/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 treatments. Show all posts
Showing posts with label treatments. Show all posts
Tuesday, January 25, 2011
Thursday, March 5, 2009
Patients, Senate, House Members Identify Significant Medicare Savings While Increasing Quality of Patient Care
/PRNewswire-USNewswire/ -- Patients on Medicare and Senators Blanche L. Lincoln (D-AR) and Johnny Isakson (R-GA) and Representative Eliot L. Engel (D-NY-17) today urged Congress to fix a flaw in the Medicare program which forces patients to undergo treatments in institutional settings when it is often unnecessary. The immediate legislative actions that can be taken to achieve Medicare savings while providing high-quality, life-saving home infusion therapy to older and disabled Americans, was the focus of an educational forum hosted by the National Home Infusion Association (NHIA).
The Medicare Home Infusion Therapy Coverage Act of 2009 was introduced earlier this year to close a gap that currently exists in coverage where the medicines used in infusions to treat serious diseases are covered, but not the medical services, supplies and equipment needed to deliver the home therapy.
"Many Arkansans on Medicare who need home infusion therapy are simply unable to afford it. As a result, they often have to enter a hospital or nursing home for the infusion treatment to be fully covered by Medicare. Not only is this an extreme hardship for the patient, it actually results in a higher cost to Medicare. This legislation would provide for full Medicare coverage of home infusion therapy, ultimately lowering costs and improving patient outcomes," said Senator Lincoln.
"Medicare coverage of home infusion therapy is a prime example of immediate action we can take to deliver high-quality patient care at a lesser cost," said Senator Isakson. "I witnessed firsthand the world of difference treatment at home makes to patients and their caregivers when my son needed to be treated with intravenous medicines a few years ago. I believe he was able to heal faster because he underwent treatment at home. Everyone should be afforded this opportunity."
"Medicare is the only major payor that does not reimburse for home infusion therapy. We cannot continue to support a healthcare system of 'have' and 'have nots'. All patients, including older and disabled Americans needing intravenous medications, should be allowed to undergo treatment in the comfort of their own homes," said Representative Engel.
Infusion therapy involves the administration of medication through a needle or catheter, and is prescribed for infections unresponsive to oral antibiotics and serious diseases including cancer, congestive heart failure, and rheumatoid arthritis, among others.
Patients at the forum shared personal stories of the health and financial challenges they have experienced due to the lack of Medicare coverage, and advocated for enactment of new legislation that will eliminate unnecessary hospital stays when physicians and patients agree that treatment at home is preferable.
"Our country can no longer afford unnecessary healthcare expenses when high-quality, low-cost options are available and preferred by physicians and patients alike," said Russell Bodoff, President, NHIA.
The "Medicare Home Infusion Therapy Coverage Act of 2009" introduced in the Senate (S.254) and in the House (H.R. 574) is sponsored by Senators Blanche L. Lincoln (D-AR), Olympia J. Snowe (R-ME) and Johnny Isakson (R-GA) and Representatives Eliot L. Engel (D-NY-17), Timothy F. Murphy (R-PA-18), Tammy Baldwin, (D-WI), and Kay Granger (R-TX).
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The Medicare Home Infusion Therapy Coverage Act of 2009 was introduced earlier this year to close a gap that currently exists in coverage where the medicines used in infusions to treat serious diseases are covered, but not the medical services, supplies and equipment needed to deliver the home therapy.
"Many Arkansans on Medicare who need home infusion therapy are simply unable to afford it. As a result, they often have to enter a hospital or nursing home for the infusion treatment to be fully covered by Medicare. Not only is this an extreme hardship for the patient, it actually results in a higher cost to Medicare. This legislation would provide for full Medicare coverage of home infusion therapy, ultimately lowering costs and improving patient outcomes," said Senator Lincoln.
"Medicare coverage of home infusion therapy is a prime example of immediate action we can take to deliver high-quality patient care at a lesser cost," said Senator Isakson. "I witnessed firsthand the world of difference treatment at home makes to patients and their caregivers when my son needed to be treated with intravenous medicines a few years ago. I believe he was able to heal faster because he underwent treatment at home. Everyone should be afforded this opportunity."
"Medicare is the only major payor that does not reimburse for home infusion therapy. We cannot continue to support a healthcare system of 'have' and 'have nots'. All patients, including older and disabled Americans needing intravenous medications, should be allowed to undergo treatment in the comfort of their own homes," said Representative Engel.
Infusion therapy involves the administration of medication through a needle or catheter, and is prescribed for infections unresponsive to oral antibiotics and serious diseases including cancer, congestive heart failure, and rheumatoid arthritis, among others.
Patients at the forum shared personal stories of the health and financial challenges they have experienced due to the lack of Medicare coverage, and advocated for enactment of new legislation that will eliminate unnecessary hospital stays when physicians and patients agree that treatment at home is preferable.
"Our country can no longer afford unnecessary healthcare expenses when high-quality, low-cost options are available and preferred by physicians and patients alike," said Russell Bodoff, President, NHIA.
The "Medicare Home Infusion Therapy Coverage Act of 2009" introduced in the Senate (S.254) and in the House (H.R. 574) is sponsored by Senators Blanche L. Lincoln (D-AR), Olympia J. Snowe (R-ME) and Johnny Isakson (R-GA) and Representatives Eliot L. Engel (D-NY-17), Timothy F. Murphy (R-PA-18), Tammy Baldwin, (D-WI), and Kay Granger (R-TX).
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