered for kids.
>
>Also, the other obstacle seems to be getting hospitals with HBO
>chambers to treat kids with brain injury. How do you get around this
>obstacle?
>
>Finally, the last I heard from the Canadian study was pretty negative
>for improvements from HBO. Have you gotten more information
>regarding this study, or any further results from any further studies
>showing HBO's effectiveness?
>
>Thanks for you thoughts and insights.
>
>Dave
>
>
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> David, Did you get a reply from the Mississippi Medicaid director
>about HBOT? I was told that Mississippi does not reimburse
>anything because if the parent can afford it up front then Mississippi
>medicaid will not pay. Just interested in what he has to say if you
>wouldn't mind telling me. Thanks Lee Skelton [log in to unmask]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>David, have you heard anything about Louisiana Medicaid? If they approved
>HBOT for this use, I might be able to change my hospital's policy....
>
>Kelly Hill
>
>
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dear Judy and other interested parties:
If you'll recall, a CDC report
[http://groups.yahoo.com/group/medicaidforhbot/files/CDC%27s%20cost%20of%20cp%20
%28p.18%29.PDF] found that each brain-injured child costs $503,000 per year
and will cost $2.4 billion over his/her lifetime--these costs are per
child, per lifetime.
That's a lot of money that keeps a lot of hands out. Brain-injured children
are big business, a big industry.
Medicaid is a state-administered program, and each state may administer
their program differently (i.e., choose what to pay for and what not to pay
for).
Interestingly, most of the states above did not respond to my query, but I
did find most of them referenced in a report by the GAO entitled *Medicaid
in Schools: Improper Payments Demand Improvements in HCFA Oversight*,
downloadable file from
http://groups.yahoo.com/group/medicaidforhbot/files/GAO_Improper_Payments.PDF T
his April, 2000 GAO report finds many school systems are encouraged to
provide Medicaid services because it is a method of enhancing state revenue.
The "Improper Payments" GAO report references an average
revenue/reimbursement of $7 to cover the "administrative" costs of
delivering a mere $2 in services rendered.
This represents a 350% revenue gain by providing Medicaid services through
the schools. Since those services are Speech Therapy, Occupational Therapy,
and Physical Therapy, then these services are obviously being provided to
brain-injured children.
Also from April, 2000 is this GAO report: *MEDICAID IN SCHOOLS: Poor
Oversight and Improper Payments Compromise Potential Benefit*
(http://groups.yahoo.com/group/medicaidforhbot/files/GAO_Improper_Payments.PDF)
From page 2: "methods used by some school districts and states to claim
Medicaid reimbursement for school-based services lack sufficient controls to
ensure that these are legitimate claims."
Also from page 2: "Our work in Michigan alone identified $28 million in
federal reimbursement for improper payments for administrative activity
claims over 2 recent years. The lack of effective controls in other states
could allow comparable improprieties to occur elsewhere."
And from page 19: "The emergence of these issues associated with
school-based services is just the latest example of the need for constant
vigilance to guard against potential exploitation that would divert limited
resources from their intended purposes."
The federal government has been aware of this practice for awhile. From the
June, 1999 GAO report entitled *MEDICAID: Questionable Practices Boost
Federal Payments for School-Based Services
(http://groups.yahoo.com/group/medicaidforhbot/files/GAO_Boosting_Payments.PDF)
"school districts' claims for administrative costs associated with
school-based health services have increased fivefold-from $82 million to
$469 million" [page 2]
And from page 12: "some school district and state practices appear intent
on maximizing their receipt of Medicaid funds through suspect financing
mechanisms."
And from the National Association of State Directors of Special Education
(NASDSE): "Tapping Medicaid Funds"
[http://groups.yahoo.com/group/medicaidforhbot/files/GAO_TappingMedicaidFunds.PD
F] is something of an update on delivery of Medicaid services through the
school systems. From page 2: "In the earlier study (1994), only 11 states
were able to provide estimates of their Medicaid revenue for school-based
services, but 28 states could supply these data for 1999-2000."
In a five year period of time, delivery of Medicaid services (Speech, OT,
and PT) went from about 20% of the states to nearly 60% of the states. This
is an increase of nearly 300%. Why the jump?
Given the documentation and the evidence, it appears that any state
providing Medicaid services through their school systems who is unwilling
to reimburse Hyperbaric Oxygen Therapy for brain-injured children has an
inherent conflict of interest.
Brain-injured children are money-makers for the state.
If Hyperbaric Oxygen Therapy improves or eliminates the brain-injury, the
states will no longer need to provide Speech Therapy, Occupational Therapy,
and Physical Therapy through Medicaid--which means they will lose a
tremendous source of revenue.
mailto:[log in to unmask]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have sworn upon the altar of God, eternal hostility against every form
of tyranny over the mind of man." --Thomas Jefferson, an early advocate of
Hyperbaric Oxygen Therapy.
----------------------------
David Freels
2948 Windfield Circle
Tucker, GA 30084-6714
USA
770/491-6776 (phone and fax)
509/275-1618 (efax, sends fax as email attachment)
mailto:[log in to unmask]
mailto:[log in to unmask]
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