/PRNewswire/ -- Military families have filed a motion for an injunction to mandate that the Defense Department's insurer, TRICARE, cover medically necessary care needed by military families' children with autism. The motion seeks a mandate that TRICARE cover the cost of Applied Behavior Analysis therapy, or ABA, which is effective in treating children with autism spectrum disorder.
According to the military families, without ABA therapy at an early age, children with autism will suffer irreparable harm. The motion alleges that numerous studies and medical professionals confirm the effectiveness of ABA therapy, yet the Defense Department continues to reject military families' claims for the therapy, relying on shifting rationales.
The case is entitled Berge v. United States of America, et al., No.10-cv-00373-RBW (D.DC), assigned to Judge Reggie B. Walton.
The military families allege that for approximately 10 years the Defense Department and TRICARE have avoided paying for ABA therapy by incorrectly claiming it was "special education" and therefore not payable under the military insurance program. After the military families demonstrated in their written arguments that the Defense Department's position was incorrect, the Defense Department shifted and began claiming that ABA therapy is not proven to be "medically or psychologically necessary."
At a hearing before Judge Walton on November 15, 2010, Department of Justice lawyer, Adam Kirschner conceded: "Special education was not the basis of" our denial of the therapy. Thus, after a decade of taking the position that ABA was "special education," the Defense Department has now abandoned that position and has contrived a new, equally erroneous, reason to not pay for the care.
Former Michigan State Senator, David Honigman, an attorney for the families, emphasized: "The Defense Department's shifting rationales for denying this therapy exposes the hollowness of its position. Time is of the essence for these children. Studies on ABA therapy emphasize that there is a small window of opportunity for these children to obtain maximum benefit from this therapy. If left to its own devices, the Defense Department would continue to keep this window of opportunity closed to these children."
Gerard Mantese, another attorney for the families, stated: "The Defense Department and the Department of Justice should do their homework and read the studies and reports, including the Defense Department's own internal documents, showing that ABA is the most effective therapy for treating autism. It is a slap in the face to these military families to deny therapy needed by their children, while these families are risking their lives for our country." In September 2010, Mr. Mantese was awarded the State Bar of Michigan's Champion of Justice Award for his work in taking legal steps to assist children with autism to access coverage for ABA therapy.
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Showing posts with label therapy. Show all posts
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Tuesday, January 25, 2011
Tuesday, March 3, 2009
Calling Policies 'Unreasonable,' 123 Members of Congress Press for Changes in Medicare Home Oxygen Policies
Calling Policies 'Unreasonable,' 123 Members of Congress Press for Changes in Medicare Home Oxygen Policies for Emergency Care, Supplies and Other Obligations After 36 Months of Service
/PRNewswire-USNewswire/ -- The following release was issued today by the Council for Quality Respiratory Care:
In a recent letter, 123 bipartisan members of Congress pressed leaders for help urging the Centers for Medicare and Medicaid Services (CMS) to revise policies governing Medicare's payment of emergency services, supplies, and other obligations after 36 months of service.
Led by Reps. Mike Ross (D-AR), Tom Price (R-GA), Heath Shuler (D-NC) and Jo Ann Emerson (R-MO), the letter addresses Centers for Medicare and Medicaid (CMS) policies that require home oxygen providers to provide, without any payment, unscheduled service and maintenance visits, 24-hour emergency care, equipment repairs and oxygen supplies for two years following the 36-month rental cap. The CMS policies also require the original oxygen provider to ensure the provision of these services even when a beneficiary moves to a part of the country where the provider does not operate.
Citing lack of payments and "unreasonable obligations," the letter states that CMS policies "are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy..."
Praising the letter, Chairman of the Council for Quality Respiratory Care (CQRC) Peter Kelly said "We applaud these members of Congress for standing up for home oxygen patients and providers in their communities." CQRC is a coalition of leading home oxygen therapy providers and manufacturers who care for nearly one half of the 1.5 million Medicare home oxygen beneficiaries. "We, too, have urged CMS to use its authority to make payments for services and supplies required by beneficiaries after 36 months."
On January 1, 2009, massive cuts to the Medicare home oxygen benefit, in the form of a 36-month cap enacted by Congress in the Deficit Reduction Act of 2005 (DRA), took effect, sending a slow but growing tidal wave of change throughout the provider community. In addressing the implementation of the 36-month cap policy, CMS issued a regulation that home oxygen providers will no longer receive Medicare payment for patient-generated, non-routine emergency visits or needed oxygen supplies, such as oxygen tubing and masks, once a beneficiary reaches the three year mark. These CMS-developed policies came at a time when the home oxygen benefit was also subject to a payment cap and an additional 9.5 percent across the board cut. The collective impact of these policies equals a 27 percent cut, totaling $845 million this year alone.
Excerpts from the letter to Speaker Pelosi, Majority Democratic Leader Hoyer and House Republican Leader Boehner, urging House leaders to ask CMS to revise post 36-month payment for home oxygen include:
"CMS' final rule, published on October 30, 2008, addressing the treatment of oxygen therapy post 36 months established very limited payment levels and unreasonable obligations that are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy."
"We seek your assistance in urging CMS to revise post-36 month oxygen payment policies to address serious shortcomings that are creating hardships for both oxygen patients and providers of these services. Without immediate changes to the Medicare policies patient care will be compromised and Medicare costs will increase."
The Council for Quality Respiratory Care, a coalition of the nation's leading home oxygen therapy providers and manufacturers representing nearly one half of the more than 1.5 million Medicare beneficiaries who depend on the home oxygen benefit for independence and quality of life.
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/PRNewswire-USNewswire/ -- The following release was issued today by the Council for Quality Respiratory Care:
In a recent letter, 123 bipartisan members of Congress pressed leaders for help urging the Centers for Medicare and Medicaid Services (CMS) to revise policies governing Medicare's payment of emergency services, supplies, and other obligations after 36 months of service.
Led by Reps. Mike Ross (D-AR), Tom Price (R-GA), Heath Shuler (D-NC) and Jo Ann Emerson (R-MO), the letter addresses Centers for Medicare and Medicaid (CMS) policies that require home oxygen providers to provide, without any payment, unscheduled service and maintenance visits, 24-hour emergency care, equipment repairs and oxygen supplies for two years following the 36-month rental cap. The CMS policies also require the original oxygen provider to ensure the provision of these services even when a beneficiary moves to a part of the country where the provider does not operate.
Citing lack of payments and "unreasonable obligations," the letter states that CMS policies "are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy..."
Praising the letter, Chairman of the Council for Quality Respiratory Care (CQRC) Peter Kelly said "We applaud these members of Congress for standing up for home oxygen patients and providers in their communities." CQRC is a coalition of leading home oxygen therapy providers and manufacturers who care for nearly one half of the 1.5 million Medicare home oxygen beneficiaries. "We, too, have urged CMS to use its authority to make payments for services and supplies required by beneficiaries after 36 months."
On January 1, 2009, massive cuts to the Medicare home oxygen benefit, in the form of a 36-month cap enacted by Congress in the Deficit Reduction Act of 2005 (DRA), took effect, sending a slow but growing tidal wave of change throughout the provider community. In addressing the implementation of the 36-month cap policy, CMS issued a regulation that home oxygen providers will no longer receive Medicare payment for patient-generated, non-routine emergency visits or needed oxygen supplies, such as oxygen tubing and masks, once a beneficiary reaches the three year mark. These CMS-developed policies came at a time when the home oxygen benefit was also subject to a payment cap and an additional 9.5 percent across the board cut. The collective impact of these policies equals a 27 percent cut, totaling $845 million this year alone.
Excerpts from the letter to Speaker Pelosi, Majority Democratic Leader Hoyer and House Republican Leader Boehner, urging House leaders to ask CMS to revise post 36-month payment for home oxygen include:
"CMS' final rule, published on October 30, 2008, addressing the treatment of oxygen therapy post 36 months established very limited payment levels and unreasonable obligations that are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy."
"We seek your assistance in urging CMS to revise post-36 month oxygen payment policies to address serious shortcomings that are creating hardships for both oxygen patients and providers of these services. Without immediate changes to the Medicare policies patient care will be compromised and Medicare costs will increase."
The Council for Quality Respiratory Care, a coalition of the nation's leading home oxygen therapy providers and manufacturers representing nearly one half of the more than 1.5 million Medicare beneficiaries who depend on the home oxygen benefit for independence and quality of life.
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