Monday, April 25, 2005 8:42 AM

Medicaid for HBOT

In the best interest of brain-injured children, a listserv has been formed to help parents and their children access 3rd-party reimbursement of Hyperbaric Oxygen Therapy (HBOT). 

New subscribers automatically receive a pdf file explaining how the US federal Medicaid law for children specifically applies to HBOT.  New subscribers also receive pdf files of recent court decisions overturning Medicaid denials of HBOT for brain-injured children.

Georgia Medicaid denied HBOT, declaring it "experimental and investigational." However, on November 19, 2002 the Georgia State Court of Appeals overturned Georgia Medicaid's denial because a categorization of "experimental and investigational" is not a legitimate reason for denial under the Federal Medicaid law for children.

Instead, Georgia Medicaid must decide if Hyperbaric Oxygen Therapy is "necessary to correct or ameliorate" pediatric brain-injury.

If HBOT is "necessary to correct or ameliorate", Georgia Medicaid must reimburse HBOT--even if every neurologist on the planet believes HBOT is experimental and investigational.

And because this decision is specifically about HBOT reimbursement from Medicaid, the other 49 state Medicaid agencies must evaluate a request for HBOT based on the same federal standard. They cannot deny HBOT with the excuse that it's "experimental and investigational", "not medically necessary", or "not the standard of medical practice"

Since federal law is applicable in all 50 US states, these court decisions can be used as models for other states. In addition, many countries around the world base their healthcare decisions on what happens in the United States.

Since this listserv began, parents have won court decisions for their brain-injured children to get HBOT in Georgia, Colorado, Maine, and Pennsylvania.

Further court decisions are pending in at least New Jersey, South Dakota, and Ohio.

Five states have indicated they will change their Medicaid policy on Hyperbaric Oxygen Therapy for brain-injured children: Alaska, Arkansas, California, Texas, and Florida.

Additionally, Virginia, West Virginia, North Carolina, South Carolina, and Missouri have all reimbursed Hyperbaric Oxygen Therapy for brain-injured children. Let's keep this list growing.

The off-label use of Hyperbaric oxygen improves recovery from brain-injury. There are reports that over 90% of all brain-injured children who receive HBOT improve. However, it is currently not accepted by pediatric neurology as a standard treatment of care for our children. Because of this non-acceptance, parents are forced to pay for hyperbaric oxygen out of pocket. Many parents have already taken out 2nd and 3rd mortgages to pay for this incredibly safe, noninvasive, life-changing, permanent therapy.

The goal of the Medicaid for HBOT listserv is to change this status.  Once Medicaid reimburses HBOT, insurance companies will quickly follow suit. It's anticipated that pediatric neurologists will surely be curious as to how 90+% of every brain-injured child can improve from HBOT when most have said such improvement is impossible.

The majority of patients in pediatric neurology seek relief from some sort of seizure disorder. Consequently children are prescribed anti-convulsants, most of which have never been subjected to randomized, double-blind controlled studies where children were the subjects in the study--which means these drugs are not FDA approved and are prescribed off-label for pediatric use.

As parents we are asking for this same standard--the off-label use of HBOT, a treatment modality that improves recovery from brain-injury. HBOT permanently and safely *repairs* the source of the problem where typically prescribed treatments (Speech Therapy, Occupational Therapy, and Physical Therapy) might briefly alleviate symptoms but never address or repair the core problem.

Unfortunately, at this time, the Pediatric Neurology community typically reacts emotionally rather than rationally to the science supporting hyperbaric oxygen for brain-injury. Most will not even discuss the issue. Because they hold credentials of perceived expertise, these palliative-care physicians have been allowed to dismiss HBOT out of hand.

This is frustrating for parents and other care administrators and as we all seek to best help our children. It is hoped and anticipated that the Medicaid for HBOT forum will help bridge this gap.

Knowledge and informed decision-making can avoid the adversarial stance taken in Georgia and truly help these children maximize their full potential. Your list membership guarantees free access to a library of 50+ downloadable PDF files relating to the efficacy of Hyperbaric Oxygen Therapy. Take advantage of it.

Since improvement and even recovery from stroke, multiple sclerosis, Alzheimer's, Parkinson's, and Traumatic Brain Injury (TBI) has also been demonstrated with hyperbaric oxygen, it's quite possible that the full potential of HBOT can obviously save millions of heartaches and billions of dollars.

While each US state is free to administer their Medicaid program according to however they want, each state must comply with the federal Medicaid law for children--which specifically stipulates that a treatment like HBOT must be paid for by state Medicaid plans--whether it is "covered by the state plan or not".

Through this forum we as parents, caregivers, advocates, physicians, therapists, and administrators will be able to exchange information, tips, and advice on how to access HBOT for our children. This is called freedom of assembly and freedom of speech as guaranteed by the first amendment in the Bill of Rights of the Constitution of the United States of America.

Together we can make a difference.

Separately we may never make a difference.

Please participate in this discussion and worthy pursuit.

Our Mission:  Helping God's Flowers Grow
The Sara's Garden was created to help assist families in need of hyperbaric treatment. We're very excited about this opportunity to minister to families. If you would like additional information on how to obtain services or if you have any questions regarding hyperbaric treatment, please feel free to contact us.