[pronut-hiv] children denied nutrition

["George M. Carter" <fiar@verizon.net>]

Sounds a bit like Medicare's Part D for Death.

Just so our friends in Africa don't think that the callousness of the Bush 
administration (Jeb included) doesn't include American children.

And global warming? Nothing to worry about! Just because most of Africa 
will turn into a desert...we'll just be sure to privatize the water and 
make people pay more for it!

Ah! A planet reserved for the Rich and the Dead! Did you know that Bush is 
a Liberal? Sure!

Tax the Poor and Spend on the Rich and War.
George M. Carter


****
'Policy' denies nutrients to 1,000: Many children were eliminated from a 
program that pays for food supplements for chronically ill Floridians.

Miami Herald - March 24, 2006
Carol Marbin Miller, cmarbin@MiamiHerald.com
http://www.aegis.org/news/mh/2006/MH060306.html


More than a thousand severely disabled or chronically ill children who 
relied on state dollars for life-sustaining nutritional supplements have 
been cut off from Florida's Medicaid program, resulting in hundreds of 
thousands of dollars in savings to the agency, state officials acknowledged 
Thursday.

Medicaid officials said they made "major policy changes" that limited the 
number of Floridians eligible for the feeding program -- including children 
with HIV or AIDS who suffer from so-called "wasting syndrome" and children 
and adults with terminal illnesses such as cystic fibrosis.

The disclosures, some of which were made during a conference call with 
doctors and nutritionists who treat Floridians who depend on the 
supplements, came only two weeks after the state's highest healthcare 
official told lawmakers no trims in spending had been made.

The policy changes worked: In June, before the changes, needy Floridians -- 
most of them with feeding tubes attached to their stomachs -- cost the 
state $1.1 million for food supplements. Last month, the Medicaid billings 
dropped to less than half that: $462,189, according to figures the 
healthcare agency provided The Miami Herald.

Reacting to outrage over the changes, detailed in a March 12 story in The 
Miami Herald, the Agency for Health Care Administration's secretary, Alan 
Levine, blamed the problem on doctors' confusion over new paperwork and 
Medicaid's system for determining who is eligible for the feedings. He said 
he was suspending the paperwork changes while agency officials talked to 
healthcare professionals whose patients were affected -- some of whom had 
called Medicaid's refusals to pay for feedings "cruel" and "dangerous."

News that agency officials had acknowledged changes to the food supplement 
program angered some state lawmakers who are in charge of the agency's budget.

Two weeks ago the agency assured the state Senate's Health Appropriations 
Committee that The Herald story detailing the inability of critically ill 
children to obtain subsidized food supplements was incorrect. Now, senators 
say, they suspect they didn't get the full story.

"It's horrible to think that an agency of the state of Florida would cut 
off life-sustaining nutrients to very, very sick children. It makes 
absolutely no sense. There's absolutely no excuse. And we're going to make 
sure it doesn't happen," said the committee's chairman, Sen. Burt Saunders, 
a Naples Republican running for attorney general.

"We asked them to respond to that [article] and they said it was more of a 
PR screw-up than anything else," Saunders added. "I'm going to ask the 
agency to appear before this committee at our very next meeting. And we're 
going to make sure that there's no restriction on access to these food 
supplements for these children."

Levine said Thursday the state's spending on supplement claims is 
"alarming" and described the program as ripe for abuse because some 
supplements can cost thousands of dollars each month. Still, he added, he 
is committed to paying for all supplements that are medically necessary.

Even though fewer children are being fed by Medicaid because of decisions 
to curtail who can get state-paid nutrition, Levine continued to insist the 
agency imposed no "cutbacks" in spending for the supplements.

He defines "cuts" as a deliberate decision to ask lawmakers for less money.

"There was no cut to the program," Levine said late Thursday. "It has the 
same appropriation we had before. We did not cut funding."

He said Medicaid provided a safety net in the new policies, allowing 
doctors to obtain "prior authorization" for supplements even for Floridians 
who technically do not meet the new criteria. What went wrong, he said, is 
doctors were unable to obtain the over-rides from the agency.

"That's why I suspended the procedure," Levine said. "It clearly wasn't 
working the way it was supposed to work."

The Medicaid changes have resulted in 2,090 fewer adults and 1,010 fewer 
children getting state-paid supplements in February, compared to June.

Among the changes outlined Thursday to the doctors and nutritionists by 
Beth Kidder, bureau chief for Medicaid services:

* Medicaid ceased reimbursements for children with HIV or AIDS who suffer 
from "wasting syndrome" or failure-to-thrive, a life-threatening form of 
malnutrition.

One result: A 16-year-old Broward County girl, who has end-stage AIDS, has 
been denied feedings since the new policy took effect, Lauren Bernstein, a 
dietitian at the Children's Diagnostic & Treatment Center in Fort 
Lauderdale, told The Miami Herald. The girl suffers from severe 
malnutrition, and the "high-calorie milk shakes" Medicaid officials 
suggested in lieu of supplements won't provide adequate nutrition, 
Bernstein said.

* Medicaid stopped reimbursements for adults who are able to receive even 
small amounts of food by mouth, such as people with cystic fibrosis who 
gain much of their nutrition through feeding tubes but can also eat some 
solid food.

* Medicaid stopped paying for supplements for children who receive at least 
half their food by mouth.

* Medicaid will not pay for supplements for children who are capable of 
eating and digesting solid food.

But even though children with kidney failure can eat solid food, the 
disease leaves them with no appetite, Pat Hare of All Children's Hospital 
in St. Petersburg told Medicaid officials, according to agency records. 
They can suffer from malnutrition and failure to thrive -- which are not 
covered diagnoses.

During the conference call, a handful of healthcare workers complained the 
state has made it extremely difficult to get approval for nutritional 
formula even for people who qualified under the new policies. Nutritionists 
said they were never told about new billing "codes" that were necessary to 
gain approval.

Clara St. Thomas, a pediatric nutritionist at the University of Miami, said 
later Thursday: "They changed the rule book and they didn't tell us the 
rules."

Even after state officials halted the new restrictions, some healthcare 
workers say they still can't get the state to pay for needed supplements.

Bernstein said a 6-year-old boy with a rare genetic disorder, Opitz-Frias 
Syndrome, who gets all his nutrition through a tube connected to his small 
intestine, had been repeatedly denied supplements since February. When 
Levine announced he had suspended the new policies, she resubmitted the claim.

On Monday, she said, the child's claim was denied again.

"That's absolutely unacceptable," Levine said after being told of 
Bernstein's frustrations. "I will not go along with that."

Sen. Ken Pruitt, a Port St. Lucie Republican who will become the next 
Senate president, said lawmakers will ensure that children get the 
supplements they need.

"We're going to fix it," Pruitt said. "You always have concern if an agency comes forward and says one thing and is doing the opposite."

___

Herald staff writer Marc Caputo contributed to this report.

060324
MH060306



Copyright © 2006 - Miami Herald. All rights reserved. Reproduced with 
permission. Reproduction of this article (other than one copy for personal 
reference) must be cleared through the Miami Herald, Permissions, One 
Herald Plaza, Miami, FL 33132-1693 TEL: (305) 
376-3719.  http://www.herald.com.

AEGiS is made possible through unrestricted grants from Boehringer 
Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb 
Company, Elton John AIDS Foundation, the National Library of Medicine, and 
donations from users like you. Always watch for outdated information. This 
article first appeared in 2006. This material is designed to support, not 
replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither 
endorses nor opposes any material. All information contained on this 
website, including information relating to health conditions, products, and 
treatments, is for informational purposes only. It is often presented in 
summary or aggregate form. It is not meant to be a substitute for the 
advice provided by your own physician or other medical professionals. 
Always discuss treatment options with a doctor who specializes in treating 
HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are 
protected by copyright as a collective work or compilation under U.S. 
copyright and other laws and are the property of AEGiS, or the party 
credited as the provider of the content.