Medicaid Illinois Prior Authorization: Fill & Download for Free

NO!! it doesn’t even appear as an off label use.- - Hospitals Tout Benefits of Hyperbaric Oxygen Therapy - -(It used to be associated with treating "the bends," but breathing pure oxygen can promote healing in other ways as well().By Magaly Olivero, Contributor Oct. 6, 2014, at 7:07 p.m.Quora required LINK: https://www.usnews.com/news/articles/ 2014/10/06/hospitals-tout-benefits-of-hyperbaric-oxygen-therapy .“”””“We’re seeing a growing need for hyperbaric oxygen therapy services in the community,” says Peters. “We’re an aging society and with that come significant challenges to healing.”But not all patients qualify for hyperbaric oxygen therapy and some experts caution consumers to only seek treatment for the 13 FDA-approved conditions:air or gas embolism, carbon monoxide poisoning, gas gangrene, crush injury, decompression sickness, arterial insufficiencies, severe anemia, intracranial abscesses, necrotizing (dying) soft tissue infections, osteomyelitis or chronic bone infections, delayed radiation injury, compromised skin grafts and flaps and acute thermal burn injury.“Hyperbaric oxygen therapy is not the magic bullet,” says Dr. Timothy Manoni, medical director of the Wound Care and Hyperbaric Center at Stamford Hospital in Connecticut. He says some patients mistakenly believe that hyperbaric oxygen therapy can cure cancer, Parkinson’s disease, Alzheimer’s disease and other conditions.“These are non-evidence based uses for hyperbaric oxygen therapy.”Treating radiation damagePeople with chronic bone and soft tissue damage caused by radiation to treat cancer represent a large portion of the patients seeking help at the Hyperbaric Medicine Center at the Beaumont Health System in Michigan, says Dr. Farris Gulli, its medical director.The center’s hyperbaric chamber fits up to a dozen people.“Radiation therapy does a very good thing – it kills cancer cells. But it also damages the tiny blood vessels that feed the cells,” says Gulli. “About five to 15 percent of cancer patients can experience chronic complications from radiation therapy.”Breast cancer survivors, for example, can develop severe chest wounds. Patients with head and neck cancers who received high doses of radiation to the jawbone risk bone damage. People treated with radiation to the pelvic area can experience bladder problems."In these cases, the lining of the bladder becomes damaged because of the lack of blood flow. The damage can lead to blood in the urine which could require blood transfusions," explains Gulli. “But with hyperbaric oxygen therapy, we grow new capillaries and the bleeding stops in a significant portion of our patients."Salvaging limbsFor people with diabetes who have advanced foot ulcers, hyperbaric oxygen therapy can “mean the difference between being able to walk and being disabled for the rest of their life,” says Dr. Anna Flattau, medical director of the Hyperbaric Medicine Program at Montefiore Medical Center in New York.Poor blood circulation and nerve damage put people with diabetes at risk of developing foot ulcers that can become seriously infected and lead to amputation. About 60 percent of non-traumatic lower-limb amputations occur in adults with diabetes, according to the U.S. Centers for Disease Control and Prevention.Montefiore focuses on preventing diabetes and keeping people with diabetes healthy, says Flattau. But if complications such as advanced foot ulcers arise, hyperbaric oxygen therapy administered in conjunction with antibiotics and other interventions may be warranted.“It makes a huge difference in the lives of patients,” she says. “The goal is to reduce amputations in our community.”Controversial “off label” usesThe use of hyperbaric oxygen therapy to treat “off label” conditions that haven’t been approved by the FDA – such as traumatic brain injury, autism, stroke, Parkinson’s disease, cerebral palsy, multiple sclerosis, Alzheimer’s disease and more – remains controversial.Many experts say patients should only receive off-label treatments if they are participating in a research study.But Dr. Carol Henricks, a neurologist at Northstar Hyperbaric in Arizona, calls the FDA’s narrow focus a “terrible shame.”She believes the nation “could dramatically reduce pain and suffering if we used hyperbaric oxygen therapy to its true potential.” The International Hyperbaric Medical Association, for example, recognizes the use of hyperbaric oxygen therapy for neurological conditions.These days, Henricks’ "biggest focus" is treating veterans suffering from “brain blast injury” as a result of being exposed to explosions. These veterans develop brain injuries and post-traumatic stress disorder with symptoms such as sleep difficulties, headaches, short-term memory loss and chronic confusion."The first thing to happen (after hyperbaric treatment) is that they sleep through the night for the first time since being injured," she says. "Then their headaches go away and over time they get more clear thinking."Henricks began using hyperbaric oxygen therapy 11 years ago after hearing from European doctors about its benefits in minimizing brain damage in stroke victims. She prescribed the treatment for some of her most challenging patients and the “results were tremendous.”“The genie was out of the bag,” she says. “There was no turning back.”Although some studies show "very positive outcomes," the use of hyperbaric oxygen therapy to treat traumatic brain injury remains “investigational,” says Niezgoda.Despite its potential, experts said the future of hyperbaric oxygen therapy could be tempered by government concerns about unauthorized uses of the treatment.The Centers for Medicare and Medicaid Services (CMS) this year implemented a prior authorization program in Illinois, Michigan and New Jersey “to address growing concerns” about patients receiving non-medically necessary hyperbaric oxygen therapy. In 2000, CMS paid $14.2 million to patients who received treatment for non-covered conditions or had inadequate documentation and another $4.9 million on excessive treatments.“We need to do a better job of policing ourselves,” says Niezgoda””””,https://www.usnews.com/news/articles/2014/10/06/hospitals-tout-benefits-of-hyperbaric-oxygen-therapy .

This certainly is interesting.It is a bit difficult to comment, though, given that most sources on the Internet are biased. The budget questions are always complicated; deficits can be disguised or enlarged using clever accounting gimmicks.What I found from Scott Walker's 2015 Budget:"Four years ago, Wisconsin faced a $3.6 billion budget deficit, property taxes had risen 27 percent over the previous decade, increasing every year, and the unemployment rate was 7.8 percent. Years of budgetary mismanagement and unchecked spending meant the State had bills it could not pay. The Budget Stabilization Fund (Rainy Day Fund) was nearly empty. The shortfall in fiscal year 2010-11 was representative of the longer-term problem – Wisconsin had a corrosive deficit because of a very simple math problem: state spending continually exceeded its revenue. State government was consistently in a reactive mode, subject to spending drivers, such as Medicaid and public employee personnel costs, which consumed resources without restraint. In prior biennia, one-time fixes and delayed payments damaged our State's fiscal foundation. The federal stimulus cash bought us little, except more time for further budgetary negligence. Predictably, this left even bigger holes, as budgeting for the moment and out of convenience was consciously chosen over planning for the future.""Today, Wisconsin has a balanced budget, property taxes on a median-valued home have decreased in each of the last four years, the unemployment rate is down to 5.2 percent, and Wisconsin is 12th in the nation in growth in per capita personal income growth. New business ventures are up nearly 11 percent, while in November 2014 Wisconsin experienced its greatest month of private sector job growth since 1990. We have also been able to invest in educational opportunities that improve the skills of our workforce and match employees with the highly-skilled jobs being created by manufacturing and other strong industries.""As a result, our economy is growing, and both job seekers and job creators are reaping the benefits. In 2010, 10 percent of employers surveyed said that our state was headed in the right direction. In 2012, 93 percent said Wisconsin is heading in the right direction. In 2014, employers expressed greater optimism about our economy than at any time since the Great Recession. This turnaround was boosted with targeted tax relief efforts, such as the manufacturing and agricultural tax relief programs enacted by Governor Walker and the Legislature in 2011, and other mechanisms to encourage investment and reduce the regulatory burdens on job creators. We have already observed businesses utilizing these benefits to create new jobs, increase wages and further grow our economy.""Wisconsin has a deficit under generally accepted accounting principles due to the state's long-term commitment to stabilize and equalize local property taxes. Payments for shared revenue and local property tax relief are paid during the local government fiscal year but are delayed in the state budget to the state's subsequent fiscal year. While this mismatch is a major contributor to the state's deficit under generally accepted accounting principles, the delay has been in place for decades in order that local government budgets, and associated local levies, remain stable."Scott Walker's Budget Projections"In the next biennium, the standard relating to annual GPR debt service will be reduced compared to the percentages for the 2013-15 biennium. Projected annual debt service payments, as a percentage of general fund tax revenues, are 4.2 percent and 3.7 percent for the 2015-17 biennium, compared to 5.2 percent and 4.5 percent annually for the 2013-15 biennium. The State made higher debt service payments in the 2013-15 biennium, resulting from the structural refunding authorizations or other actions in previous biennia that deferred debt service payments to the 2013-15 biennium and future years. The State was committed to paying debt service payments due in the 2013-15 biennium, which peaked at all-time highs, and remains committed to making debt service payments in the 2015-17 executive budget. The amount of outstanding State debt paid from GPR has decreased by 8.1 percent over the past two years, and with limited new bonding authority in this 2015-17 executive budget, this trend will continue.""The State looks favorable when rating agencies combine outstanding debt and unfunded pension liabilities. In this analysis, the aggregate obligations for the State are "below the median for U.S. States." In November 2014, Moody's Investors Service changed the outlook on the State's bond rating to "positive" from "stable." This outlook change was due, in part, to the State's increased liquidity and the strength of its pension program."Scott Walker also writes that:"Coupled with a nearly $1.6 billion reduction in our Generally Accepted Accounting Principles (GAAP) deficit since 2011 and the strongest public employee pension system in the nation, it is clear why businesses and investors are bullish on Wisconsin. These achievements are the opposite of many other states, where bonding downgrades, upside-down pension funds and structural problems combine to place a stranglehold on prosperity."There were downgradings in the Standard and Poor's bond ratings of neighboring states, such as Minnesota and Illinois. Iowa's and Michigan's have remained constant.Wisconsin has a lower debt burden than other states. Wisconsin's state debt per capita is $7,863, lower than the national average of $16,178 per capita, and ranked 47th lowest in the country. The debt burden is lower than in the neighboring states of Illinois, Iowa, Michigan and Minnesota. Only Tennessee, Nebraska and Indiana have lower state debt burdens per capita. Neighboring Illinois ranks 5th nationally, with a debt burden higher than all states except Alaska, Hawaii, Connecticut and Ohio.It should also be noted that: "As the economy has responded to our policies, we have been able build a strong financial reserve. For three consecutive years (fiscal years 2010-11, 2011-12 and 2012-13), Wisconsin made significant contributions to its Rainy Day Fund – the only time it has done so in consecutive years. The Rainy Day Fund now has a $279 million balance after years of neglect and is more than 165 times larger than when Governor Walker took office."Scott Walker has apparently provided tax relief to the taxpayers of Wisconsin:Scott Walker has slowed the growth of property taxes:Also, Wisconsin ranked #9 in terms of income tax revenue to GSP in 2010, #11 in 2014, and is projected to fall to #14 in 2015, according to USGovernmentRevenueThis Bloomberg BusinessWeek article, "Scott Walker's Lagging Indicators",is less sanguine over Wisconsin's performance.While Wisconsin lags the national median, Wisconsin is ahead of 3 of its neighbors, Michigan, Iowa and Illinois.Also, I don't know how fair this is, because this starts immediately after Walker took office, before he had time to make policy changes and there could have been residual effects from the policies of prior governors. There also are other factors: North Dakota, for example, leads the nation in income growth, but much of this is due to an uptick in oil and gas extraction along the Bakken formation.It's difficult to reach a definitive conclusion on how Walker has performed relative to other state governors. Clearly the state has improved, but it is difficult to decompose the turnaround into (a) effects due to Walker's leadership and (b) effects of the broader national recovery.What is noticeable is that Wisconsin did a quicker job reducing the deficit than the federal government. Wisconsin law mandates that the two-year budget be balanced. "Why?" you may ask.All US states, except for Vermont, have some form of balanced budget amendment. The federal government, on the other hand, continues to run deficits year after year: the budget was last balanced in 2001, and it was only balanced four times since 1970 and nine times since 1950. Why can the federal government run deficits, but the states cannot?Simple: A state is more beholden to the whims of the bond market than the federal government is.A state cannot run a deficit indefinitely, because if it does, the bond markets will anticipate future defaults and demand a high interest rate premium on new debt, as well as on existing debt when it is rolled over, making it costly to engage in prolonged deficit spending. This acts as a brake on state debt. State debt is $5.1 trillion, or $16,178 per capita, as opposed to a federal debt of $18 trillion, or $57,067 per capita.The federal government, unlike the states, can print money and have the Federal Reserve purchase bonds from the Treasury and monetize the debt. This is instructive as a contrast between the federal and state governments.

The United States keeps on getting more amiable to the act of telehealth, helping foster the development of virtual consideration organizations and items each state in turn. What's more, these industry-affecting changes are happening quickly. The American Telemedicine Association as of late announced that 80% of all US states have moved to improve telemedicine inclusion or repayments in the course of recent years, as per their most recent overview of state laws and strategies.Yet, what are the qualities that make a state telemedicine-accommodating? Here, we investigate the three generally noticeable "kind disposition" factors:State populaceClinical permitting and practice lawsMedicaid arrangementsThese bits of knowledge are helpful whether you're recruiting for a facility or looking for telemedicine work.#1 State PopulationIt's nothing unexpected the US' most mainstream states for telemedicine administrations line up with the most populated regions by and large. All through our quite a long while as a telemedicine staffing organization, we've noticed the most well known states for telemedicine work to be (in no specific request):CaliforniaTexasFloridaNew YorkArizonaFurthermore, it's no fortuitous event that 4 of these 5 states additionally make up the main 4 most populated states in the whole nation. However, populace isn't the solitary factor adding to the uptick in telemedicine administrations and patient clients.#2 State Medical Licensing and Practice LawsDeveloping state laws, rules, and corporate act of medication translations additionally assume a part in figuring out which states are appropriate for telemedicine organizations to flourish. As a rule, the most un-prohibitive states make it simpler for new telemedicine organizations and new businesses to dispatch their administrations without the extra concern of state's clinical board oversight limitations and legitimate activity.As of this composition, 16 states limit clinical inclusion to simultaneous inclusion ONLY, while 29 states have explicit laws that take into consideration nonconcurrent care models or usually known as store and forward consideration.In any case, business-accommodating clinical permitting and practice laws actually assume a supporting role to populace regarding telehealth-kind disposition. For instance:The exceptionally populated territory of California has a substantially more tough application with respect to the corporate act of medication. This state totally disallows the corporate act of medication and requires "that business or the board choices and exercises bringing about power over a doctor's act of medication, be made by an authorized California doctor and not by an unlicensed individual or element."Additionally, Texas actually stays one of the top states regarding interest for telemedicine administrations, despite the fact that they likewise are known as perhaps the most lawfully prohibitive states for telemedicine. For telehealth app development new businesses, Texas is probably going to be one of the states that gives organization activities experts the most cerebral pains.#3 Medicaid Reimbursement PoliciesNormally, people that depend on government-financed medical care are more averse to look for administrations from virtual consideration suppliers if there is no repayment for the clinical costs brought about.Manat, a lawful and counseling firm, as of late explored the individual state laws and Medicaid approaches identified with telemedicine across each of the 50 states. The information was then used to aggregate states into one of 3 classes dependent on each state's telehealth neighborliness gotten from these arranged lawful complexities.Progressive, Moderate, Restrictive StatesIn Manat's state positioning, everything except 12 states positioned as one or the other moderate or reformist, which demonstrates that telehealth-related state limitations are consistently being limited for the two patients looking for virtual consideration and doctors/organizations giving virtual consideration.Progressive Telehealth StatesThe Frozen North, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Maine, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, Nevada, New York, Utah, Vermont, WashingtonModerate Telehealth StatesAlabama, D.C., Delaware, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, Oregon, South Dakota, Tennessee, Virginia, Wisconsin, West Virginia, WyomingRestrictive Telehealth StatesArkansas, Georgia, Massachusetts, Maryland, North Carolina, North Dakota, New Hampshire, Ohio, Pennsylvania, Rhode Island, South Carolina, TexasThe most Restrictive State for Telehealth: MassachusettsMassachusetts is one state where telemedicine organization attempts may encounter some more administrative obstacles, and patients may foot the telehealth doctor's visit expenses as a rule. Massachusetts doesn't have a conventional Medicaid repayment strategy for charge for-administration clinical consideration through telehealth. Additionally, doctors in this state should have a pre-set up relationship with a patient before they can recommend drugs.Also, Massachusetts is one of only a handful few leftover states yet to join the Interstate Medical Licensure Compact which smoothes out the cycle for doctors to get multi-state clinical licenses.While essentially all state Medicaid programs give repayment to some telehealth administrations, arrangements are not steady across the U.S., and a few states' strategies are substantially more telehealth-accommodating than others, a new Manatt examination shows.Manatt, a lawful and counseling firm, directed an audit of laws and Medicaid program approaches identified with telehealth across every one of the 50 states. The investigation zeroed in on six major questions: practice norms and licensure; inclusion and repayment; qualified patient settings; qualified supplier types; qualified advances; and administration constraints. In view of the investigation, the firm classified states into three classifications:Progressive, in which state law and Medicaid strategy empower and support the expansive utilization of telehealth.Moderate, in which state law and Medicaid strategy are blended or respectably uphold the expansive utilization of telehealth.Restrictive, in which state law and Medicaid strategy may restrain the expansive utilization of telehealth.Here is the way every one of the 50 states and Washington, D.C., piled up:ProgressiveAlaskaArizonaCaliforniaColoradoConnecticutFloridaHawaiiIdahoMaineMinnesotaMissouriMontanaNebraskaNew JerseyNew MexicoNevadaNew YorkUtahVermontWashingtonModerateAlabamaD.C.DelawareIowaIllinoisIndianaKansasKentuckyLouisianaMichiganMississippiOklahomaOregonSouth DakotaTennesseeVirginiaWisconsinWest VirginiaWyomingRestrictiveArkansasGeorgiaMassachusettsMarylandNorth CarolinaNorth DakotaNew HampshireOhioPennsylvaniaRhode IslandSouth CarolinaTexasState ActionsEvery one of the 50 states and Washington, D.C., have made moves to improve admittance to telehealth because of COVID-19. Most of moves states have made fall into the accompanying three classes:Licensure prerequisites and reestablishment waiversDevelopment of inclusion of telehealth under the state Medicaid programDevelopment of inclusion of telehealth under business wellbeing back up plansLicensure Requirements and Renewal WaiversPrior to the crisis revelation, clinical sheets of 49 states and D.C. necessitated that suppliers conveying care by means of telehealth should be authorized in the state where patient is situated, for certain exemptions. To grow the medical care labor force and improve admittance to mind while social removing measures are set up, each of the 50 states and D.C.* are briefly deferring authorizing prerequisites, permitting suppliers to convey care through telehealth and practice across state lines as well as incidentally assisting the cycle to get authorized to convey telehealth. The Federation of State Medical Boards gave proposals for administrative, state, and neighborhood governments on licensure necessities during a pandemic to guarantee that these transitory changes incorporate patient insurance shields.For instance, in Florida, with endorsement, out-of-state suppliers may briefly convey telehealth administrations to Floridians without achieving a Florida permit. A few states, for example, Alabama, have embraced crisis authorizing techniques and assisted the cycle to offer transitory licenses to qualified clinical staff during the pronounced crisis.What's more, the U.S. Medication Enforcement Administration (DEA) declared that DEA-enrolled suppliers may incidentally recommend controlled substances by means of telehealth to patients in states where the supplier isn't enlisted to rehearse telehealth with DEA.Development of Medicaid Telehealth CoveragePrior to the announced crisis, every one of the 50 states and D.C. given repayment to some type of telehealth (i.e., live voice and video) in Medicaid expense for-administration.Presently, in light of COVID-19, each of the 50 states and D.C.** have briefly extended admittance to telehealth for Medicaid beneficiaries. These arrangements incorporate at least one of the accompanying guidelines:Patient can be at home during a telehealth visit;Supplier repayment for telehealth is equivalent to that of a conventional in-person visit;Extra telehealth administrations are covered;Different methods of innovation are covered, for example, utilizing a telephone without video; andA first-time meeting with a patient shouldn't be face to face.Washington State has a remarkable program. The Washington Health Care Authority has bought a predetermined number of licenses of a well known video conferencing stage for suppliers who don't approach such innovation and are organizing suppliers who principally serve Medicaid recipients or are in more modest practices with less foundation, among different contemplations.For distant patient checking and store-and-forward, a few states remember that for their approach (Arizona), however most do exclude such a stage. Maryland refined its unique chief request by adding offbeat (single direction) telehealth to be repaid by Medicaid and business guarantors.